| 【中文摘要】 目的 分析LASIK术中角膜瓣并发症的相关因素，术中处理方法，并探讨二次手术的时机。 设计 回顾性临床研究。 研究对象 本中心3年中所有接受屈光手术的患者12313 例，（24015 眼），术前平均等效球镜度数-7.35D+ 2.82D。 方法 分析发生术中角膜瓣并发症的13只眼，术中采取规范化处理，取消激光治疗，术后进行相应的客观检查，包括验光及角膜地形图。并在首次手术后12 ~ 30天，进行二次手术。 主要指标 术后屈光度、角膜地形图及裸眼视力。结果 所有发生术中角膜瓣并发症的患眼，在接受二次手术后，视力都达到了预期的效果，与对侧眼比较无显著性差异（P<0.01 ）。纽扣瓣以及碎瓣、瓣不全的位置在瞳孔区内的患者，屈光度都发生了改变，表现为球镜度降低（1.06 + 0.52 D），同时散光度数、轴位也有变化。所有发生纽扣瓣并发症的患者，角膜K值在瓣愈合完整后均显著性降低（t=11.595，P=0.000），平均降低了2.95+0.13，其余并发症的角膜K值未发生显著性改变。 结论 准分子激光术中发生角膜瓣并发症时，不要过激处理，尤其不要急于进行激光治疗，根据并发症的具体情况确定二次手术的时机，并完成充分的准备，均能获得预期的疗效。
【关键词】激光手术；近视/外科学；并发症；再手术
【Abstract】 Objective To Analyze the factors affecting the intraoperation flap complications of LASIK and the management, for determining the better time to take reoperation. Design Retrospective clinical research. Participants The total 12313 patients, 24015 eyes, of which the average spherical equivalent (SE) refraction was -7.35D+ 2.82D, accepted LASIK treatment in recent 3 years. Method 13 eyes were failed to accomplish operation because of flap complications, while the laser treatment was canceled. Routine management was carefully performed. Topography and refraction were taken and all the cases accepted reoperations after 12 to 30 days. Main Outcome Measures The UCVA, refraction and cornea topography after first session and reoperation. Result There were no statistically significant differences between complication eyes and the other eyes. In the patients of button hole and incomplete flap with the cutting across the pupil area, the refraction changed with decreasing on spherical power and the variety of cylinder as well the axis. Topography changed in the patients of button hole. K value decreased significantly （t=11.595，P=0.000）, average 2.95+0.13, after the rehealing of cornea, while eyes of other complications had no significant change. Conclusions To avoid sequelae of intraoperation complications, proper management is highly important, and no laser treatment should be done in the procedure. After sufficient preparations, excellent visual acuity can be achieved through reoperation.
【Key Words】 laser surgery; myopia/surg; complications; reoperation
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