研究飞秒激光原位角膜磨镶术（FS-LASIK）制作角膜瓣过程中前房气泡迁移的解剖学及术中相关因素。
To study the anatomic and intraoperative factors responsible for gas bubble migration in the anterior chamber during femtosecond laser-assisted in situ keratomileusis (FS-LASIK) flap creation.
作者信息
Lata Suman, Mandal Sohini, Sinha Rajesh, Titiyal Jeewan S
机构信息
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Cornea and External Eye Disease, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India.
出版信息
Indian J Ophthalmol. 2025 Jul 1;73(7):1000-1004. doi: 10.4103/IJO.IJO_3098_23. Epub 2025 Apr 17.
PURPOSE
This study investigates the factors responsible for gas bubble migration into the anterior chamber during femtosecond-assisted laser-assisted in situ keratomileusis (FS-LASIK) flap creation.
METHODS
A retrospective data analysis was conducted on 20 eyes of 12 patients undergoing bilateral laser-assisted in situ keratomileusis surgery, where intraoperative gas bubble migration was observed. Data from age-matched controls without gas bubble migration were also analyzed. Various preoperative and intraoperative parameters were compared between the groups, including refractive error, keratometry, white-to-white (WTW) distance, angle parameters, anterior chamber depth (ACD), central corneal thickness, flap diameter, pulse energy, suction time, anterior chamber width (ACW), angle opening distance (AOD) 500 and AOD 750, trabecular iris space area (TISA) 500, TISA 750, trabecular iris area (TIA) 500, TIA 750, and anterior chamber width (ACW) using CASIA anterior segment optical coherence tomography (ASOCT), to find the correlation between angle anatomy and migration of gas bubble in AC.
RESULTS
The study found no significant differences in median age and spherical error between the groups. However, significant differences were observed in WTW (study: 11.5 ± 0.377 mm, control: 11.78 ± 0.181 mm; P = 0.04), ACD (study: 3.39 ± 0.372 mm, control: 3.86 ± 0.284 mm; P = 0.005), angle (study: 35.22° ±4.28°, control: 41.79° ± 3.95°; P = 0.002), ACW (study: 11.37 ± 0.435 mm, control: 11.83 ± 0.264 mm; P = 0.01), flap diameter (study: 8.82 mm, control: 8.68 mm; P = 0.04), and suction time (study: 62 ± 12.89 sec, control: 85.3 ± 13.35 sec; P = 0.0009). The laser energy parameters were similar between the groups.
CONCLUSION
Smaller WTW, larger flap diameter, lower ACD, and ACW are significant predisposing factors for gas bubble migration into the anterior chamber during FS-LASIK. Preoperative evaluations using Pentacam and CASIA ASOCT can help identify eyes at risk.
目的
本研究调查在飞秒激光制瓣准分子原位角膜磨镶术（FS-LASIK）制作角膜瓣过程中，导致气泡进入前房的相关因素。
方法
对12例接受双眼激光原位角膜磨镶术且术中观察到气泡迁移的患者的20只眼进行回顾性数据分析。同时分析年龄匹配的无气泡迁移对照组的数据。比较两组间各种术前和术中参数，包括屈光不正、角膜曲率、白对白（WTW）距离、房角参数、前房深度（ACD）、中央角膜厚度、角膜瓣直径、脉冲能量、负压吸引时间、前房宽度（ACW）、房角开放距离（AOD）500和AOD 750、小梁虹膜空间面积（TISA）500、TISA 750、小梁虹膜面积（TIA）500、TIA 750以及使用CASIA眼前节光学相干断层扫描（ASOCT）测量的前房宽度（ACW），以找出房角解剖结构与前房内气泡迁移之间的相关性。
结果
研究发现两组间年龄中位数和球镜度数无显著差异。然而，在WTW（研究组：11.5±0.377mm，对照组：11.78±0.181mm；P = 0.04）、ACD（研究组：3.39±0.372mm，对照组：3.86±0.284mm；P = 0.005）、房角（研究组：35.22°±4.28°，对照组：41.79°±3.95°；P = 0.002）、ACW（研究组：11.37±0.435mm，对照组：11.83±0.264mm；P = 0.01）、角膜瓣直径（研究组：8.82mm，对照组：8.68mm；P = 0.04）和负压吸引时间（研究组：62±12.89秒，对照组：85.3±13.35秒；P = 0.0009）方面观察到显著差异。两组间激光能量参数相似。
结论
较小的WTW、较大的角膜瓣直径、较低的ACD和ACW是FS-LASIK术中气泡迁移至前房的重要易感因素。使用Pentacam和CASIA ASOCT进行术前评估有助于识别高危眼。
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