Abstract：
OBJECTIVE: To analyse the occurrence and potential causes of lens capsule-related complications during femtosecond laser-assisted cataract surgery (FLACS).
METHODS: This prospective consecutive cohort study included the first 1600 eyes (from 1140 consecutive patients) who received FLACS performed by the same surgeon from May 2015 to December 2018. The potential causes and characteristic signs of capsulotomy-related complications, including incomplete capsulotomies and radial anterior capsule (AC) tears, were summarised based on the agreement of two ophthalmologists after they analysed the surgical videos. Subgroup analysis was conducted to characterise the capsulotomy learning curve.
RESULTS: Of the 1600 eyes, 52 (3.25%) had incomplete capsulotomies and 22 (1.38%) had radial AC tears. The most common causes of incomplete capsulotomies were eye tilt (16 eyes, 30.77%), air bubbles or ocular secretions at the interface (14 eyes, 26.92%) and white cataracts (7 eyes, 13.46%). Additionally, 54.55% (12/22) of AC tears were due to incomplete capsulotomy and secondary capsulorhexis. A significant difference was noted between the first 200 eyes and subsequent groups in terms of the incidence of incomplete capsulotomies. No difference was observed in the incidence of AC tears after the initial 100 procedures.
CONCLUSIONS: The most common causes of incomplete capsulotomies were eye tilt and air bubbles or ocular secretions at the interface. Secondary capsulorhexis after incomplete capsulotomy is the main risk factor for AC tears. There was a steep learning curve for laser capsulotomy in the first 100 operated eyes, as evidenced by the higher complication rate, but this stabilised after 200 procedures.
METHODS: This prospective consecutive cohort study included the first 1600 eyes (from 1140 consecutive patients) who received FLACS performed by the same surgeon from May 2015 to December 2018. The potential causes and characteristic signs of capsulotomy-related complications, including incomplete capsulotomies and radial anterior capsule (AC) tears, were summarised based on the agreement of two ophthalmologists after they analysed the surgical videos. Subgroup analysis was conducted to characterise the capsulotomy learning curve.
RESULTS: Of the 1600 eyes, 52 (3.25%) had incomplete capsulotomies and 22 (1.38%) had radial AC tears. The most common causes of incomplete capsulotomies were eye tilt (16 eyes, 30.77%), air bubbles or ocular secretions at the interface (14 eyes, 26.92%) and white cataracts (7 eyes, 13.46%). Additionally, 54.55% (12/22) of AC tears were due to incomplete capsulotomy and secondary capsulorhexis. A significant difference was noted between the first 200 eyes and subsequent groups in terms of the incidence of incomplete capsulotomies. No difference was observed in the incidence of AC tears after the initial 100 procedures.
CONCLUSIONS: The most common causes of incomplete capsulotomies were eye tilt and air bubbles or ocular secretions at the interface. Secondary capsulorhexis after incomplete capsulotomy is the main risk factor for AC tears. There was a steep learning curve for laser capsulotomy in the first 100 operated eyes, as evidenced by the higher complication rate, but this stabilised after 200 procedures.
摘要：
目的：分析飞秒激光辅助白内障手术（FLACS）中晶状体囊相关并发症的发生和潜在原因。
方法：这项前瞻性连续队列研究包括2015年5月至2018年12月接受同一位外科医生进行FLACS的前1600只眼（来自1140例连续患者）。囊切开术相关并发症的潜在原因和特征性体征，包括不完全的囊切开术和放射状前囊（AC）撕裂，在分析手术录像后，根据两名眼科医生的同意进行了总结。进行亚组分析以表征囊切开术学习曲线。
结果：在1600只眼睛中，52（3.25％）具有不完全的囊切开术，22（1.38％）具有放射状AC撕裂。不完全的囊切开术的最常见原因是眼睛倾斜（16眼，30.77%），界面处的气泡或眼部分泌物(14只眼睛，26.92%)和白色白内障(7只眼，13.46%）。此外,54.55％（12/22）的AC撕裂是由于不完全的囊切开术和继发性撕囊。在前200只眼和随后的组之间，在不完全的囊切开术的发生率方面存在显着差异。在最初的100次手术之后,在AC撕裂的发生率方面没有观察到差异。
结论：包囊切开术不完全的最常见原因是眼睛倾斜和界面处的气泡或眼部分泌物。不完全囊切开术后继发撕囊是AC撕裂的主要危险因素。在前100只手术的眼睛中，激光囊切开术的学习曲线陡峭，并发症发生率较高，但这在200次手术后稳定下来。
方法：这项前瞻性连续队列研究包括2015年5月至2018年12月接受同一位外科医生进行FLACS的前1600只眼（来自1140例连续患者）。囊切开术相关并发症的潜在原因和特征性体征，包括不完全的囊切开术和放射状前囊（AC）撕裂，在分析手术录像后，根据两名眼科医生的同意进行了总结。进行亚组分析以表征囊切开术学习曲线。
结果：在1600只眼睛中，52（3.25％）具有不完全的囊切开术，22（1.38％）具有放射状AC撕裂。不完全的囊切开术的最常见原因是眼睛倾斜（16眼，30.77%），界面处的气泡或眼部分泌物(14只眼睛，26.92%)和白色白内障(7只眼，13.46%）。此外,54.55％（12/22）的AC撕裂是由于不完全的囊切开术和继发性撕囊。在前200只眼和随后的组之间，在不完全的囊切开术的发生率方面存在显着差异。在最初的100次手术之后,在AC撕裂的发生率方面没有观察到差异。
结论：包囊切开术不完全的最常见原因是眼睛倾斜和界面处的气泡或眼部分泌物。不完全囊切开术后继发撕囊是AC撕裂的主要危险因素。在前100只手术的眼睛中，激光囊切开术的学习曲线陡峭，并发症发生率较高，但这在200次手术后稳定下来。
