von Rüden Dennis, de Ortueta Diego
AURELIOS Augenlaserzentrum, Recklinghausen GmbH, Erbruch 34-36, 45657, Recklinghausen, Deutschland.
Ophthalmologie. 2023 Jan;120(1):27-35. doi: 10.1007/s00347-022-01687-3. Epub 2022 Jul 27.
The aim was to analyze and compare the refractive results of anxious patients treated with transepithelial photorefractive keratectomy (TransPRK) while under general anesthesia (ITN) versus patients treated under local anesthesia (TRO).
The TransPRK treatment was performed with the AMARIS 1050 RS laser (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) in a group of patients with ITN and a group of patients, treated as usual with TRO. The method used an aspheric aberration neutral ablation profile, as well as SmartPulse technology and 7D eyetracking. In ITN propofol and rocuronium were injected intravenously. The artificial respiration was via a resuscitation bag after intubation with a laryngeal mask. To achieve pain insensitivity in the group of patients in TRO three drops of Conjucain Edo 0.4% were instilled at intervals of a few minutes. Follow-up examinations were performed after 1 and 4 days and after 1 and 3 months.
A total of 35 consecutive TransPRK laser treatments under ITN were retrospectively compared with a group of 699 eyes treated with TransPRK under TRO in the period from February 2017 to December 2021. The preoperative sphere had a range of -5.50 to -1.0 dpt, the average cylinder was 1.19 dpt and cylinders were treated up to 4.75 dpt. The results after 3 months follow-up showed a predictability of 100% eyes within the target correction of less than 0.5 dpt in ITN and in TRO 97%. The astigmatic correction showed 91% of eyes in ITN with less than 0.5 dpt and an angle of error of 83% within ±5°. In TRO 96% of eyes showed astigmatic correction with less than 0.5 dpt and an angle of error of 77% within ±5°. After 3 months 83% of eyes treated in ITN reached a visual acuity of 1.0 or more and 84% of eyes treated in TRO.
The TransPRK performed in ITN led to equal refractive results than when treated as usual in TRO. For anxious patients there is the possibility of laser vision correction in ITN. Because of shorter treatment time and accordingly shorter time under general anesthesia, TransPRK is an advantage for LASIK surgery.
分析并比较全身麻醉下经上皮准分子激光角膜切削术（TransPRK）治疗的焦虑患者与局部麻醉下治疗的患者（TRO）的屈光结果。
使用AMARIS 1050 RS激光（德国克莱诺施泰姆市SCHWIND眼科技解决方案有限公司）对一组全身麻醉患者（ITN）和一组常规局部麻醉治疗的患者（TRO）进行TransPRK治疗。该方法采用非球面像差中和消融模式，以及智能脉冲技术和7D眼动追踪。在全身麻醉组中，静脉注射丙泊酚和罗库溴铵。插管喉罩后通过复苏袋进行人工呼吸。为使局部麻醉组患者达到无痛觉，每隔几分钟滴入三滴0.4%的复方卡因。在术后1天、4天、1个月和3个月进行随访检查。
回顾性比较了2017年2月至2021年12月期间35例全身麻醉下连续进行的TransPRK激光治疗与699例局部麻醉下接受TransPRK治疗的眼。术前球镜度数范围为-5.50至-1.0屈光度，平均柱镜度数为1.19屈光度，柱镜度数治疗至4.75屈光度。3个月随访结果显示，全身麻醉组100%的眼在目标矫正范围内（小于0.5屈光度），局部麻醉组为97%。散光矫正方面，全身麻醉组91%的眼小于0.5屈光度，83%的眼误差角度在±5°以内。局部麻醉组96%的眼散光矫正小于0.5屈光度，77%的眼误差角度在±5°以内。3个月后，全身麻醉组83%的眼视力达到1.0或更高，局部麻醉组为84%。
全身麻醉下进行的TransPRK与局部麻醉下常规治疗的屈光结果相当。对于焦虑患者，全身麻醉下进行激光视力矫正成为可能。由于治疗时间较短，相应地全身麻醉时间也较短，TransPRK对于准分子原位角膜磨镶术（LASIK）手术来说是一个优势。
