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

Abstract
Figure/Table
References (17)
Related Citation (15)

Download: PDF (779 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

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

Received: 05 May 2019

Corresponding Authors: Xingcun Wang, Department of Ophthalmology, the PLA Hospital of 322, Datong 037047, China (Email: wxceye3221979@sohu.com)

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20190505-00131 OR https://www.cjoovs.com/EN/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.