A refractive procedure team of PUMCH has successfully performed more than 2000 femtosecond laser surgeries and helped myopia and astigmatism patients take off their glasses. The team is led by Professor Li Ying, Physician-in-charge Wang Zhonghai, Associate Professor Long Qin from the Department of Ophthalmology and consists of doctors and nurses from the Department of Ophthalmology and the Department of Anesthesiology. A big sample size study showed from many respects that the surgery is safe and effective, and 100% patients believed they gained better sight in daytime and life has become easier. For many years, the Department of Ophthalmology is responsible for the training of surgical procedures of laser-assisted in situ keratomileusis (LASIK), and the China Consensus on Laser Corneal Refractive Surgery compiled by the PUMCH team has been adopted by the National Corneal Disease Group and promoted across China. The team won third prize of medical achievements of PUMCH in 2015 for its nation-leading surgery amount, high satisfaction of patients and promotion of the procedures across the country.
Femtosecond laser small incision lenticule extraction is short named SMILE surgery. It involves creating a high-precision lenticule (thin circular disc of tissue) that is removed through a small incision in an intact cornea. It replaces the roughly 20 mm side cut of LASIK to a small incision of less than 4 mm.
Benefits of SMILE include being micro-invasive, without the need to create a flap, less damage of corneal nerves, less dry eye and better sight. Patients can return to normal life the next day of surgery, without any limit to physical movement. Other advantages of the procedure include less impact on eyeball movement, higher surgical precision, better predictability and less visual regression. In the making of cap, the thickness, depth and diameter can be adjusted to suit each patient. According to Professor Li Ying, SMILE is like LASIK but has no flap, and is like PRK but has no pain, and is safe and stable. The hospital has performed SMILE for two years and helped more than 2000 patients take off their glasses.
The making of cap is the most testing part in SMILE operations. Besides, the expensive devices and higher fees also led to higher outcome expectations from patients. Our hospital, however, has its unique experience in surgical safety. A surgeon needs to improve his or her skills through four stages: observation, attempt, effect and experience. The surgeon is asked to pay attention to key links: rich and detailed examinations before surgery, perfect disinfection and coordination with anesthesiology department during surgery, complete examinations after surgery and follow-up checks. When many Chinese hospitals only have basic post-op examinations, PUMCH has created a complete post-op examination system: first, OCT observation of corneal relocation, then, observation of incision healing and nerve fiber through confocal microscope, and at last, assessment of dry eye conditions. PUMCH is the first Chinese hospital to use ACCMetrics to analyze the length, wideness, curve and node of nerve fibers so as to assess the recovery with precision.
Relying on its comprehensive advantages, the Department of Ophthalmology, during the course of performing SMILE, created unexpected clinical and social benefits. Corneal stroma lens freshly removed in SMILE, without the need of preservation, were directly transplanted to patients of corneal ulcer. More than 40 patients were saved from the danger of becoming blind and their operation fees were also reduced from 40,000 yuan to 2,000 yuan. This technological innovation has brought more chance of recovery to patients who once had no choice but to wait for corneas from donors.
Refractive procedures have a history of 20 years. PUMCH was the first Chinese hospital to introduce excimer laser surgery in 1993, and is presently one of the few hospitals capable of both Intraocular and extraocular surgeries and the performance of
TransPRK and SMILE. Surgery scheme can be tailored according to the patient’s cornea conditions, sight expectations, profession and age. All patients, whether they are young athletes, middle-aged entrepreneurs or retired persons, can have their choice in our hospital. ICL is the top option for patients of high myopia or extra high myopia, and the surgery does not hurt cornea, is reversible and has good sight outcome. TransPRK, on the other hand, is one of excimer laser procedures. Completed all through excimer laser, it features no incision on the cornea and suits groups with myopia less than 600 degrees, and has seen obviously increasing performance in recent years.
Thanks to its comprehensive advantages on cornea and refractive problems, PUMCH has treated a huge amount of patients with cornea diseases and refractive surgery complications transferred from hospitals across the country. It has long been responsible for the national training of excimer laser surgical procedures and has won trust from patients and the medical community.
Disc of Standardized Operations in Corneal Refractive Surgery edited by Li Ying
SMILE surgery (R)
Report by GUO JING