Wu Ningling, Christenbury Joseph G, Dishler Jon G, Bozkurt Tahir Kansu, Duel Daniel, Zhang Lijun, Hamilton D Rex
J Refract Surg. 2017 Sep 1;33(9):584-590. doi: 10.3928/1081597X-20170621-06.
To identify risk factors for opaque bubble layer (OBL) formation and compare the incidence of OBL using a cone modification technique versus the original technique for LASIK flap creation using the VisuMax laser (Carl Zeiss Meditec, Jena, Germany).
This retrospective study examined videos of flap creation using the VisuMax laser to identify OBL occurrence. Eyes were divided into three groups: eyes where OBL occurred using the original technique (OBL group), eyes where OBL did not occur using the original technique (no OBL group), and eyes in which the cone modification technique was used for LASIK flap creation (larger flap diameter) (cone modification technique group). Preoperative measurements including simulated keratometry (flat and steep) values, white-to-white distance (WTW), pachymetry, patient age and gender, amount of correction, flap parameters, energy setting, corneal hysteresis, and corneal resistance factor were analyzed to identify parameters with statistical difference between the OBL and no OBL groups. Incidence of OBL was compared between the original and cone modification techniques.
OBL incidence was significantly lower with the cone modification technique (7.6%; 7 of 92 eyes) than with the original technique (28.8%; 34 of 118 eyes) (Fisher's exact test, P = .0009). Factors identified with a significant difference between eyes with and without OBL using the original technique were: corneal thickness (OBL: 561.2 μm, no OBL: 549.6 μm, P = .0132), WTW diameter (OBL: 11.6 mm, no OBL: 11.9 mm, P = .0048), corneal resistance factor (OBL: 10.4 mm Hg, no OBL: 9.6 mm Hg, P = 0.0329), and corneal astigmatism (OBL: 0.80 diopter, no OBL: 1.00 diopter, P = .0472) CONCLUSIONS: Less astigmatic, thicker, denser, and smaller corneas increased the risk of OBL using the original technique for flap creation. The cone modification technique was associated with lower risk of OBL formation, even in eyes with significant risk factors for OBL using the original technique. [J Refract Surg. 2017;33(9):584-590.].
确定不透明气泡层（OBL）形成的危险因素，并比较使用圆锥改良技术与使用VisuMax激光（德国耶拿卡尔蔡司医疗技术公司）进行LASIK瓣制作的原始技术时OBL的发生率。
这项回顾性研究检查了使用VisuMax激光制作瓣的视频以确定OBL的发生情况。眼睛分为三组：使用原始技术发生OBL的眼睛（OBL组）、使用原始技术未发生OBL的眼睛（无OBL组）以及使用圆锥改良技术进行LASIK瓣制作（瓣直径更大）的眼睛（圆锥改良技术组）。分析术前测量值，包括模拟角膜曲率（平坦和陡峭）值、白到白距离（WTW）、角膜厚度测量、患者年龄和性别、矫正量、瓣参数、能量设置、角膜滞后和角膜阻力因子，以确定OBL组和无OBL组之间具有统计学差异的参数。比较原始技术和圆锥改良技术之间OBL的发生率。
圆锥改良技术的OBL发生率（7.6%；92只眼中有7只）显著低于原始技术（28.8%；118只眼中有34只）（Fisher精确检验，P = .0009）。使用原始技术时，有OBL和无OBL的眼睛之间存在显著差异的因素为：角膜厚度（OBL：平均561.2μm，无OBL：平均549.6μm，P = .0132）、WTW直径（OBL：平均11.6mm，无OBL：平均11.9mm，P = .0048）、角膜阻力因子（OBL：平均10.4mmHg，无OBL：平均9.6mmHg，P = 0.0329）和角膜散光（OBL：平均0.80屈光度，无OBL：平均1.00屈光度，P = .0472）。结论：散光较小、角膜较厚、较致密且较小的眼睛，使用原始瓣制作技术时OBL的风险增加。圆锥改良技术与较低的OBL形成风险相关，即使在使用原始技术时有显著OBL危险因素的眼睛中也是如此。[《屈光手术杂志》。2017；33(9)：584 - 590。]
