Clinically significant laser in situ keratomileusis flap striae
Clinically significant laser in situ keratomileusis flap striae
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DOI：
10.1016/j.jcrs.2017.09.023
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发表时间：
2017-12-01
影响因子：
2.8
通讯作者：
Cohen, Mark
中科院分区：
文献类型：
--
作者：
Wallerstein, Avi;Gauvin, Mathieu;Cohen, Mark
目的描述发病率，危险因素，和结果之前和之后的冲洗临床显着的激光原位角膜磨镶术（LASIK）皮瓣striae.Setting多外科医生多中心标准化协议practice.Design回顾性病例对照series.Methods眼睛与条纹需要皮瓣剥离和冲洗被确定。收集术前、术中和术后变量。发病率，危险因素，和outcomes.Results：109403眼LASIK，条纹治疗的眼睛的发病率为0.79%（n = 875），8.7%的灌溉手术后的第一个小时。术前等效球镜（SE）和消融深度指数增加了条纹风险（R2 = 0.9674; P <0.001）。条纹诱导了一个小的远视移位，在复位后逆转（平均0.22屈光度[D] +/- 0.52 [SD] vs-0.02 +/- 0.45 D）（P <0.001）。在矫正后，68.0%、87.0%和96.0%的患眼的裸眼远视力（UDVA）分别为20/20、20/25、20/40或更好，而在矫正前分别为25.0%、55.0%和84.0%（P <0.001）。经条纹治疗的患眼达到UDVA 20/20的患者减少了13%。51.0%的眼在矫正远视力下降1行或1行以上，安全指数在矫正后恢复到对照值（0.99 vs 1.00）（P > 0.05）。激光屈光增强进行了6.28%的relifted条纹的眼睛与3.04%的nonstriae control eyes.Conclusions：皮瓣条纹需要外科医生干预发生在0.79%的眼睛。较高的术前SE值与条纹风险呈指数增加相关。通过提拉和冲洗治疗显著提高了准确性、有效性和安全性，接近对侧对照眼的水平，尽管条纹治疗眼更可能需要准分子激光再治疗。
Purpose To describe the incidence, risk factors, and outcomes before and after irrigation of clinically significant laser in situ keratomileusis (LASIK) flap striae.Setting Multisurgeon multicenter standardized protocol practice.Design Retrospective case-control series.Methods Eyes with striae necessitating flap relift and irrigation were identified. Preoperative, intraoperative, and postoperative variables were collected. Incidence, risk factors, and outcomes were assessed.Results: Of the 109 403 eyes that had LASIK, the incidence of striae-treated eyes was 0.79% (n = 875), with 8.7% irrigated the first hour after surgery. The preoperative spherical equivalent (SE) and ablation depth exponentially increased the striae risk (R2 = 0.9674; P < .001). Striae induced a small hyperopic shift that reversed after the relift (mean 0.22 diopter [D] +/- 0.52 [SD] versus -0.02 +/- 0.45 D) (P < .001). After relifting, 68.0%, 87.0%, and 96.0% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20, 20/25, 20/40 or better versus 25.0%, 55.0%, and 84.0%, respectively, before the relift (P < .001). Thirteen percent fewer striae-treated eyes achieved a UDVA of 20/20. Before relifting, 51.0% of striae eyes lost 1 or more lines of corrected distance visual acuity, with a safety index reverting to control values (0.99 versus 1.00) (P > .05) after the relift. A laser refractive enhancement was performed in 6.28% of relifted striae eyes versus 3.04% in nonstriae control eyes.Conclusions: Flap striae requiring surgeon intervention occurred in 0.79% of eyes. Higher preoperative SE values were associated with an exponential increase risk for striae. Treatment by lifting and irrigation significantly improved the accuracy, efficacy, and safety to a level close to that of contralateral control eyes, although striae-treated eyes were more likely to need excimer laser retreatment.