12 EyeWorld Asia-Pacific | December 2024 医生简介 Nic Reus, MD, PhD, FEBOS-CR | Breda, The Netherlands, Molengracht 21, 4811 CK | nreus@amphia.nl Ke Yao, MD | Chief & Professor, Zhejiang University Eye Hospital Eye Center, Second Affiliated Hospital Zhejiang University School of Medicine | xlren@zju.edu.cn 声明Reus: Alcon, Johnson & Johnson, and Zeiss Yao: None 参考文献 1. Yu, Y., et al., Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up. Clin Exp Ophthalmol, 2016. 44(6): p. 472-80. 2. Zhang, X., et al., Performance of femtosecond laser-assisted cataract surgery in Chinese patients with cataract: a prospective, multicenter, registry study. BMC Ophthalmol, 2019. 19(1): p. 77. 3. Zhong, Y., et al., Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: comparison of internal aberrations and visual quality. Graefes Arch Clin Exp Ophthalmol, 2022. 260(3): p. 901-911. 4. Chen, X., et al., Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg, 2017. 43(4): p. 486-491. 5. Lyu, D., et al., Comparison of Perioperative Parameters in Femtosecond Laser-Assisted Cataract Surgery Using 3 Nuclear Fragmentation Patterns. Am J Ophthalmol, 2020. 213: p. 283-292. 6. Zhu, Y., et al., Parameters of Capsulorrhexis and Intraocular Lens Decentration After Femtosecond and Manual Capsulotomies in High Myopic Patients With Cataracts. Front Med (Lausanne), 2021. 8: p. 640269. 7. Zhu, Y., et al., Lens capsule-related complications of femtosecond laser-assisted capsulotomy versus manual capsulorhexis for white cataracts. J Cataract Refract Surg, 2019. 45(3): p. 337-342. 8. Zhang, X., et al., Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve. Br J Ophthalmol, 2024. 9. Yu, Y., et al., Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg, 2015. 41(12): p. 2614-23. 10. Zhu, S., et al., Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg, 2017. 43(11): p. 1430-1435. 11. Wang, H., et al., Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review. PLoS One, 2023. 18(4): p. e0284181. 12. Xu, J., et al., Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis and systematic review. Adv Ophthalmol Pract Res, 2022. 2(1): p. 100027. 13. Chen, X., et al., Comparing the Curative Effects between Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification Surgery: A Meta-Analysis. PLoS One, 2016. 11(3): p. e0152088. 14. Chen, X., et al., Cataract: Advances in surgery and whether surgery remains the only treatment in future. Adv Ophthalmol Pract Res, 2021. 1(1): p. 100008. 2. 减少角膜内皮细胞丢失 FLACS的一个显著优点是它能够最大限度地减少角膜内皮细胞的丢 失，特别是硬核白内障病例。研究报告称，FLACS组在术后三个月的 ECL约为7.85%，而CPS组在相似的术后阶段的ECL更高，为19.96% 。这强调了飞秒激光预碎核对角膜内皮的保护作用。4 同时，个性化的 FLACS设置也可以最大限度地发挥保护作用。研究表明，3级核白内 障适合六分模式预碎核，而4级或5级适合4象限碎核。5 3. 降低手术能量 FLACS减少了手术过程中所需的能量，因为激光预先做晶状体碎核。 因此，在超声乳化过程中需要较少的超声能量，从而减少术中对眼 部组织的创伤并缩短手术时间。 4. 术中并发症少 与CPS相比，FLACS的术中并发症发生率较低。这一优势在复杂白内 障中更为明显，尤其是白色白内障。6，7 FLACS将前囊膜撕裂、不规则 撕囊和偏心撕囊的发生率从12.1%（8/66）降低到0%（0/66）。7 尽管FLACS具有优势，但它并非没有遇到挑战。飞秒激光设备的高昂 成本是阻碍其被广泛采用的重要障碍。但随着生活水平的提高，这 来源：姚克, MD 个问题的影响将变得不那么重要。此外，FLACS需要专门的设备维护 和手术医生的学习曲线，这可能会削弱其优势。8 此外，FLACS后出现 术后荧光素染色和干眼症的风险更高9，比手动创建的角膜切口引起 更多的SIA，这可能是由于飞秒机器的角膜切口定位不准确或不确 定造成的。10 随着技术的不断进步，FLACS的未来充满希望。手术参数的持续优化 和个性化可以进一步降低并发症发生率，缩短手术时间，改善视力 恢复。将FLACS与其他新兴技术（如光学相干断层扫描（OCT）和人工 智能（AI））相结合可以提高手术精度、自动化流程并提高安全性。 许多研究对FLACS进行了系统评估。近年来，飞秒激光辅助白内障手 术已经证明比传统的超声乳化具有显著的临床优势。FLACS提高了 精度，降低了并发症发生率，加快了术后恢复，特别是在硬核白内障 和高度近视等复杂病例中。11-13 尽管成本和技术挑战仍然存在，但未 来，FLACS很可能成为占主导地位的白内障手术方法，特别是对于屈 光性白内障手术。14 专题通向精准和完美之路—超乳vs.飞秒
RkJQdWJsaXNoZXIy Njk2NTg0