SMILE术中失吸的发生率和特点

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

Abstract
Figure/Table
References (14)
Related Citation (15)

Download: PDF (5544 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

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

Received: 06 November 2019

Corresponding Authors: Wei Chen, Department of Ophthalmology, Shenzhen Hospital of Peking University, Shenzhen 518036, China (Email: jennifercw6@163.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.cn115909-20191106-00298 OR https://www.cjoovs.com/EN/Y2020/V22/I4/274

[1]	Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: Results of a 6 month prospective study. Br J Ophthalmol, 2011, 95(3): 335-339. DOI: 10.1136/ bjo.2009.174284.
[2]	Wong CW, Chan C, Tan D, et al. Incidence and management of suction loss in refractive lenticule extraction. J Cataract Refract Surg, 2014, 40(12): 2002-2010. DOI: 10.1016/j.jcrs.2014.04. 031.
[3]	Liu M, Wang J, Zhong W, et al. Impact of suction loss during small incision lenticule extraction (SMILE). J Refract Surg, 2016, 32(10): 686-692. DOI: 10.3928/1081597X-20160608-02.
[4]	张丰菊. SMILE角膜屈光手术专家共识的临床解读. 中华眼视光学与视觉科学杂志, 2017, 19(3): 129-130. DOI: 10.3760/ cma.j.issn.1674-845X.2017.03.001.
[5]	Park JH, Koo HJ. Comparison of immediate small-incision lenticule extraction after suction loss with uneventful smallincision lenticule extraction. J Cataract Refract Surg, 2017, 43(4): 466-472. DOI: 10.1016/j.jcrs.2016.12.034.
[6]	Reinstein DZ, Archer TJ, Vida RS, et al. Suction stability management in small incision lenticule extraction: incidence and outcomes of suction loss in 4 000 consecutive procedures. Acta Ophthalmol, 2020, 98(1): e72-e80. DOI: 10.1111/aos.14215.
[7]	Osman IM, Awad R, Shi W, et al. Suction loss during femtosecond laser-assisted small-incision lenticule extraction: Incidence and analysis of risk factors. J Cataract Refract Surg, 2016, 42(2): 246-250. DOI: 10.1016/j.jcrs.2015.10.067.
[8]	谭倩, 马代金. SMILE的研究进展. 中华眼视光学与视觉科学杂志, 2017, 19(4): 251-256. DOI: 10.3760/cma.j.issn.1674- 845X.2017.04.011.
[9]	Reinstein DZ, Archer TJ, Vida RS, et al. Suction Stability Management in SMILE: Development of a Decision Tree for Managing Eye Movements and Suction Loss. J Refract Surg, 2018, 34(12): 809-816. DOI: 10.3928/1081597X-20181023-01.
[10]	中华医学会眼科学分会眼视光学组. 我国飞秒激光小切口角膜基质透镜取出手术规范专家共识(2018 年). 中华眼科杂志, 2018, 54(10): 729-736. DOI: 10.3760/cma.j.issn.0412- 4081.2018.10.003.
[11]	Cheng W, Liu L, Yu S, et al. Real-Time Intraocular Pressure Measurements in the Vitreous Chamber of Rabbit Eyes During Small Incision Lenticule Extraction (SMILE). Curr Eye Res, 2018, 43(10): 1260-1266. DOI: 10.1080/02713683.2018. 1485949.
[12]	马娇楠, 王雁, 张琳, 等. 角膜基质透镜取出术中负压脱失的临床研究. 中华眼科杂志, 2018, 54(12): 890-896. DOI: 10.3760/cma.j.issn.0412-4081.2018.12.005.
[13]	Kim BK, Mun SJ, Lee DG, et al. Management of incision failure during small incision lenticule extraction because of conjunctivochalasis. Am J Ophthalmol Case Rep, 2017, 7: 134- 137. DOI: 10.1016/j.ajoc.2017.06.020.
[14]	张丰菊, 孙明甡. 进一步提升SMILE的视觉质量. 中华眼视光学与视觉科学杂志, 2018, 20(10): 577-581. DOI: 10.3760/cma. j.issn.1674-845X.2018.10.001.