University of California San Francisco, Department of Ophthalmology, 10 Koret Way, K-301, San Francisco, CA 94143, USA.
Ophthalmology. 2011 Sep;118(9):1760-5. doi: 10.1016/j.ophtha.2011.01.053. Epub 2011 May 6.
To evaluate the risks of flap displacement after LASIK.
Retrospective case series.
We included 41 845 consecutive adults who underwent LASIK surgery at Optical Express in the United Kingdom, including 81 238 eyes, of which 14 555 were hyperopic and 66 681 myopic or mixed astigmatic. We treated 57 241 eyes with the IntraLase FS-60 femtosecond laser and 23 997 with the Moria S.A. ONE Use-Plus automated microkeratome.
We calculated the incidence of all flap displacements in the study population during an observational time period of ≥12 months after surgery. Independent variables were entered into logistic regression models to identify risk factors. Postoperative outcomes were assessed.
The incidence and odds ratios (OR) of flap displacement in the study population and in categories of refractive error and flap surgery technique.
The incidence of flap displacements was 10 in 81 238 LASIK procedures (0.012%), including 8 hyperopic eyes (0.055%) and 2 myopic eyes (0.003%). All flap displacements occurred within 48 hours of surgery and none were preceded by ocular trauma. They were classified as "early flap displacements" (EFD). The incidence of EFD after microkeratome surgery was 0.033% (n = 8), and after femtosecond laser it was 0.003% (n = 2). In hyperopic eyes having microkeratome surgery, the incidence was 0.179% (n = 7). In a logistic regression model, the strongest predictor of EFD after LASIK was hyperopia, recording an OR of 19.29 (P<0.001). The OR of developing an EFD after microkeratomy was 10.53 times higher than after femtosecond laser (P<0.005). In hyperopes, the OR of an EFD was 18.87 times higher after microkeratomy than after femtosecond treatment. Four of 10 displaced flaps needed secondary surgery, and 1 eye lost 2 lines of best-corrected visual acuity.
The incidence of flap displacements during a 12-month period after LASIK was extremely low (0.012%). Although the small number of displacements with the femtosecond laser limits conclusions, the risk of EFD was higher after microkeratome surgery than femtosecond laser.
评估 LASIK 术后瓣移位的风险。
回顾性病例系列。
我们纳入了在英国 Optical Express 接受 LASIK 手术的 41845 例连续成年人，共 81238 只眼，其中远视眼 14555 只，近视眼或混合散光眼 66681 只。我们用 IntraLase FS-60 飞秒激光治疗了 57241 只眼，用 Moria S.A. ONE Use-Plus 自动微型角膜刀治疗了 23997 只眼。
我们在术后≥12 个月的观察期内计算了研究人群中所有瓣移位的发生率。将独立变量输入逻辑回归模型以确定危险因素。评估术后结果。
研究人群中瓣移位的发生率和比值比（OR），以及屈光不正和瓣手术技术分类中的 OR。
在 81238 例 LASIK 手术中，有 10 例（0.012%）发生瓣移位，包括 8 例远视眼（0.055%）和 2 例近视眼（0.003%）。所有瓣移位均发生在手术 48 小时内，均无眼部外伤史。它们被归类为“早期瓣移位”（EFD）。微型角膜刀手术后 EFD 的发生率为 0.033%（n=8），飞秒激光手术后为 0.003%（n=2）。远视眼行微型角膜刀手术后 EFD 的发生率为 0.179%（n=7）。在逻辑回归模型中，EFD 后 LASIK 的最强预测因子是远视，记录的比值比为 19.29（P<0.001）。微型角膜刀术后 EFD 的比值比高于飞秒激光 10.53 倍（P<0.005）。在远视眼中，微型角膜刀术后 EFD 的比值比高于飞秒激光治疗的比值比为 18.87 倍。10 例移位瓣中有 4 例需要二次手术，1 只眼视力丧失 2 行最佳矫正视力。
LASIK 术后 12 个月内瓣移位的发生率极低（0.012%）。虽然飞秒激光治疗瓣移位的数量较少限制了结论，但微型角膜刀手术后 EFD 的风险高于飞秒激光。
