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Professor Hu Liang talked about refractive hotspots: How to complete a more perfect corneal refractive surgery?

Posting time:2022-12-02 07:18:23

Professor Hu Liang talked about refractive hotspots: How to complete a more perfect corneal refractive surgery?

Editor's note: The development of refractive surgery is both an opportunity and a challenge. Refractive surgery is an extremely innovative and developing field. The emerging new technologies and new surgical methods continue to bring more diverse choices. higher requirements. During the Vision China 2022 conference (hereinafter referred to as the VC conference), a number of refractive surgery sessions were held to help Chinese refractive surgeons improve their surgical skills. "International Ophthalmology News" had the honor to interview Professor Hu Liang from Wenzhou Medical University Affiliated Ophthalmology and Optometry Hospital, and shared his experience in the new progress of refractive surgery, the treatment of postoperative complications after refractive surgery, and how to do refractive surgery well. , experience. New Advances in Refractive Surgery: Full Femtosecond Lens Reuse & Corneal Biomechanics At this VC conference, many new advances in refractive surgery research were presented. Professor Hu highlighted two highlights: Reuse. In full femtosecond surgery, a large number of corneal stromal lenses are completely removed, and in most cases, the surgeon directly discards the removed lenses. In recent years, more and more scholars have begun to study how to reuse this part of the lens, turning waste into treasure, and have made certain progress in basic research and clinical disease treatment. The basic research focuses on the in vitro culture of human corneal fibroblasts and the biomechanical characteristics of isolated corneal stromal lenses; clinical disease treatment focuses on how to use corneal stromal lenses for autologous or allogeneic eyes to correct hyperopia and presbyopia , Repair corneal ulcer, treat keratoconus, etc. Although the relevant research is still in the preliminary stage and has not been widely used clinically, this is a bright spot that is very worth looking forward to. Corneal biomechanics research. Before, people paid more attention to corneal morphology. Now it is found that corneal biomechanics also affects all aspects of corneal refractive surgery. The cornea is not a transparent plastic, it is both an optical organ and an organ of biological materials. Biomechanics will affect all aspects of surgical design and surgical safety, so many scholars have paid attention to and studied the related issues of corneal biomechanics. This is beneficial to improve the safety and precision of surgery. Pain management of full laser superficial surgery At present, full femtosecond surgery, half-femtosecond surgery, and TPRK superficial surgery are the three main types of corneal superficial surgery. The corneal surface surgery does not create an incision on the cornea, which is beneficial to maintain the biomechanical properties of the cornea, which is a very obvious advantage. Professor Hu and his colleagues have done many cases of corneal surface surgery, and found that this type of surgery also has shortcomings, that is, postoperative pain. How to avoid postoperative pain? The Eye and Optometry Hospital Affiliated to Wenzhou Medical University has designed a series of related methods to relieve pain in patients: 1. Preventive methods. Promote the rapid repair of corneal epithelium and avoid postoperative pain. Carry out patient education; use drugs to reduce inflammation and pain before surgery, such as non-steroidal anti-inflammatory drugs half an hour before surgery; use ice water during surgery to reduce pain; wear bandages with high oxygen permeability after surgery, etc. 2. For patients with severe and unbearable postoperative pain, a small amount of topical anesthetic can be considered, which can quickly relieve pain, speed up prognosis, and improve the patient's experience. But pay attention to the dose of epidermal anesthetic, too much use will affect the corneal epithelial healing. Professor Hu pointed out that taking the above measures can reduce the postoperative pain of patients with superficial surgery and improve the patient's surgical experience. Influencing factors and countermeasures of post-refractive dry eye Post-refractive dry eye is a very common complication after refractive surgery, and the incidence is high. On the one hand, many patients suffer from dry eye before surgery, and the incidence of postoperative dry eye is nearly 90%. membrane and conjunctival goblet cells; in addition, some patients wear contact lenses for a long time before surgery, which will also affect the tear film. These factors all lead to an increase in the incidence of postoperative dry eye. Generally, dry eye after refractive surgery is mainly affected by neurological factors. Within three months to six months after surgery, the tear film will slowly return to the preoperative state. Professor Hu pointed out that during this period, according to the patient's condition, individualized drug treatment can be carried out for different components of the tear film to improve the tear film state of the patient, that is, "hydration", secretion promotion and other methods to improve dry eye symptoms, improve postoperative visual acuity and visual quality. How to complete a more perfect corneal refractive surgery? For a perfect corneal refractive surgery, preoperative examination and design are very important. The most appropriate surgical method should be selected according to the patient's condition, and the occurrence of related complications should be prevented. Professor Hu took full femtosecond surgery as an example, and introduced the relevant surgical points and techniques: It is very important to fix the patient's position and head position during the operation. After the patient is lying flat, if the head is tilted, the centering of the patient will also change. Conduct patient education. Patients need to know when to keep their eyes open, when to stare at a vague green light, and for how long. The surgeon needs to communicate with the patient in detail, and the patient has corresponding expectations and can better cooperate with the surgical operation. Precise centering. Especially for patients with large Kappa angle, how to accurately center the positioning is a big challenge. During the laser scan, the patient is instructed to keep the eyeball still. When taking the corneal stroma lens, the action is gentle, and do not repeat the operation at the visual axis, so as not to affect the recovery of vision. There are many surgical skills in corneal refractive surgery. While mastering the surgical skills, the surgeon should also be familiar with the possible complications and treatment plans, so as to be well-informed, so as to have a more perfect surgical effect. Conclusion Affected by the repeated epidemics, the VC meeting has been postponed twice, and it is very difficult to hold this meeting. As the first national offline academic conference of ophthalmology this year, the VC conference has a large number of people who signed up for the conference. The epidemic could not stop everyone's enthusiasm for academic exchanges. Professor Hu said that as the organizer, on the one hand, the conference must be well organized; on the other hand, epidemic prevention must be done well. At present, a lot of epidemic prevention and control work has been done, including setting up a nucleic acid testing point at the entrance of the conference to conduct nucleic acid testing for participants free of charge. We hope to establish a safe and comfortable academic exchange environment so that everyone can enjoy the academic event. I wish the VC conference a complete success and the participants a fruitful harvest.

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