About 10% of patients who have myopic laser surgery need "rework". The 10% failure rate was published in the British Journal of Ophthalmology. Hospitals in some hostile environments have even lower success rates than 70%. Safe excimer laser myopia surgery in the end what to do?
Like magic surgery
May 19, 2011, 2:00 p.m., capital medical university affiliated with the Beijing Tongren hospital eye center refractive specialist. As usual, crowded with patients in the waiting room 30 square meters. They are not ordinary eye patients, but medically known as refractive errors, myopia, hyperopia or astigmatism - a group of pleasant rays of light passing through the eye's refractive cornea and crystals can not focus on the retina.
Here, excimer laser surgery is performed to reshape the curvature of the cornea. Surgeons use wavelengths in the ultraviolet spectrum that are invisible, which can very accurately break the molecular bonds between corneal cells, corneal tissue vaporization, and other tissues, and will not produce any thermal damage.
The operating room opening time of 13:00, has done nearly 5:00 end. The reporter saw a group of patients of a dozen people fish in and fish out.
Surgery requires carving and grinding jade-like fine skills, but the short time is unimaginable. The anesthesia goes from eye to eye, only about five minutes. In the examination room, a nurse said this afternoon, ***60 cases, "almost every day there are making less 20-30.
The walls of the waiting room are covered with "patient information". A "wide range of excimer laser surgery, excimer laser refractive keratectomy (PRK), excimer laser subepithelial keratomileusis (LASEK) and excimer laser in-situ keratomileusis (LASIK) three surgical scopes are the most widely used, and have been clinically proven to date, and the most LASIK safe and effective.
Liu Xiaoming, a myopic patient from Hebei, was in the last batch of the day. Two days ago, she specifically rushed from his home at Beijing Tongren Hospital to check and rule out various contraindications to surgery, her choice of LASIK doctor. The operation cost her six months of salary: 4,368 yuan eye, before taking medication and additional checks after the operation, **** 9,500 yuan. And if it's done at home, you can save at least $3,000.
"I wouldn't be afraid to have it done at a small hospital, either...? Isn't it true that a lot of people have already done this surgery need to rework this?" Just out of the operating room, she said.
The next day, she found joy in watching TV without her glasses and calling her, "It was like magic, the doctor said my vision could return to 1.2," but then she began to rumor concerns.
The return to work wave is worrying
The news of the "return to work wave" first came from Shanghai. Fifteen years ago, radial keratotomy (RK) for myopia was all the rage. But a few years later, many patients who underwent the procedure suffered serious post-operative complications that led to vision regression. The media said the number of ophthalmologic, surgical weights in Shanghai's tertiary hospitals exceeded 600 within a year, compared with an annual growth rate of 20 percent.
In Beijing, the situation is equally bleak. It was recently reported that in some hospitals, more than 1,000 people had myopic laser surgery in a month, while nearly 100 patients had "reworked" their surgeries, accounting for about 10 percent of the total number of patients.
The question that arises is obvious: the RK technology that emerged 15 years ago has been phased out because of its own shortcomings and replaced with safer PRK, LASEK or LASIK, but with RK on its heels 15 years later, won't these technologies be enhanced?
This follows similar warnings. Last December 15, the UK's National Institute for Clinical Excellence (NICE) published a report entitled "Guidelines for the widespread use of LASIK surgery for refractive error are insufficient, there is little evidence of a long-term safe surgical approach, and LASIK should not be used as a matter of routine clinical practice without further research and approval within the National Health Service (NHS). Service (NHS).
In the report, NICE tallied four clinical data and found that the morbidity rate postoperative corneal flap, corneal flap dissolution, corneal flap thinning, corneal flap deviation in position was about 4%, cornea had a burning sensation 5%, and that its morbidity was about 2% of the morbidity of the corneal tissue.
The Sunday Times, which grabbed coverage of the NICE report before it was released, also cited data published in an ophthalmology paper by Dr. Peter S. Hersh of the New Jersey Medical School, which said that such surgeries take 1/10th of the time of surgery, rather than the 1/1,000th of the time of surgery that many of the stories advertised in the report. The global shock was known as the "British call off excimer laser surgery incident.
The BBC has done a follow-up report. Bruce, chairman of NICE's Interventional Medicine Advisory Committee. Prof. Campbell said that vision correction can be addressed safely by wearing glasses or contact lenses, and that any risky eye treatments such as LASIK require special attention in their interviews.
Professor Campbell also warned that a small number of people have worse vision after LASIK surgery, and that ophthalmologists are being concerned about possible long-term side effects of the procedure.
However, the BBC reported that they were more objective about the NICE report also interviewed a number of clinicians and generally expressed disappointment.
The eye surgery industry has also rejected the NICE report in the US. In 2004, 1.2 million laser eye surgeries were performed in the United States and only 100,000 in the United Kingdom, and USAeyes sarcastically notes on its Web site that if the first discovery of postoperative complications occurring outspokenly was so high, it would have been the United States.
What are the new findings?
Domestic media reports have again raised public questions about excimer laser surgery. From May 20, journalists have called NICE, Queen Victoria Hospital, UK, Eye Center Ophthalmology Journal, author of the paper, Dr. Hersh.
May 26, Britain's Queen Victoria Hospital, Eye Center Shiraz Director. Dr. Sheraz Daya Bay (SHERAZ Daya Bay) replied to an e-mail from the newspaper issue.
Reporter: How is the clinical application of LASIK in the United Kingdom? Is the public accepting of this procedure?
Daya: L-Asik is more popular in the UK than in other countries because there are several aspects of the conservative tendencies of the British nature and excessive security issues, LASIK has not yet entered the NHS (the equivalent of welfare health care - ed.), and the British people are not accustomed to that health care spend their own money.
Journalist: is the procedure safe for long-term safety?
Daya: as long as the correct medical procedures are carried out and there are no contraindications for patients, there is no problem.
Reporter: But NICE has issued a warning.
Dexia Bank:?The ICE report is very poor, very old data. There is no new data, including the inference that there is little experience of clinical practice in the UK is incorrect. The NICE report does not take sufficient account of the level and practice experience in the UK in this area. As far as I know, this issue is being reassessed and we believe that the new conclusions should be different.
Reporter: Ophthalmology once wrote that it said that 1 in 10 patients needed a second operation, and this figure was at your treatment center?
Daia: A secondary treatment or revision is not considered a failure, as previously misunderstood. In the last few years, the rate of secondary treatment for surgery at our own center was 2 percent, and with the introduction of the femtosecond laser corneal laminar knife technology, it has now dropped further to 0.5 percent. I personally think that if there is 10 percent (failure rate), this phenomenon happens in some good medical centers, 2005, do not want to become ashamed.
Reporter: What's your new take on this technology now?
Daya: the technology is very good, represents the future direction of development of the technology, we were able to use this technology to change the lives of so many people, really memorable ah!
Dr. Hersh also dismisses it as 1/10 in the article's misconceptions, "I'd say a 10% rate of secondary surgery, which is often used to achieve better visual outcomes, and less than 1% of surgical complications.
NICE is very ? cautious. In terms of the number of contacts, Woodward, the public **** relations manager, said Prof. Campbell took it very seriously and "is looking into your interview questions and will respond later."
Problems remain
The academic ophthalmology community also organized a discussion after the publication of the NICE report two months ago. Zhao Jialiang, chairman of the ophthalmology branch of the Chinese Medical Doctors Association, said their main point five, "There is nothing new to add to the journal Popular Medicine.
LASIK is currently recognized as the world's safest and most effective refractive surgery, and they do not dispute that, but "whether the operation will be successful or not is closely related to the surgical design, the level of doctor's skills, whether the laser equipment is good or bad, and the influence of other factors. PRK was introduced in China in 1993, and subsequently carried out by LA SIK, the overall level is synchronized with the world's advanced level, the level is low. Synchronized with the world's advanced level, the low level, poor conditions of medical institutions to carry out excimer laser surgery, low price competition, so people worry about the phenomenon. "
Professor Zhao Jialiang estimated that in the past two years in the country to do this kind of surgery patients more than a million. In fact, he said, any surgery has risks, and so does excimer laser surgery, which is just the icing on the cake surgery, is not so, patients must choose carefully.
In the Tongren Hospital Eye Center refractive specialty pre-operative book of informed consent, the list of 21 potentially serious consequences: serious cases of infection, the need for allogeneic corneal replacement, as well as serious impact on visual acuity; the presence of overcorrection, undercorrection and refractive rollback; sometimes pathologic myopia can not be determined before the surgery, the degree of postoperative progression may be more than the original degree; any refractive patient has a second surgery is possible...
"Although the likelihood of surgical complications is very low, we want to make these clear to every patient that excimer laser surgery is a minimally invasive procedure, and you can't achieve the desired results in 100 percent of patients," said Dr. Zhou Yuehua, associate director of the specialist.
However, the doctor's own technical mastery, the reliability of the equipment and the execution of standardized medical procedures can nevertheless make LASIK such a delicate surgery perfect. Data provided show that, according to Zhou Yuehua, Tongren Hospital surgery to achieve the expected results of the proportion of more than 95 percent, from 1993 to the present, there have been no serious complications.
Second surgery does not equal failure because each patient's condition is different, and some surgeries themselves are designed to be done a second time, such as for older patients with high myopia," he said.
But in some areas there are obvious safety gaps. Over a four-day period from May 16-19, 2010, Tongren Hospital admitted three patients with serious LASIK complications. In their medical records, Zhou Yuehua wrote down the diagnosis of "corneal flap fragmentation" and "dissolution" of the corneal flap because he didn't want to over-explain, "colleagues in this position in other hospitals are not at liberty to comment. "
Such cases of surgical failure, Tongren Hospital encountered hundreds of times a year. "Popular medicine disclosed that" less than 70% success rate in some hospitals, the situation is not optimistic. "An insider is not a secret secret, some hospitals in order to reduce costs, the use of foreign direct purchase of equipment
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When you are faced with a large and small hospitals are riddled with advertisements, hospitals say how their equipment is new, how advanced, how the doctor Smart Choices really lets you know what to expect.
It is recommended that you consume the choice is rationally calm, alert to the market called the loudest fishmongers, often stinking fish! Medical advertisements, are often watered down and exaggerated!
1. choose the device, you have to pay attention to a misunderstanding:
Excimer laser treatment of myopia common misconceptions:
A. Laser accurate generation is the best?
A: There is no single sign of advanced laser "representation" in the world! Don't blindly believe the advertisements and media propaganda! Because 12 out of 10 manufacturers of excimer lasers in the world, each manufacturer has its own number of replacements, comparable only to the generations of the same manufacturer.
B. The smaller the excimer laser spot, the better?
A: Not really! When the field is too small, the emission frequency is constant, and the extended operating time can interfere with the procedure.
C. Isn't laser equipment better?
A: No. Technological updates, especially medical updates usually take 5-10 years to validate a new machine requires the physician to get used to it and familiarize themselves with it, just like a new car has a break-in period.
D.How do I know if the equipment is good or bad?
A. Data is the most convincing!
The world's leading excimer laser devices:
Wavelength Energy Scan Time
Germany, UK, Bohle 193nm 120-180 gauss 6 sec patented
Germany Alice 193134 fiducials 22 sec
U.S. Yuchi 193,140 fiducials 25
American Eagle ( American Eagle), 193130 Flying Dot 18
Japan Nidek 193130-150 Rotating 30
(omitted)
From the table, it can be seen that the data of the various lasers are basically the same, but there are differences at the time of the surgery! The shorter the time, the longer the corneal exposure time, reducing the drying effect on the operating table for patients undergoing surgery,
E. Follow the ads!
2. choose a hospital better to choose a doctor: It is often said: "The mountain is not high, God's spirit, the water is not deep, there is the name of the dragon is", "worship Buddha, worship Buddha, rather than blindly worship" temple "because sometimes! "Temple God small", but "temple" big God, they worship "temple" is better to seek "God".
In addition, the qualification of the surgeon depends not only on the degree level but also on the actual clinical experience of the surgeon's position in the field of myopia. There are a lot of cases of experience in myopic laser surgery? Years of history of myopic laser surgery? Surgeon if you have enough experience? Does it have a record of failure? What are the effects of myopia surgery done?
You can interview the surgeon directly, but also from the side.
3. Surgical insurance
In addition, the qualification of the surgeon depends not only on the degree level, but also on the actual clinical experience of the doctor's position in the field of myopia. As the saying goes: "The mountain is not high, God's spirit, the water is not deep, the name of the dragon is" seek "Buddha" not seek "God", "God" worship "temple", "God", "God", "God", "God", "God", "God", "God", "God", "God", "God", "God". "The worship of the "temple" is better sought, for sometimes the "temple" and the "god" are large, and sometimes the "temple" and the "god" are small. ", "God", good to seek the true God's worship temple.