SMILE术中失吸的发生率和特点

doi:10.3760/cma.j.cn115909-20191106-00298

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摘要目的：探讨飞秒激光小切口角膜基质透镜取出术（SMILE）术中失吸的发生率、发生特点、处理方法及预后情况。方法：回顾性系列病例研究。收集2016年6月至2019年3月于北京大学深圳医院眼科行SMILE时术中发生失吸的患者16例（16眼），对其发生率、眼别、性别、失吸部位、失吸发生时眼球转动方向、处理方法及预后情况进行分析。其中眼别、性别构成比较采用Pearson卡方检验。结果：共纳入行SMILE患者1 698例（男517例，女1 181例），3 365眼（右眼1 692只，左眼1 673只），术中发生失吸16例（16眼），发生率为0.46%。其中右眼9只（9/16），左眼7只（7/16），男5例（5/16），女11例（11/16）。不同性别（χ2 =0.005，P=0.944）、不同眼别（χ2 =0.229，P=0.632）失吸率差异无统计学意义。失吸位于激光扫描直径（3.62±2.55）mm处，多在直径2 mm内。按失吸部位分为：透镜底层失吸4眼（1/4），其中2眼当即改为飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK），另2眼当即改为准分子激光上皮瓣下角膜磨镶术（LASEK）；透镜边切失吸1眼（1/16），当即改为LASEK；透镜上层失吸10眼（5/8），其中8眼当即重吸并继续行SMILE扫描上层及做小切口，分离并完整取出透镜， 1眼3周后重新行SMILE并完整取出透镜，1眼当即重吸并继续行SMILE，但发生再次失吸而在2周后改行LASEK；上层边切失吸1眼（1/16），直接用5 ml注射器针头划开上层边缘并完整取出透镜。按失吸发生即刻眼球转动方向分为：鼻上2眼（2/16）、颞上9眼（9/16）、鼻下2眼（2/16）、颞下2眼（2/16）、正下1眼（1/16）。所有失吸病例术后3个月均达术前最佳矫正视力。结论：SMILE术中失吸的发生率低，多发生于扫描透镜的上层和近瞳孔中央区。Bell现象为失吸的主要原因。不同的失吸部位和状态应有不同的处理方式，经过合理的处理后仍可获得良好的术后远期视力。

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关键词 ：失吸, 飞秒激光小切口角膜基质透镜取出术, 术中并发症

Abstract：Objective: To explore the incidence, characteristics, treatments, and outcomes of suction loss cases during small incision lenticule extraction (SMILE). Methods: In this retrospective non-comparative review of case series studies, 16 eyes of 16 patients occurred suction loss in 3 365 consecutive SMILE procedures between June 2016 and March 2019 in the Shenzhen Hospital of Peking University. They were analyzed for the incidence, the eye, the gender, the locations of suction loss, the instant rotated directions of the eyes during the suction loss, treatments, and prognoses. Data were analyzed using Chi-square test. Results: This study included totally 3 365 eyes (1 692 right eyes, 1 673 left eyes) of 1 698 consecutive patients (517 males, 1 181 females). Suction loss occurred in 16 patients (16 eyes), including 9 right eyes (9/16), 7 left eyes (7/16), from 5 males (5/16) and 11 females (11/16). The incidence of suction loss was 0.46%. There were no significant difference between the loss of aspiration and gender (χ2 =0.005, P=0.944), and eye (χ2 =0.229, P=0.632). Suction loss was located at the laser scanning diameter of 3.62±2.55 mm, mostly within the diameter of 2 mm. The eyes were categorized by suction loss interface and managements: 4 eyes had suction loss in the lenticule interface (1/4), 2 of which were changed to femtosecond laser-assisted laser in-situ keratomileusis (FS-LASIK) immediately, and the other 2 eyes were converted to laser epithelial keratomileusis (LASEK) at once; 1 eye occurred suction loss during lenticule side cut (1/16), and changed to LASEK immediately; 10 eyes had suction loss in the cap interface (5/8), of which 8 eyes promptly redocked and restarted cap and removed the lenticule completely, 1 eye underwent SMILE procedure in 3 weeks later. 1 eye immediately redocked and followed the re-SMILE same cap procedure, in which case, however, another suction loss occurred and the LASEK was performed in 2 weeks later. 1 eye had suction loss in small incision (1/16), and the small incision was cut with a 5 ml injection needle with the lenticule completely removed. The 16 eyes with suction loss were also categorized by the instant rotation directions in suction loss: 9 eyes in upper temporal (9/16), 2 eyes in lower temporal (1/8), 2 eyes in upper nasal (1/8), 2 eyes in lower nasal (1/8) and 1 eye in down (1/16). The uncorrected visual acuity of all the suction loss cases achieved the preoperative best corrected visual acuity 3 months after surgery. Conclusions: Suction loss during SMILE is rare. It mostly occurs in cap interface and near the center of the pupil. Bell's reflexes the main cause of suction loss. Different sites and states of suction loss should have different managements and properstrategies will not affect the long-term postoperative visual acuity.

Key words： suction loss small incision lenticule extraction intraoperative complications

收稿日期: 2019-11-06

通讯作者: 陈伟（ORCID：0000-0002-7417-2564），Email：jennifercw6@163.com

引用本文:

陈伟陈嘉宝许美萍. SMILE术中失吸的发生率和特点[J]. 中华眼视光学与视觉科学杂志, 2020, 22(4): 274-279. Wei Chen, Jiabao Chen, Meiping Xu. The Incidence and Characteristics of Suction Loss in Small Incision Lenticule Extraction Procedures. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(4): 274-279. DOI: 10.3760/cma.j.cn115909-20191106-00298

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191106-00298 或 https://www.cjoovs.com/CN/Y2020/V22/I4/274

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