目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术中负压脱失的原因,并分析其处理方法及临床效果.方法 巢式病例对照研究.选取2013年9月至2017年9月在天津市眼科医院屈光手术中心接受SMILE的患者信息,术中发生负压脱失的患眼纳入负压脱失组,与负压脱失组同日行SMILE但无术中及术后并发症的患者纳入对照组.分别于术前及术后1 d、1周、1个月、3个月、6个月评估患者屈光度及视力.负压脱失组与对照组之间正态分布的计量参数比较应用独立样本t检验,计数资料及单向有序计数参数用χ2检验.负压脱失组与对照组术眼术后实际矫正等效球镜度数(SE)随着术前预测SE的变化评估采用Pearson直线相关分析.结果 本研究共纳入206例(344只眼)患者,年龄为(22.9±5.0)岁,男性109例,女性97例.其中负压脱失组25例(27只眼),对照组181例(317只眼).负压脱失发生时间:(1)扫描透镜后表面(5只眼,18.5％);(2)透镜侧切(1只眼,3.7％);(3)扫描透镜前表面(16只眼,59.3％);(4)扫描切口(5只眼,18.5％).主要原因有术中眼球异常转动(14只眼,51.9％),角膜表面水分过多(13只眼,48.1％).负压脱失组与对照组之间角膜帽直径分别为(7.78±0.22)和(7.60±0.25)mm,差异有统计学意义(t=2.341,P=0.040).术后3个月时,负压脱失组3.7％(1只眼)术眼最佳矫正视力降低1行;对照组仅2.6％(6只眼)术眼最佳矫正视力降低1行.负压脱失组及对照组术眼裸眼视力>0.10的比例分别为92.6％(25只眼)及91.3％(209只眼),术眼残余SE在±0.50 D之间者分别占85.2％(23只眼)及93.4％(214只眼).结论 SMILE术中负压脱失最常见于扫描透镜前表面时,角膜表面水分过多、术中突然眼动或角膜帽直径过大均可能诱发负压脱失;负压脱失可能造成患者术后视力恢复速度缓慢,但有效的处理可使患者最终的视力恢复不受影响.%Objective To investigate the classification, possible risk factors, managements and clinical outcomes of suction loss in small incision lenticule extraction (SMILE). Methods In this nested case control study, subjects undergoing SMILE surgery between September 2013 and September 2017 were enrolled in the study. Eyes suffered from suction loss were included in the suction loss group, and eyes without intraoperative complications and operated at the same date were included in the control group. The refraction and visual outcomes were evaluated at preoperative and postoperative 1 day, 1 week, 1, 3 and 6 months. Independent t test and Pearson relation analysis were used for statistical analysis. Results The study included 206 cases (344 eyes), of which 25 cases (27 eyes) were in suction loss group and 181 cases (317 eyes) were in control group. Suction loss occurred at: (1) scanning posterior surface of lenticule (5, 18.5％);(2) scanning lenticule side cut (1, 3.7％);(3) scanning anterior surface of lenticule (16, 59.3％);(4) scanning incision (5, 18.5％). The main reasons included: (1) abnormal eye movement (14, 51.9％);(2) extra fluid on corneal surface (13, 48.1％). There was significant difference in cap diameter between two groups (t=2.341, P<0.05). At postoperative 3 months, 3.7％ (1 eyes) of eyes in cases lost one line; 2.6％(6 eyes) of eyes in controls lost one line. 92.6％(25 eyes) and 91.3％(209 eyes) of eyes had a UCVA of 0.10 LogMAR or better in cases and controls, respectively;85.2％(31 eyes) and 93.4％(214 eyes) of eyes had a residual SE between ± 0.50D in cases and controls, respectively. Conclusions Suction lost during anterior surface of cornea was most common in SMILE surgery. Extra fluid in cornea surface, sudden eye movement of patient and larger corneal cap may result in suction loss. And it may slow the visual recovery, but appropriate and effective managements will be benefited to the final visual outcomes.
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