Jabbur Nada S, Myrowitz Elliott, Wexler Jeffrey L, O'Brien Terrence P
Refractive Surgery Center, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Cataract Refract Surg. 2004 May;30(5):993-9. doi: 10.1016/j.jcrs.2003.09.067.
To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome.
Outpatient ambulatory laser vision correction centers.
This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a flap complication. Charts were reviewed with attention to initial preoperative data, intraoperative details of the aborted LASIK, postoperative examination, possible causes of the flap complication, timing and technique of second refractive surgery, and final visual outcome.
Causes of the aborted LASIK were identified in 13 of 16 eyes (81.2%) and included eye squeezing (5 eyes), loss of suction or machine failure (5 eyes), steep corneas (2 eyes), and learning curve of the surgeon (1 eye). The mean time until the second surgery was 135 days (range 49 to 372 days). Repeat flaps were created deeper and larger than the initially attempted flaps when possible. No patient had a final uncorrected visual acuity (UCVA) worse than 20/30 after the second surgery. Two eyes (12.5%) lost 1 line of best spectacle-corrected visual acuity.
A planned delayed reoperation after sufficient corneal healing following an intraoperative flap complication can result in satisfactory recovery of UCVA.
描述因术中瓣并发症导致准分子原位角膜磨镶术（LASIK）手术失败后二次屈光手术的技术及时机，并确定最终视力结果。
门诊流动激光视力矫正中心。
本回顾性非对照病例系列研究纳入了16例患者（16只眼），这些患者在初次LASIK手术因瓣并发症失败后接受了二次屈光手术。回顾病历，关注初始术前数据、LASIK手术失败的术中细节、术后检查、瓣并发症的可能原因、二次屈光手术的时机和技术以及最终视力结果。
16只眼中的13只（81.2%）确定了LASIK手术失败的原因，包括眼球挤压（5只眼）、吸力丧失或机器故障（5只眼）、角膜陡峭（2只眼）以及术者的学习曲线（1只眼）。二次手术的平均时间为135天（范围49至372天）。尽可能制作比初次尝试的瓣更深、更大的重复瓣。二次手术后没有患者的最终裸眼视力（UCVA）比术后20/30更差。2只眼（12.5%）最佳矫正视力下降了1行。
术中瓣并发症后，在角膜充分愈合后进行计划性延迟再次手术可使UCVA得到满意恢复。
