Excimer laser refractive corneal surgery (including PRK, LASIK and LASEK) has a history of more than 20 years. Clinical results show that LASIK surgery is a safe and effective method to correct myopia. But to ensure the safety and improve the quality of surgery, we must master three aspects:
Strictly grasp the indications and contraindications of surgery.
To ensure the safety and good quality of the operation, the first thing is to master the indications and contraindications of the operation, and not blindly pursue profits and relax the indications.
Experience shows that the indications of excimer laser refractive corneal surgery are: the patient must have the desire to take off the lens and reasonable postoperative expectation, be over 18 years old, have a relatively stable refractive state (no obvious change in degree) in recent two years, have checked all the parameters to meet the surgical requirements, have no active inflammation and organic lesions, have no diseases limited by surgery, and wear contact lenses for 2 weeks before operation. These conditions are the premise of laser surgery for myopia. Contraindications: the patient's age does not meet the surgical requirements; Eye examination parameters do not meet the surgical requirements; Active inflammation of eyes, such as acute conjunctivitis, keratitis, blepharitis, dacryocystitis and iritis; Organic eye diseases, such as retinal detachment, cataract, glaucoma, etc. Limited operation and systemic diseases that affect postoperative recovery, such as scar constitution and diabetes; Women during pregnancy and lactation; Patients lack understanding of surgery or expect too much; Patients with psychological abnormalities such as depression.
Conduct a comprehensive and systematic preoperative examination
Patients should be thoroughly, comprehensively and in detail examined before operation. Routine eye examination includes visual examination, including naked eye near and far vision and corrected vision; Examination of intraocular pressure, axial length, corneal topography and corneal thickness; Dry eye screening; Slit lamp examination includes conjunctiva, sclera, cornea, iris, anterior chamber, pupil and lens. After mydriasis, the lens periphery and anterior vitreous should also be examined; Fundus examination; The refractive power examination includes comprehensive optometry, subjective optometry, mydriasis optometry and subjective optometry on the day of operation; External eye examination includes more than a dozen examinations such as orbit, eyelid and lacrimal sac. In addition to routine preoperative examination, wavefront aberration examination is also needed to collect iris data and night vision pupil data of patients. Including these factors in the surgical design can maximize the postoperative night vision ability of patients, reduce postoperative visual discomfort such as glare and halo, and meet the needs of patients driving and working at night.
Clinically, it was found that some patients missed diagnosis because of incomplete preoperative examination and could not be treated in time, which led to postoperative complications. For example, fundus examination must fully examine the peripheral retina, because the peripheral retina of patients with high myopia is prone to degeneration or dry holes. If the operation is not found in time, the patient is likely to have serious blinding diseases such as retinal detachment after operation. If retinal detachment can be found in time and given preventive fundus laser treatment, the occurrence of retinal detachment can be prevented, and laser surgery for myopia is still feasible after recovery.
Improve the qualifications of doctors and medical institutions
Doctors who perform excimer laser surgery must undergo strict training and examination and obtain the qualification certificates of large medical equipment (PRK, LASIK) issued by the Ministry of Health. At present, some hospitals blindly pursue the amount of surgery, which reduces the threshold for doctors to enter and the indications for surgery, resulting in some adverse consequences.
Excimer laser surgery has been developed for 20 years, and its equipment and technology have entered the advanced stage of individualized treatment. For example, patients with large pupil and high-order aberration should be treated with individualized surgery guided by wavefront aberration under iris recognition and positioning; Tissuesaving is applied to patients with thin cornea, which can make patients retain more corneal tissue after operation, and the biomechanics of cornea after operation is more stable and the safety is further guaranteed. Femtosecond laser can make femtosecond laser corneal flap, which can truly personalize corneal flap, which further improves the safety compared with traditional micro-corneal lamina. Six-dimensional eye tracking ensures the accuracy of laser scanning, realizes point-to-point correction, and fully guarantees the surgical quality and postoperative visual quality of patients.
Advanced medical equipment is an important guarantee for safety, but at present there are "second generation, third generation and fourth generation machines" and "second hand and third hand" machines in the industry. The old machines eliminated by many big hospitals are reused by some hospitals. The performance of these machines is uneven, but their purchase cost and operating price are very low. They attract patients at a price below cost. Using this machine for myopia surgery is easy to cause some postoperative complications such as poor corneal flap making, postoperative glare and poor night vision.
In order to ensure the quality of laser surgery for myopia, we must strictly grasp the indications and contraindications of surgery, conduct a comprehensive and systematic preoperative examination, select experienced doctors and medical institutions with advanced personalized treatment technology, and most importantly, take the doctor's goodwill as the highest criterion for doctors to practice medicine.