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Tham khảo tài liệu 'fundamentals, surgical techniques, and complications - part 8', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Marcel Dekker Inc. Madison Avenue New York New York 10016 Copyright Marcel Dekker Inc. All rights reserved. 26 Intraoperative Complications LI WANG MANJULA MISRA and DOUGLAS D. KOCH Cullen Eye Institute Baylor College of Medicine Houston Texas U.S.A. A basic medical tenet is that it is better to prevent a complication than it is to treat it. This is perhaps magnified with LASIK the elective nature of which makes even the slightest deviation from a perfect outcome a potential disappointment for both surgeon and patient. The intraoperative complication rate for LASIK is reportedly between 0.7 and 6.6 1-6 . Most of these complications have been found to occur as a result of creating the keratectomy with the microkeratome 7 8 . As will be reviewed in this chapter the preoperative examination is critical to identify risk factors for specific intraoperative complications. Surgeon experience is a vital factor as well several studies have documented the steep learning curve associated with the performance of LASIK 1 2 6 7 9-12 . A sharp decline in the number of complications is expected after sufficient surgical and medical experience has been gained in the management of laser refractive patients. Preparation and attention to detail with each procedure are fundamental as are familiarity with all equipment and instrumentation by surgeon and assistant alike. Cooperation between all members of the surgical team with clearly identified roles for each individual and development of an unvarying efficient routine that incorporates redundant safety measures will also help to minimize intraoperative complications. Finally proper management and counselling of the patient who experiences a complication will maximize the likelihood of a positive outcome for all concerned. A. MICROKERATOME-RELATED FLAP COMPLICATIONS Each surgeon s microkeratome complication rate and profile will vary with the model of instrument used individual ocular anatomy and surgeon experience. Microkeratome The .
