基于单中心FS-LASIK术中前房气泡的临床观察

doi:10.3760/cma.j.cn115909-20190505-00131

摘要
图/表
参考文献(17)
相关文章 (15)

全文: PDF 779KB HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨飞秒激光制瓣LASIK（FS-LASIK）术中前房气泡的发生率、危险因素、发生机制及对手术效果和角膜内皮细胞的影响、处理方法和预防措施。方法：回顾性系列病例研究。选择2012年 2月至2017年11月在中国人民解放军第三二二医院眼科屈光中心自愿接受FS-LASIK且术前常规检查确认为符合手术适应证的患者1 379例（2 749眼），将发生前房气泡患者的气泡眼作为观察组，将患者对侧未发生前房气泡的眼作为对照组。统计分析术中发生前房气泡患者的裸眼视力（UCVA）、最佳矫正视力（BCVA）、角膜曲率、角膜厚度、前房深度、等效球镜度（SE）、角膜直径、角膜内皮细胞密度、角膜内皮细胞面积的变异系数、六边形角膜内皮细胞比率、眼压等手术前后相关参数。采用定量数据重复测量方差分析、t检验对数据进行分析。结果：1 379例（2 749眼）患者中25例（27眼）发生前房气泡，发生率0.98%。术中观察发现气泡均由房角移动至瞳孔区，鼻侧12眼（44%）、颞侧 9眼（33%）、下方4眼（15%）、上方2眼（7%）。Ⅰ级前房气泡16眼（59%）、Ⅱ级10眼（37%）、Ⅲ级 1眼（4%），Ⅲ级气泡影响自动识别跟踪，需在手动跟踪模式下完成准分子激光切削。术中观察还发现在进行准分子激光角膜基质切削时气泡在前房内发生了较高频率的振动。观察组（23眼）与对照组（23眼）比较，角膜直径、曲率、厚度及前房深度、眼压、术前SE、术后SE、术前BCVA、术后UCVA 组间差异均无统计学意义（P>0.05），但发生前房气泡的患者（25例）角膜直径[（11.11±0.31）mm] 与未发生前房气泡的患者（1 354例）角膜直径[（11.51±0.33）mm]比较差异有统计学意义（t=-3.28， P=0.003）。角膜内皮细胞密度组间差异有统计学意义（F分组=2.486，P分组=0.022），组内各时间点比较差异无统计学意义（F时间=1.342，P时间=0.260）。六角形角膜内皮细胞组间差异无统计学意义（F分组 =0.469，P分组=0.497），组内各时间点比较差异有统计学意义（F时间=5.966，P时间=0.004）。角膜内皮细胞面积变异系数组间差异无统计学意义（F分组=0.106，P分组=0.746），组内各时间点差异有统计学意义（F时间=21.248，P时间<0.001）。结论：前房气泡的产生可能受到术者个人因素、患者种族差异、设备类型、角膜直径、角膜瓣直径、小梁网位置、pocket深度等多种因素的影响。气泡可能经小梁网逆行进入前房，致角膜内皮细胞损害。降低前房气泡发生率，可有效提高术后视觉质量。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：飞秒激光, 角膜瓣, 准分子激光原位角膜磨镶术, 前房气泡, 并发症

Abstract：Objective: To investigate the incidence rate, risk factors, mechanisms of occurrence, influence of surgical effects on corneal endothelial cells, and the management and preventive measures of anterior chamber bubbles during femtosecond laser in situ keratomileusis (LASIK). Methods: In this retrospective study, 1 379 patients (2 749 eyes) in the PLA Hospital of 322 from February 2012 to November 2017, who underwent routine examinations and agreed to undergo LASIK surgery using femtosecond laser, were included in this research. The observation group included eyes with anterior chamber bubbles; the control group included the fellow eyes of patients who had anterior chamber bubbles in only one eye. Intraoperative and early postoperative parameters of eyes with anterior chamber bubbles were described and analyzed. Measurements and analyses included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal curvature, corneal thickness, anterior chamber depth, spherical equivalent (SE), corneal diameter, corneal endothelial cell density, coefficient of variation, percentage of hexagonal endothelium cells, intraocular pressure, et al. A repeated measures analysis of variance and t-test were used for data analysis. Results: Twenty-five patients (27 eyes) had anterior chamber bubbles in 1 379 patients (2 749 eyes). The incidence rate of anterior chamber bubbles was 0.98%. Anterior chamber bubbles moved from the anterior chamber angle to the pupil. Locations were as follows: 12 eyes located on nasal side (44%), 9 eyes located on the bitemporal side (33%), 4 eyes located on the lower side (15%) and 2 eyes located on the upper side (7%). Anterior chamber bubbles were identified on 3 levels: 16 eyes were on the firstlevel (59%), 10 eyes were on the second-level (37%) and one eye was on the third-level (4%). The thirdlevel anterior chamber bubbles affected the self-tracking system, so LASIK surgery was finished using the manual identification system. When excimer laser cutting was performed on anterior chamber bubbles, auto frequency was used during eye shaking. The preoperative and postoperative differences between the control group (23 eyes) and observation group (23 eyes) were not statistically significant for parameters such as corneal endothelial cell density, corneal diameter, corneal curvature, corneal thickness, anterior chamber depth, intraocular pressure, preoperative and postoperative MRSE, preoperative BCVA and postoperative UCVA. The difference in corneal diameter between the eyes in patients (25 cases) with anterior chamber bubbles and patients (1 354 cases) without anterior chamber bubbles was statistically significant (t=-3.28, P=0.003). The difference in corneal endothelial cell density between the control group and observation group was statistically significant (Fgroups=2.486, Pgroups=0.022), the difference between the preoperative and postoperative parameters for corneal endothelial cell density within the same group was not statistically significant (Ftime=1.342, Ptime=0.260) nor was the difference in percentage of hexagonal endothelium cells between the groups (Fgroups=0.469, Pgroups=0.497). The difference between preoperative and postoperative parameters for percentage of hexagnal endothelium cells within the same group was statistically significant (Ftime=5.966, Ptime=0.004). The difference in the coefficient of variation between the control and observation groups was not statistically significant (Fgroups=0.106, Pgroups=0.746), but the difference between preoperative and postoperative parameters in the percentage of the coefficient of variation within the same group was statistically significant (Ftime=21.248, Ptime<0.001). Conclusions: Anterior chamber bubbles are affected by the surgeon, race of the patients, equipment, corneal diameter, corneal flap diameter, the trabecular meshwork situation and pocket thickness. Gas bubbles may be entering the anterior chamber through the trabecular reticulum, and that can damage the corneal endothelial cells. Reducing the incidence rate of anterior chamber bubbles could boost visual quality

Key words： femtosecond laser corneal flap laser in situ keratomileusis anterior chamber bubbles complication

收稿日期: 2019-05-05

通讯作者: 王兴存（ORCID：0000-0002-9437-5166），Email：wxceye3221979@sohu.com

引用本文:

王兴存朱立强张广峰杨海青王勇敢左文渊. 基于单中心FS-LASIK术中前房气泡的临床观察[J]. 中华眼视光学与视觉科学杂志, 2020, 22(6): 434-440. Xingcun Wang, Liqiang Zhu, Guangfeng Zhang, Haiqing Yang, Yonggan Wang, Wenyuan Zuo. Clinical Observation of Anterior Chamber Bubbles Based on a Single Center during Femtosecond Laser in situ Keratomileusis. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(6): 434-440. DOI: 10.3760/cma.j.cn115909-20190505-00131

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190505-00131 或 https://www.cjoovs.com/CN/Y2020/V22/I6/434

[1]	张钰, 陈跃国, 夏英杰. WaveLight FS200飞秒激光制瓣的 LASIK手术发症临床研究. 中华眼科杂志, 2016, 52(1): 41-46. DOI: 10.3760/cma.j.issn.0412-4081.2016.01.011.
[2]	Zhang XX, Zhong XW, Wu JS, et al. Corneal flap morphological analysis using anterior segment optical coherence tomography in laser in situ keratomileusis with femtosecond lasers versus mechanical microkeratome. Int J Ophthalmol, 2012, 5(1): 69-73. DOI: 10.3980/j/issn.2222-3959.2012.01.14.
[3]	李仲佶, 段宇辉, 米生健, 等. 飞秒激光辅助LASIK制瓣术中发生前房气泡的影响因素和处理. 国际眼科杂志, 2017, 17(12): 2363-2366. DOI: 10.3980/j.issn.1672-5123.2017.12.46.
[4]	王勤美. 屈光手术学. 北京: 人民卫生出版社, 2011:129.
[5]	于秋菊, 张永红, 陈月, 等. FS200飞秒与ZiemerLDV飞秒制瓣并发症的对比分析. 中国实用眼科杂志, 2016, 34(12): 1282- 1285. DOI: 10.3760/cma.j.issn.1006-4443.2016.12.011.
[6]	刘慧颖, 周行涛. 飞秒激光辅助准分子激光原位角膜磨镶术后角膜内皮细胞密度的临床研究. 中国眼耳鼻喉科杂志, 2012, 12(4): 234-236. DOI: 10.3969/j.issn.1671-2420.2012.04. 012.
[7]	Zhang J, Zhou YH. Effect of suction on macular thickness and retinal nerve fiber layer thickness during LASIK used femtosecond laser and Moria M2 microkeratome. Int J Ophthalml, 2015, 188(4): 777-783. DOI: 10.3980/ j.issn.2222-3959.2015.04.24. eCollection 2015.
[8]	Ang M, M ehta JS, Rosman M, et al. Visual outcomes comparison of 2 femtosecond laser platforms for laser in situ keratomileusis. J Cataract Refract Surg, 2013, 39(11): 1647- 1652. DOI: 10.1016/j.jcrs.2013.04.044. Epub 2013 Sep 20.
[9]	雷玉琳, 郑秀云, 侯杰, 等. 飞秒激光制瓣发生前房气泡的处理探讨. 临床眼科杂志, 2011, 19(3): 272-274. DOI: 10.3969/ j.issn.1006-8422.2011.03.031.
[10]	肖卉, 范忠义, 宋磊, 等. 飞秒激光制作角膜瓣LASIK并发症的观察和处理. 中国实用眼科杂志, 2015, 33(12): 1396-1399. DOI: 10.3760/cma.j.issn.1006-4443.2015.12.020.
[11]	郑秀云, 雷玉琳, 侯杰, 等. 飞秒激光制瓣LASIK术中发生前房气泡51眼临床分析. 中华眼视光学与视觉科学杂志, 2012, 14(6): 374-376. DOI: 10.3760/cma.j.issn.1674-845X.2012.06. 013.
[12]	Rush SW, Cofoid P, Rush RB. Incidence and outcomes of anterior chamber gas bubble during femtosecond flap creation for laser-assisted in situ keratomileusis. J Ophthalmol, 2015, 2015: 542127. DOI: 10.1155/2015/542127. Epub 2015 Apr 20.
[13]	Lifshitz T, Levy J, Klemperer I, et al. Anterior chamber gas bubbles after corneal flap creation with a femtosecond laser. J Cataract Refract Surg, 2005, 31(11): 2227-2229. DOI: 10.1016/ j.jcrs.2004.12.069.
[14]	侯杰, 雷玉琳, 郑秀云. 飞秒激光制瓣发生前房气泡致术后角膜内皮细胞丢失一例. 中华眼科杂志, 2016, 52(7): 531-533. DOI: 10.3760/ cma.j.issn.0412-4081.2016.07.012.
[15]	邢星, 李世洋, 赵爱红, 等. 飞秒激光小切口角膜基质透镜取出术与准分子激光原位角膜磨镶术治疗近视对角膜内皮细胞密度影响的比较. 眼科新进展, 2016, 36(3): 247-249. DOI: 10.13389/j.cnki.rao.0412-4081.2016.0066.
[16]	Acquart S, Gain P, Zhao M, et al. Endothelial morphometry by image analysis of corneas organ cultured at 31 degrees C. Invest Ophthalmol Vis Sci, 2010, 51(3): 1356-1364. DOI: 10.1167/ iovs.08-3103. Epub 2009 Oct 22.
[17]	Tomita M, Watabe M, Waring GO, et al. Corneal endothelial cell density after myopic intra-LASIK and the effect of AC gas bubbles on the corneal endothelium. Eur J Ophthalmol, 2011, 21(4): 363-367. DOI: 10.5301/EJO.2010.6100.