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目的探讨准分子激光原位角膜磨镶术(LASIK)在制作角膜瓣时发生并发症的影响因素以及预防和处理。方法通过对实施LASIK手术的近视1586例(3136眼)进行研究。手术中均使用Moria2微型角膜刀制作角膜瓣,观察角膜瓣并发症发生的影响因素及预防和处理。结果不完全瓣1例(1眼),占0.03%:角膜瓣过薄及破损3例(3眼)占0.10%:游离瓣2例(2眼)占0.06%;出现岛屿现象5例(5眼)占0.16%;纽扣瓣2例(2眼)占0.06%;共计13例(13眼),占总手术人数的0.41%。有9例(9眼)不影响角膜基质床光学治疗区,当时行激光切削,另4例(4眼)2～3月后重新制作角膜瓣完成LASIK手术,均取得了良好的视力。结论LASIK手术尽管可能发生角膜瓣并发症,但发生率较低,熟练掌握机器的性能,提高手术技巧及术前对每一患者详细的分析和设计是降低角膜瓣并发症的保证。
Objective To investigate the influencing factors and prevention and treatment of complications when laser in situ keratomileusis (LASIK) is used to make corneal flap. Methods 1586 cases (3136 eyes) of myopia undergoing LASIK were studied. Moria2 microkeratome was used in the surgery to make the corneal flap, and the influencing factors and prevention and treatment of the complications of the flap were observed. The results of incomplete flap in 1 case (1 eye), accounting for 0.03%: 3 cases of corneal flap is too thin and damaged (3 eyes) accounted for 0.10%: free flap in 2 cases (2 eyes) accounted for 0.06%; island phenomenon occurred in 5 cases (5 Eyes) accounted for 0.16%; button flap in 2 cases (2 eyes) accounted for 0.06%; a total of 13 cases (13 eyes), accounting for 0.41% of the total number of operations. Nine cases (9 eyes) did not affect the optical treatment area of corneal stromal bed. Laser ablation was performed in the other four cases (4 eyes). Reconstructed corneal flaps after 2 ~ 3 months to complete LASIK surgery, all achieved good visual acuity. Conclusions LASIK is a safe procedure to reduce the complications of corneal flap, although the incidence of corneal flap complications may be low. Proficiency in machine performance, surgical technique and preoperative detailed analysis and design of each patient are the best ways to reduce the complications of corneal flap.