Davidorf J M, Zaldivar R, Oscherow S
Instituto Zaldivar, Mendoza, Argentina.
J Refract Surg. 1998 Mar-Apr;14(2):114-22. doi: 10.3928/1081-597X-19980301-09.
To identify intraoperative and early postoperative adverse events and complications that may be encountered after the laser in-situ keratomileusis (LASIK) learning process.
One hundred sixty-nine consecutive eyes of 108 patients who had LASIK by a surgeon experienced in LASIK were studied. All intraoperative and early postoperative adverse events and complications were noted. Patients were examined at 1 day and 1 to 3 months after surgery. Six baseline refractive groups were studied: high myopia with astigmatism (-10.25 to -17.50 D; 18 eyes), moderate myopia with astigmatism (-6.00 to -9.50 D; 31 eyes), low myopia with astigmatism (-0.75 to -5.87 D; 81 eyes), mixed astigmatism (-0.25 to +0.50 D; 6 eyes), low to moderate hyperopia with astigmatism (+1.00 to +3.75 D; 19 eyes), and high hyperopia with astigmatism (+4.25 to +7.37 D; 12 eyes). Seventy-eight percent (132 eyes) had a primary LASIK procedure; 22% (37 eyes) had LASIK after previous refractive surgery. Primary and secondary LASIK procedures were analyzed together. The Nidek EC-5000 or the Chiron PlanoScan excimer lasers were used.
The most commonly observed adverse intraoperative events were minor corneal bleeding (3%) and thin flap (1%). The most commonly observed postoperative events were punctate epithelial keratopathy (6%) and small epithelial defect 1 day after surgery (5%). The most serious complication occurred in three eyes with preoperative high hyperopia (spherical equivalent refraction greater than +4.00 D) in which corneal topographic abnormalities resulted. At last examination, mean postoperative spherical equivalent refraction was less than +1.00 D in all groups. Spectacle-corrected visual acuity was 20/20 in 70 eyes (41%) and 20/25 or better in 119 eyes (70%). Loss of spectacle-corrected visual acuity of two or more lines occurred in five eyes (3%), three of which had preoperative high hyperopia with abnormal postoperative corneal topography.
Our prospective study should help LASIK surgeons gauge their expectations of intraoperative and early postoperative complications. Surgeons should proceed cautiously when treating patients with high hyperopia, because a higher incidence of loss of spectacle-corrected visual acuity may be encountered postoperatively.
确定在准分子原位角膜磨镶术（LASIK）学习过程中可能遇到的术中及术后早期不良事件和并发症。
对108例接受LASIK手术的患者的169只眼睛进行了研究，手术由一位有LASIK经验的外科医生实施。记录所有术中及术后早期不良事件和并发症。患者在术后1天以及1至3个月接受检查。研究了六个基线屈光组：高度近视合并散光（-10.25至-17.50 D；18只眼）、中度近视合并散光（-6.00至-9.50 D；31只眼）、低度近视合并散光（-0.75至-5.87 D；81只眼）、混合散光（-0.25至+0.50 D；6只眼）、低度至中度远视合并散光（+1.00至+3.75 D；19只眼）以及高度远视合并散光（+4.25至+7.37 D；12只眼）。78%（132只眼）接受了初次LASIK手术；22%（37只眼）在先前屈光手术后接受了LASIK手术。对初次和二次LASIK手术进行了综合分析。使用了Nidek EC - 5000或Chiron PlanoScan准分子激光。
最常见的术中不良事件是轻微角膜出血（3%）和薄瓣（1%）。最常见的术后事件是点状上皮性角膜炎（6%）和术后1天的小上皮缺损（5%）。最严重的并发症发生在3只术前高度远视（等效球镜度大于+4.00 D）的眼睛中，导致了角膜地形图异常。在最后一次检查时，所有组的术后平均等效球镜度均小于+1.00 D。70只眼（41%）的眼镜矫正视力为20/20，119只眼（70%）的眼镜矫正视力为20/25或更好。5只眼（3%）出现了眼镜矫正视力下降两行或更多，其中3只术前为高度远视且术后角膜地形图异常。
我们的前瞻性研究应有助于LASIK外科医生评估他们对术中及术后早期并发症的预期。在治疗高度远视患者时，外科医生应谨慎行事，因为术后可能会遇到更高的眼镜矫正视力丧失发生率。
