飞秒激光小切口角膜基质透镜取出术透镜残留的处理

目的：探讨飞秒激光小切口角膜基质透镜取出术（SMILE）后不同程度残留透镜的处理方法。方法： 回顾性系列病例研究。选取2020年8月1─29日于潍坊眼科医院由同一位医师完成全飞秒SMILE手术的患者288例（557眼），对患者行常规随访和围手术期处理。记录透镜残留及处理的情况。结果： 288例（557眼）均完成手术。术后1 d裸眼视力（UCVA）为-0.2～0.2（-0.026±0.075）（LogMAR视力）； 术后1个月UCVA-0.2～0.2（-0.062±0.055）（LogMAR视力）。术后1 d残余等效球镜度为-1.00～+1.00 （+0.11±0.43）D；术后1个月残余等效球镜度为-1.00～+1.00（+0.20±0.36）D。6眼（1%）出现透镜残留，其中4眼术后UCVA好，残留透镜组织呈短条状，靠近周边部，予以随访观察；1眼术后UCVA 1.0， 残余屈光度大，Pentacam见角膜不规则，眼前节光学相干断层成像（AS-OCT）见层间透镜组织残留， 行残留透镜取出术；1眼透镜边切完成后脱负压，即刻重新吸引，完成激光扫描，术中透镜组织分离和取出困难，术后UCVA差，残余屈光度大，Pentacam见角膜形态不规则，AS-OCT示层间透镜组织 残留，患者拒绝进一步治疗，予以随访观察。结论：SMILE术中透镜残留的发生率低，根据具体情 况妥善处理残留的透镜，仍可获得满意的效果。

Clinical Observations and Treatment of Lens Residue after Femtosecond Laser Small Incision Lenticule Extraction

Objective: To investigate clinical treatment for lens residue after femtosecond laser small incision lenticule extraction (SMILE). Methods: Retrospective cases series study. A total of 288 patients (557 eyes) who underwent SMILE surgery in Weifang Eye Hospital from August 1 to 29, 2020 were selected for routine perioperative management. The lenticule residual retained was recorded postoperatively. Results: Two hundred eighty-eight patients (557 eyes) underwent surgery. Uncorrected visual acuity 1 day after surgery was -0.2-0.2, with an average of -0.026±0.075 (LogMAR). One month after surgery, the visual acuity of the naked eye was -0.2-0.2, with an average of -0.062±0.055 (LogMAR). The residual spherical equivalent refractive errors were -1.00-+1.00 D on the 1st day after surgery, with an average of +0.11±0.43 D. The residual spherical equivalent refractive errors were -1.00-+1.00 D one month after surgery, with an average of +0.20±0.36 D. There was lenticule residual retention in 6 eyes (1%). Among the cases with lenticule residual retention, 4 eyes had good visual acuityand the residual was in a shortstrip close to the peripheral area. The visual acuity of one naked eye was 1.0, but the postoperative residual refractive index was large. Pentacam showed corneal irregularity and the lenticule residual retention could be observed with anterior segment optical coherence tomography (AS-OCT). Then a secondary extraction was performed. One eye lost suction when the lenticule edge cut was completed; suction was restored immediately and laser scanning was completed. However, the lenticule separation and removal was difficult. The visual acuity of the naked eye was poor postoperatively. Pentacam showed corneal irregularity and AS-OCT showed the lenticule residual retained. The patient refused further treatment and was followed up. Conclusions: SMILE has a low incidence of partially retained lenticule. Satisfactory results can still be obtained by proper disposal of residual lenses.