Professor Zhao Jialiang of Peking Union Medical College Hospital of China Academy of Medical Sciences Professor Chu Renyuan Professor of Ophthalmology and Otolaryngology Hospital affiliated to Fudan University Professor Qu Jia of Beijing Tongren Hospital Professor of School of Ophthalmology and Optics of Wenzhou Medical College Professor Zhou of Huashan Hospital affiliated to Fudan University Professor Wang Qinmei of Department of Ophthalmology and Otolaryngology affiliated to Fudan University Professor of School of Ophthalmology and Optics of Wenzhou Medical College Zhongshan Eye Center of Guangzhou Sun Yat-sen University.
Executive Officer/Huang Yi
Expert support
Department of Ophthalmology, Peking Union Medical College Hospital, China Academy of Medical Sciences
Professor Zhao Jialiang
Eye, Otolaryngology Hospital affiliated to Fudan University
Professor Chu Renyuan, Associate Professor Zhou
Beijing Tongren Hospital Ophthalmology
Professor Zhou Yuehua.
Zhongshan Ophthalmology Center of Guangzhou Sun Yat-sen University
Professor Wang Zheng
Wenzhou medical college ophthalmology optics college
Professor Qu Jia and Professor Mei.
Department of Ophthalmology, Huashan Hospital Affiliated to Fudan University
Professor Ye Wen
On February 6, 2004, The Sunday Times published an article entitled "Ophthalmic surgery is too dangerous for the national medical service system". The article pointed out that in view of the recent problems such as decreased vision, decreased corneal intensity, infection and retinal detachment in some patients undergoing excimer laser in situ keratomileusis (LASIK), the medical supervision department of the British government stopped it. It is also pointed out that the failure rate of eye laser surgery is about 10%, not 0. 1% as mentioned in most advertisements. The British Institute for Clinical Optimization (NICE) also believes that LASIK should not be used as a clinical routine in the UK, and LASIK should not be included in the UK national health care system without further research and approval.
After this article was reprinted by many domestic media, the saying that "Britain stopped excimer laser surgery" spread like wildfire, and the failure rate of excimer laser surgery was as high as 10%, which triggered the question of "whether excimer laser surgery is safe". Many people who hope to treat myopia through surgery are at a loss.
In order to enable readers to objectively look at the so-called "Britain stopped excimer laser surgery" incident and have a deeper understanding of excimer laser surgery, so as to receive surgery more safely and obtain better surgical results, this magazine invited domestic ophthalmologists to express their views on the British incident, the development status of excimer laser surgery in China and how to ensure the safety of surgery.
Explain the article
At present, millions of people in China have realized their dream of taking off their glasses and recovering their clear vision through laser surgery. At the same time, more people are preparing for surgery. The disclosure of the "British incident" is undoubtedly a big blow to these people. So, is the British statement scientific? How do other western countries react to this? Is the failure rate of laser surgery that high? What is the situation in our country? Listen to the experts.
Question 1: Is the failure rate really as high as 10%?
Chu Renyuan and Zhou: Correctly treat "10% failure rate"
If the normal corneal tissue changes after laser surgery, such as corneal infection and perforation, it is a recognized complication, and its proportion is usually less than 65438 0%. The difference may mainly lie in the definition of "failure" or "unsuccessful" caused by the limitation of preoperative degree itself. Most people think that after the operation, the naked eye vision reaches 1.0, and the operation is completely successful. In fact, naked eye vision is very important, but visual quality is more important. People with poor postoperative visual quality, although their visual acuity has reached 1.0, have problems such as blurred vision and decreased night vision, which will seriously affect their daily life. Statistics show that the visual quality after excimer laser surgery can not reach the level of wearing glasses, and usually exceeds 20% in high myopia. The failure rate of 10% is not high if the statistics of surgical failure rate in Britain include the problems of postoperative aberration increase (in most cases, after laser surgery) and visual quality decline.
Wang Zheng: The report exaggerated the problems in LASIK surgery.
In 2004, the British Institute of Clinical Optimization was asked to evaluate the effectiveness and safety of LASIK surgery, and in June, 2004, 65438+February, 65438+May, 2004, it issued "Guidelines for LASIK surgery to treat ametropia". Before the official publication of this document, the Sunday Times published an article entitled "Ophthalmic surgery is too dangerous for the national medical service system" on February 6, 65438, which was reprinted by many media and caused a shock in Britain and even the whole world. Ophthalmologists, medical institutions and patients from all over the world have expressed their opinions. Most people think that the British media reported this matter carelessly and exaggerated the problems existing in LASIK surgery. Many of their comments and guesses are wrong.
Some ophthalmologists in Britain think that the literature cited by NICE is too old, ignoring the recent progress of LASIK surgery and the emerging new technologies, such as wavefront-guided surgery. The American non-profit organization "Refractive Surgery Quality Assurance Committee" also issued a statement, questioning the failure rate of LASIK surgery reported by British media as high as 10%. The executive director of the organization said, "We are an organization that represents the interests of patients. If the failure rate of LASIK is really that high, we will point it out first. " According to statistics, in 2004, about 6.5438+0.2 million people in the United States underwent LASIK surgery, while the amount of surgery in Britain was only 6.5438+0.2 million. In the United States, the incidence of LASIK complications is about 3%, and the serious complications requiring surgical treatment are below 0.5%. Many recent studies also show that the incidence of serious complications of LASIK is below 0.5%, even below 0. 1%.
Qu Jia and Wang Qinmei: The statement of failure rate is unscientific.
First of all, we should understand the correct meaning of "failure rate", which is not a strict medical term. In medicine, the incidence of "complications" is generally used to explain the safety of surgery. It is unscientific and imprecise to use only the word "failure rate" to explain safety. Give a very simple example: a patient found that the visual quality decreased after laser surgery, which can be said to be "surgery failure"; Another patient's vision was seriously damaged after laser surgery, which is also called "operation failure", but there is a big difference between the two.
After consulting the original article "Ophthalmic surgery is too dangerous for the national medical service system" published in the Sunday Times, we found that the main reason for this article is that a British pharmaceutical company named Boots was forced to close its nine excimer laser centers after performing excimer laser surgery for myopia patients, which caused public concern about the safety of excimer laser treatment. In fact, the problem of only one company cannot represent the level and real situation of excimer laser surgery in the world. The failure rate 10% mentioned in this paper is quoted from the journal Ophthalmology. Literally, it refers to the failure rate of ophthalmic surgery, not just excimer laser surgery.
Zhou Yuehua: It is incredible that the failure rate is so high.
If the failure rate of excimer laser surgery is really as high as 10%, then this surgery is worth "stopping". Imagine, if the failure rate of this operation is so high, 10 people will have surgery and 1 people will fail, how many people will suffer and regret because of this operation!
Question 2: Isn't the approval of being included in the national medical service system equivalent to "stopping surgery"?
Zhou Yuehua: Conceptual error.
Not being allowed to enter the national medical service system does not mean that excimer laser surgery is not done or banned in Britain, but it is not allowed to enter the "medical insurance" equivalent to China.
Wang Zheng: "Stop" is groundless.
Since 1990, the national medical service system has been providing LASIK surgery for patients who wear glasses or contact lenses to correct their poor eyesight, with about 800 people every year, accounting for 0.8% of LASIK surgery in Britain. The guide document of NICE in the UK is mainly aimed at the question whether LASIK surgery can be used as a routine method to treat ametropia in the British National Health Service like frame glasses and contact lenses, so the requirements for its safety are very strict.
At the same time, because the national medical service system in Britain provides free medical care, it is also in line with international practice not to include LASIK in the routine treatment of the national medical service system.
Chu Renyuan and Zhou: Caution, not prohibition.
The focus of British reports is excimer laser to correct myopia, especially high myopia, which has many complications. I hope everyone will be cautious, not opposing or prohibiting.
Question 3: Why are there so many serious problems in LASIK surgery in Britain?
Zhou Yuehua: I started late, and my technology is slightly inferior.
There are two main reasons why there are so many problems in LASIK surgery in Britain: first, LASIK surgery in Britain started late, which is only three to five years, so the technical level and proficiency of doctors are not too high; Second, in Britain, LASIK surgery is mostly performed in some private clinics, but not in public hospitals. The medical level, hardware facilities and emergency handling capacity of private clinics are relatively poor. At the same time, Britain has a relatively complete medical supervision system. Once the problem is found, the administrative department will take necessary measures to prevent the situation from deteriorating.
Question 4: What is the level of excimer laser surgery in China? Have you encountered many problems like those in Britain?
Zhou Yuehua: The domestic situation is not optimistic.
Excimer laser surgery has been carried out in China for more than ten years, and thousands of myopia patients have benefited from it. It should be noted that the problems encountered by Britain also exist in China, and even the situation in some parts of China is much more serious than that in Britain. As one of the earliest hospitals in China to carry out excimer laser surgery, Beijing Tongren Hospital often meets patients from all over the country who ask for "rework" because of failed surgery. A small number of them have obtained relatively satisfactory vision after the second operation, while others are not so lucky. People with vision degradation and blindness need corneal transplantation.
At present, there are three biggest problems in excimer laser surgery in China: First, the gap in medical level (including hardware and software) is too large, which directly leads to the difference in the success rate of surgery. For example, in some regular large hospitals, the success rate of this operation can reach more than 99%, while in some small hospitals, the success rate of this operation is only 70% or even lower; Secondly, the use of surgical equipment lacks supervision, and many hospitals attract patients at low prices. I don't know that this low price is obtained by using cheap and low-performance machines and reusing surgical instruments. Thirdly, many medical institutions regard excimer laser surgery as a tool to make money, and false advertisements are overwhelming. Patients often blindly seek medical treatment because they listen to advertisements.
Wang Zheng: Medical advertisements lack supervision, and the quality of medical care is difficult to guarantee.
The development of medical institutions in different regions and at all levels in China is unbalanced, and the training and supervision system of relevant medical management departments is not perfect, which leads to great differences in doctors' technical level and medical effect. In addition, the domestic refractive surgery market is vicious competition, the supervision of medical advertisements is weak, the price competition is serious, and the medical quality is difficult to guarantee. Another major consequence of this is that the medical investment is getting less and less, and it is difficult to apply advanced equipment and technology in time, which leads to the slow development or even stagnation of refractive surgery in China. In the long run, it will be very unfavorable to patients.
Qu Jia and Wang Qinmei: Generally speaking, they are in step with the advanced level in the world, but they still need to be cautious.
In China, excimer laser was introduced in 1993 to perform PRK surgery, and then LASIK surgery was performed. At present, there are more than 700 excimer laser surgery centers of different scales in China. Last year, about 500,000 excimer laser operations were performed in China. Generally speaking, the level of excimer laser surgery in China has been synchronized with the advanced level in the world, and it is developing rapidly and steadily. However, there is a big gap in the overall medical level in China. Some medical institutions with low level and poor conditions are also carrying out excimer laser surgery. Most of the failed cases happened there. The surgeons are inexperienced, the operation process is not standardized, the equipment is backward (even imported foreign obsolete equipment), and the low-price competition directly leads to the decline of medical quality and the surge of medical disputes.
Question 5: Is excimer laser surgery safe and effective?
Zhao Jialiang: There are advantages and risks.
Excimer laser surgery has been carried out for more than 20 years. At present, it is widely carried out all over the world, and thousands of people have recovered their clear vision through this operation. This alone has fully explained the advantages of excimer laser in the treatment of myopia. At the same time, excimer laser surgery, like any other surgery, has certain risks. More importantly, because the operation is performed on the normal cornea, it is the icing on the cake and unnecessary. Therefore, it is suggested that patients have a more comprehensive and correct understanding of the risks of this operation.
Wang Zheng: This is by far the safest and most effective refractive surgery.
LASIK is a highly selective operation, and both doctors and patients should be aware of the risks of the operation itself. Although many years of clinical practice and millions of clinical results around the world have proved that LASIK is the safest and most effective refractive surgery so far, it must be reminded that LASIK's "safety and effectiveness" is based on correct surgical design, skillful surgical skills, high-quality surgical equipment and perfect postoperative follow-up, any of which will directly affect the surgical effect.
Zhou Yuehua: Choosing the right hospital and doctor is the first condition to ensure safety.
Excimer laser surgery is safe as long as you choose the right hospital and doctor. Actually, wearing contact lenses is not safer than laser surgery. Taking Beijing Tongren Hospital as an example, there are almost no safety hazards after excimer laser surgery, and dozens of people wearing contact lenses go to see a doctor every year because of infection.
Chu Renyuan and Zhou: Six Necessary Conditions to Ensure the Quality of Surgery
With the continuous updating of surgical equipment and examination instruments, and the continuous improvement of surgical methods and skills, the safety of excimer laser surgery has been greatly improved compared with the past. In short, to ensure the quality of surgery, the following six conditions must be met: ① preoperative examination is comprehensive and correct; ② The surgical design is just right; ③ The surgeon is skilled; ④ Perfect hardware facilities; ⑤ Patients cooperate properly; ⑥ Standardize medication and postoperative follow-up.
Qu Jia and Wang Qinmei: Standardize operation and strengthen supervision.
The ideal refractive surgery should achieve the following goals: safe and effective; The visual quality has not decreased; Accurate and predictable; The effect is stable; Keep the eyeball structure intact; The operation is painless; Postoperative reaction is light; Fast recovery; Reversible and adjustable.
In view of the phenomenon that some hospitals in our country carry out excimer laser surgery without authorization, which seriously reduces the safety of surgery and intensifies the contradiction between doctors and patients, the relevant departments should adopt the principle of "grasping with both hands" In medical treatment, it is necessary to formulate unified surgical standards, improve the threshold of surgical qualification, and standardize surgical operations; In terms of supervision, the relevant government administrative departments should take effective measures as soon as possible to strengthen supervision and effectively manage hospitals, doctors and medical equipment that carry out excimer laser surgery.
The reporter's testimony:
From the incisive analysis of your ophthalmologist, we can clearly draw the following conclusions:
1. The statement that excimer laser surgery is stopped in Britain is purely misunderstood. "Not approved to be included in the national medical service system" does not mean that excimer laser surgery is banned in Britain, but is not included in the free medical coverage, just as LASIK surgery is not covered by medical insurance in China.
2. Although the failure rate as high as 10% is not exact, concerns about the safety of laser surgery are not groundless.
3. Excimer laser surgery is icing on the cake and not necessary. Like any other operation, there are certain risks, and some complications may occur after operation, which need careful consideration by patients.
4.LASIK surgery is recognized as the safest and most effective refractive surgery in the world at present, but the success of the surgery is closely related to the surgical design, the technical level of doctors, the quality of laser equipment and other factors.
Although the level of surgery in China has kept pace with the world, the level of medical care is far from the same. It is suggested that patients keep a clear head, don't follow advertisements or be confused by "low price", and choose hospitals with guaranteed quality and skilled doctors for surgery.
Analysis article
In order to receive surgery safely and obtain the best surgical effect, it is necessary to have a deep understanding of excimer laser related knowledge, including the types, indications, risks, operation steps and complications of surgery.
Taking off glasses does not change the essence of myopia.
Zhao Jialiang (Professor), Department of Ophthalmology, Peking Union Medical College Hospital, China Academy of Medical Sciences
Every patient who has undergone or will undergo excimer laser surgery should know that surgery can only make you take off your glasses, but it can't change the essence of your myopia. For a simple example, if the preoperative myopia is 1 0,000 degrees and the postoperative naked eye vision is 1.0, you don't need to wear glasses. Although it looks like a normal person on the surface, your intraocular structure and retina are still in the primitive state of high myopia. All possible complications of high myopia, such as glaucoma and retinal detachment, may occur. Don't neglect your eyes because you don't need to wear glasses.
Family list of excimer laser myopia surgery
Department of Ophthalmology, Affiliated Otolaryngology Hospital of Fudan University, Wang Xiaoying (Doctor)
Excimer laser originated at the beginning of 1970. It is a dimer of inert gas and halogen molecules, and its wavelength is in the ultraviolet spectrum, which is an invisible light. Its biggest feature is that the energy it releases can destroy the molecular bonds of corneal cells very accurately and vaporize corneal tissue without any thermal damage to nearby tissues. At present, there are four kinds of excimer laser surgery, as shown in the following table.
Comparison table of excimer laser surgery methods
Mode of operation
PRK
Laser-assisted in situ keratomileusis
LASEK
Epi-LASIK
Time of birth
1983
1990
1999
In 2002
operation sequence/order
Corneal epithelium was removed first, and then myopia was corrected by excimer laser. After a few days, corneal epithelium regenerated and recovered.
First, make a corneal flap on the cornea with a knife, then open the corneal flap, cut it with laser, and finally reset it.
The corneal flap is made of 20% ethanol without a knife.
Using corneal epithelial knife instead of ethanol as corneal flap is much thinner than LASIK.
superiority
The operation method is simple, safe and effective for moderate and low myopia.
Myopia treatment has a wide range of degrees, no pain after operation, and rapid recovery of vision.
Good safety, less irritation symptoms than PRK, light or no corneal opacity; People with thin corneas can also have surgery.
Good safety, less irritation symptoms, light or no corneal opacity; People with thin corneas can also have surgery.
disadvantaged
It will hurt for several days after operation, and my vision will slowly recover. If the degree is high, corneal opacity and hormonal ocular hypertension may occur after operation.
There are complications related to corneal flap (such as flap displacement, flap loss, etc.) ), thin cornea can not be operated.
The surgical technique is high, and the visual recovery is slower than LASIK. Subcorneal opacity and hormonal ocular hypertension may occur in patients with high myopia after operation.
The surgical technique is high, and the visual recovery is slower than LASIK. Subcorneal opacity and hormonal ocular hypertension may occur in patients with high myopia after operation.
Best sign
100 ~ 500 degrees myopia, hyperopia below 600 degrees
100 ~ 1200 myopia, hyperopia below 600 degrees, corneal thickness above 480 microns.
100 ~ 500 degree myopia, hyperopia below 600, corneal thickness below 480 microns can not do LASIK surgery,
Or the corneal thickness is more than 480 microns, but the myopia degree is still below 250 degrees after LASIK. I hope to remove the myopia degree as much as possible.
People who are allergic to alcohol and are not suitable for LASIK surgery are the same as LASEK.
Surgical expenses
low
High-ranking, higher-ranking, more important
High-ranking, higher-ranking, more important
high
As can be seen from the above table, no surgical method is perfect, only the most suitable one is the best.
It is risky to operate on a normal cornea.
Ye Wen (Professor), Ophthalmology Department, Huashan Hospital, Fudan University
I. Intraoperative risks
Intraoperative complications mainly occurred in the process of skin flap making. At this time, if there are problems in patient cooperation, doctor operation or instrument operation, it will lead to corneal flap being too thin, corneal flap being free, corneal flap being incomplete, corneal flap being deviated, even corneal flap being cut through, corneal flap being broken and so on.
Second, early postoperative risk.
Infection, overcorrection or undercorrection, laser cutting eccentricity, dry eye, visual fatigue and other complications may occur in the early stage after excimer laser surgery. Due to the lack or incompleteness of epithelium, the recovery of PRK and LASEK is slow, accompanied by pain and corneal opacity. Although LASIK has the advantages of rapid recovery, no pain, fewer problems and short medication time, there are still complications such as lamellar keratitis, interlaminar foreign body and epithelial implantation. In addition, excimer laser surgery will also affect the visual quality, such as night myopia and glare. If the thickness of corneal flap is uneven during LASIK, ghost may appear.
Third, the long-term risk after surgery.
Patients with high and ultra-high myopia are prone to visual deterioration after excimer laser surgery, and may have secondary corneal swelling due to the thin thickness of residual cornea. Corneal flap may not heal completely after LASIK. In the case of trauma or other eye surgery, the flap will be displaced or lost, which may occur two years or more after LASIK. Patients should be carefully considered before operation.
Correctly treat surgical risks
Qu Jia (Professor), Ophthalmology and Optometry Hospital affiliated to Wenzhou Medical College
Most of the "patients" undergoing excimer laser surgery are not the so-called "eye disease" patients, but the "healthy" people with ametropia. These people often choose surgery in order to meet the physical examination requirements of employment units, or to take off their glasses for life, improve their quality of life, or to be more beautiful and convenient. They have high expectations for the operation and will put forward more requirements for the safety and effectiveness of the operation. It is normal that the complications of this operation become the most concerned issue.
The complications of excimer laser surgery can be divided into two categories: one is irreversible damage that affects eye health, such as infection and secondary keratoconus. At present, such complications rarely occur. Since 1995, the excimer laser surgery was carried out in the Optometry Hospital affiliated to Wenzhou Medical College, the incidence of complications was less than 0. 1%, and a considerable proportion of these 0. 1% was due to visual quality problems. The second kind of complications is about the evaluation of visual quality, such as contrast sensitivity, glare and other functional visual indicators. The corrected vision of some patients can achieve the expected goal, but the visual quality can not achieve the expected effect, resulting in postoperative dissatisfaction. This aspect needs further research and exploration.
The biggest drawback of direct excimer laser surgery-visual quality decline
Dr. Yu Zhiqiang, Excimer Laser Center, Eye, Otolaryngology Hospital, Fudan University
In recent years, excimer laser myopia surgery is surging all over the country, and all kinds of advertisements are overwhelming, boasting that excimer laser is magical and omnipotent. In fact, any operation has advantages and disadvantages, and there is no perfect operation in the world.
Regardless of the obvious problems that may occur in excimer laser surgery, such as corneal flap failure, laser eccentric cutting, etc., even a seemingly successful surgery-the naked eye vision of the patient reaches 1.0, or even 1.5, still has its defects-the visual quality declines.
Visual quality is a higher-level concept than vision, which requires not only normal vision above 1.0, but also clarity, comfort and stability. In addition to the positive diopter, it also involves aberration, contrast sensitivity, night vision, tear film stability and other factors. At present, excimer laser technology can only improve the naked eye vision, but not the visual quality. On the contrary, surgery will also lead to a decline in visual quality.
First, the aberration increases.
Excimer laser surgery is to correct diopter by removing part of corneal tissue and changing corneal curvature. However, laser not only changes the curvature of cornea, but also changes the aberration of the whole eyeball system. The smaller the aberration, the clearer and more comfortable the vision. Although the postoperative aberration can be larger or smaller in theory, the current understanding and application of aberration is far from perfect compared with the natural state, that is to say, the postoperative aberration increases in most cases, which affects the visual quality.
Second, the contrast sensitivity is reduced.
Contrast sensitivity is also an index to measure visual quality. The postoperative visual acuity of some myopia patients has reached 1.0, but they will feel that the color of the visual target on the visual chart is lighter and not as sharp as before. This situation is the performance of decreased visual sensitivity. The decrease of contrast sensitivity is related to myopia degree and optical cutting area before treatment. The higher the originality, the smaller the optical cutting area, and the more obvious the decrease of contrast sensitivity.
Third, vision loss at night.
Myopia patients above 300 degrees usually complain that their eyesight at night is not as good as during the day, or that their eyesight drops in the rainy days in the early stage after excimer laser surgery. Especially when driving at night, when the opposite car turns on the high beam, the driver will feel that he can't see anything in front. In fact, this is a difficult problem that excimer laser surgery has not yet overcome. The main reasons are the decrease of contrast sensitivity and the increase of aberration mentioned above. Therefore, it is suggested that friends with moderate or high myopia who need to drive at night should be cautious when considering excimer laser surgery.
Fourthly, the stability of tear film decreased.
There is a tear film on the normal corneal surface, which is also an important part of the refractive system of human eyes. Once the tear film is destroyed, the front surface of the eyeball loses its integrity. On the one hand, it will cause problems such as dry eyes, foreign body sensation and visual fatigue. On the other hand, it will also affect the refractive system of the eyeball. When light passes through the tear film, irregular scattering will occur, which will also increase the aberration and decrease the visual quality.
LASIK surgery cuts off the nerve endings in the superficial layer of cornea when making corneal flap, which reduces corneal sensitivity and malnutrition, thus affecting the stability of tear film. Although the stability of tear film will gradually recover with the repair of corneal nerve endings, it often takes half a year or even longer.
Hope: "improving visual quality" is included in the key research topic.
Recently, under the leadership of Wenzhou Medical College, Peking Union Medical College Hospital, Guangzhou Zhongshan Eye Center, Eye, Otolaryngology Hospital affiliated to Fudan University and other medical units 10 participated in the research of "improving the safety and effectiveness of refractive surgery", a key project of the Tenth Five-Year Plan of the Ministry of Science and Technology: on the premise of standardizing and standardizing excimer laser surgery, further explore the influence of visual quality factors; On the basis of meeting the principles of safety, effectiveness, accuracy, stability and minimal damage, it also meets the requirements of clear, comfortable and lasting optometry.
Guiding article
Once the operation is decided, how to choose a hospital and a suitable doctor to ensure the quality of the operation has become the primary problem. I suggest you listen to the expert's advice first.
Laser surgery is a systematic project.
Ye Wen (Professor), Ophthalmology Department, Huashan Hospital, Fudan University
Zhou Hao (Ph.D.), Department of Ophthalmology, Eye, Otolaryngology Hospital, Fudan University.
Excimer laser surgery is not a simple procedural surgery. It is impossible to achieve ideal surgical results only by an experienced surgeon and an advanced laser surgery equipment. It is a complex system engineering, and every link, such as preoperative examination, surgical design, intraoperative operation, patient cooperation, postoperative medication and nursing, is closely related to the surgical effect.
The preoperative examination should be correct.
Detailed preoperative examination is essential, including vision examination, refractive examination, anterior segment and fundus examination, intraocular pressure examination, corneal thickness measurement, corneal topography examination, wavefront aberration examination, contrast sensitivity, tear film rupture time and tear secretion test. The following three tests are very important and directly related to the success or failure of the operation.
Medical optometry The theory of medical optometry was put forward by Professor Chu Renyuan in 2000 and has been widely adopted. The difference between medical optometry and ordinary optometry lies in emphasizing the improvement of binocular visual function. In addition to accurately checking the refractive power of each eye, it is also necessary to check the binocular balance, eye position, accommodation and binocular monocular function. Using medical optometry to design the amount of surgery can ensure high visual quality after operation.
Patients with pre-clinical keratoconus detected by corneal topography and anterior segment analysis system should be followed up for a long time, and it is not advisable to perform hasty surgery to avoid artificial corneal perforation.
Preoperative preparation needs to be improved
Applying antibiotic eye drops for a period of time before operation can reduce bacteria in conjunctival sac and prevent postoperative infection. But the time should not be too long, usually 3 ~ 5 days, so as not to damage corneal epithelium by preservatives in eye drops.
It is also important to clean the conjunctival sac the day before surgery. If the irrigation is insufficient, bacteria and secretions will remain in the conjunctival sac, which will easily lead to postoperative infection. However, if the washing is excessive and the concentration of disinfectant is too high, it will lead to corneal epithelial detachment and epithelial implantation after operation.
The operation should be standardized and the cooperation between doctors and patients should be better.
How effective the operation is, the design and operation of the operation are very important. In addition, because the operation is performed under topical anesthesia, if the patient does not cooperate well during the operation and does not pay close attention to the red light above the head according to the doctor's requirements, when the eyeball moves beyond the range that the machine can track, it will lead to the reduction of cutting accuracy and eccentric cutting, and may even lead to the interruption of the operation. Therefore, patients should fully understand the operation process before operation and carry out some simple training to avoid being too nervous during the operation.
Postoperative follow-up should be adhered to.
Excimer laser surgery should be followed up on time, closely observe the postoperative situation, evaluate the surgical effect, find postoperative complications in time, and use drugs reasonably under the guidance of doctors. Generally speaking, antibiotic eye drops are routinely used for 2 weeks and corticosteroid eye drops 1 ~ 2 months after operation. The second day after operation, one week after operation, one month, three months and six months should be reviewed regularly.