激光遥测技术用于矫正视力：带有注释的完整操作（不适用于胆小者）

So, watch the video, and I will show the frames with comments. This is a real operation on a patient in a German clinic, the recording was made on a device like the “black box” of the VisuMAX device. In this case, the patient has agreed to use the recording for training purposes, usually access to such records is strictly limited.
因此，观看视频，我将显示带评论的帧。 这是在德国诊所对患者进行的真正操作，记录是在VisuMAX设备的“黑匣子”之类的设备上进行的。 在这种情况下，患者已同意将记录用于培训目的，通常严格限制访问此类记录。
First, briefly repeat
首先，简短地重复the last post about why you need to cut just such a lens inside the eye, and then get it:最后一篇关于为什么需要在眼内切开这样一个镜头的文章，然后再进行讨论：
Very briefly, the operations of past generations formed just such an unpleasant “lid” that kept on one flap during healing. The “cover” of the flap is removed, the lens is evaporated, the “cover” is put back.
简而言之，过去几代人的手术就形成了一种令人不快的“盖子”，在愈合过程中一直保留在一个皮瓣上。 取下襟翼的“盖子”，将镜头蒸发，放回“盖子”。
The invasiveness is high, the “lid” never takes root completely (with injuries and physical exertion it sometimes comes off with extremely unpleasant consequences), a lot of heat is used in the incisions that penetrates into the eye tissues, the Bowman's membrane is severely damaged both by cutting and by thermal fronts.
侵入性很高，“睑”永远无法完全扎根(由于受伤和体力消耗，有时脱落会带来非常不愉快的后果)，切口中使用了大量的热量，渗透到眼组织中，鲍曼氏膜很严重切割和热锋损坏。
The idea of ​​the next generation is to cut the lens right inside the cornea, and then get it through a thin incision without this “cap”. The effect is possible because lasers allow focusing inside the tissue, not on its surface. That is, you can make a cut here according to this scheme:
下一代的想法是在角膜内切开晶状体，然后通过没有该``帽''的细切口将其切开。 因为激光允许聚焦在组织内部而不是在组织表面，所以这种效果是可能的。 也就是说，您可以根据以下方案在此处进行切割：
Now we are watching the render operation:
现在，我们正在观看渲染操作： First, the bottom surface of the lens inside the cornea, then the top, then a small incision on the side — and remove the lens with tweezers.首先，角膜内侧的晶状体底面，然后是顶部，然后是侧面的小切口，然后用镊子将晶状体取下。
This is what any clinic will show you so that you do not get scared. The real operation looks like this (now telemetry):
这是任何诊所都会向您显示的内容，这样您就不会害怕。 实际操作如下所示(现在是遥测)：
First, the patient is asked to look at the flashing green light. The lamp does not just burn, but flashes, so that a person catches it in focus quite often. The eye makes an incredible amount of micro movements, saccades per second, but this is the pace that allows the surgeon to produce a proper eye grip later.
首先，要求患者查看闪烁的绿灯。 灯不仅会燃烧，还会闪烁，因此一个人经常将其聚焦。 眼睛每秒会产生令人难以置信的微动作，扫视，但这是使外科医生在以后产生适当的眼力的速度。
Here you can see the tampon in the defocus (in the video it moves on the left side of the eye) — this surgeon once again wipes the surface to insure against the microbunches of fat floating on it. The second purpose of this touch is to check how the premedication went. The patient must answer if he senses something. He should not feel anything, his nerves are already disconnected with tetracaine.
在这里，您可以看到散焦中的棉塞(在视频中，它在眼睛的左侧移动)—该外科医生再次擦拭了表面，以确保其上漂浮着微束的脂肪。 这种接触的第二个目的是检查用药的进行情况。 如果患者感觉到某些东西，则必须回答。 他不应该有任何感觉，他的神经已经被丁卡因断开了。
Here is the capture approaching the eye, which is clearly seen by the appearance closer to the zone of sharpness of the iris:
这是接近眼睛的捕获，通过靠近虹膜锐化区域的外观可以清楚地看到它：
Alignment and fixation of pneumatic grip is performed. The moment of capture itself can be seen by an easy rotation of the eye, and this effect is very important to control during the correction of astigmatism, because a turn of 30 degrees negates the whole operation for the case of astigmatism. Therefore, the surgeon adjusts the alignment.
进行气动夹具的对准和固定。 可以通过轻松旋转眼睛就可以看到捕获的瞬间，并且在散光矫正过程中控制该效果非常重要，因为在散光的情况下旋转30度会取消整个操作。 因此，外科医生调整对准。
After a successful capture, we switch the observation range from visible to infrared to control the process and not blind the patient:
成功捕获后，我们将观察范围从可见光切换到红外光以控制过程，并且不会使患者失明：
Slowly expanding ring from the edges of the eye to the center is the millions of femtolaser micropulses that form a cut on the upper surface of the lenticular lens inside the cornea. The surface of the cornea is not cut. I recall the main effect — the evaporation of several cells inside the layer of the cornea, and then the release of a relatively large amount of gas, gently pushing tissue.
数百万个飞秒激光微脉冲从眼睛的边缘到中心缓慢扩张，这些微脉冲在角膜内部的双凸透镜上表面形成切口。 角膜表面未切开。 我记得主要的作用-角膜层内几个细胞的蒸发，然后释放相对大量的气体，轻轻推动组织。
The bottom surface of the lens is finished:
镜头的底面已完成：
The second circle, which expands from the center of the eye to the edges, is the upper surface of the lens, which is also cut inside the cornea layer, without direct “piercing” the surface:
从眼睛中心向边缘扩展的第二个圆是晶状体的上表面，它也在角膜层内切开，而没有直接“刺穿”该表面：
At about 01:02 a cut is formed through the surface of the cornea to the cut lens. Lenticule, but in the video it is extremely difficult to make out. Through this incision the lens will reach.
在大约01:02，通过角膜表面形成切口至切口晶状体。 小透镜，但是在视频中很难分辨出来。 通过该切口，晶状体将到达。
Now, switching the view (and the end of the video from the laser) — the patient from under the control of the CNC is given under the hands of the surgeon (in fact, he moves under the device from under the laser closer to the doctor’s hands). The first step is to wet the eye:
现在，切换视图(以及激光的视频结尾)—在CNC的控制下，患者是在外科医生的指导下进行操作的(实际上，他从激光下方移到设备下方，离手术台更近了)。医生的手)。 第一步是润湿眼睛：
Switching the lens of the microscope, fixing the eye so that it does not twitch, with tweezers. It tucks, but the patient did not feel (for pain relief) and does not even see the tweezers properly (or rather, sees the surgeon's hands above his head):
切换显微镜的透镜，用镊子固定眼睛，使其不致扭动。 它会塞满，但患者没有感觉到(缓解疼痛)，甚至没有正确看到镊子(或更确切地说，看到外科医师的手在头顶上方)：
The incision to extract lentikuly neatly divided instrument — spatula:
切开整齐整齐的器械切口-刮铲：
This is a very interesting place, the first small spatula First, the upper edge of the lens and the surrounding tissues are separated, and then the lower edge of the lens (in the frame below):
这是一个非常有趣的地方，首先是小刮铲。首先，将晶状体的上边缘和周围的组织分开，然后将晶状体的下边缘分开(在下面的框架中)：
The spatula moves with inconspicuous jerks — this is the resistance of the micro-spikes, arising from the discrete structure of the cut, in some places the individual fibers are not “unstick”, and they need to be moved apart. It’s just not possible to pull the lenticule over the edge, it can catch, so a full spatula is always made on the surface so that air enters the cavity between the upper edge of the lens and the cornea and the lower edge of the lens and the cornea. The most terrible part is as follows:
刮铲的移动不明显，这是切口的离散结构引起的微尖峰的阻力，在某些位置，单个纤维不会“松开”，需要分开。 只是不可能将微透镜拉到边缘上，它可以抓住，因此必须在表面上完全刮铲，使空气进入晶状体的上边缘和角膜以及晶状体的下边缘和边缘之间的空腔。角膜。 最可怕的部分如下：
The surgeon’s hand lies with his elbow on a special support, and with his wrist rests on the patient’s forehead. The spatula is designed so that even if the surgeon is pushed (slightly) or the patient is distracted by a loud bang, the eye will not be damaged. However, all such factors should be strictly excluded.
外科医生的手将肘部放在特殊的支撑物上，手腕放在病人的前额上。 铲刀的设计使即使外科医生(轻轻地)被推动或大声的撞击使患者分心，也不会损坏眼睛。 但是，应严格排除所有这些因素。
So, the lens is divided and ready for extraction from the inside of the cornea. The surgeon picks up the tweezers and catches the lenticle:
因此，将晶状体分开并准备从角膜内部取出。 外科医生拿起镊子，抓住了扁豆：
That's it. You can finish this, but you still need to wash the eyes. Here you can see how the supply of fluid works:
而已。 您可以完成此操作，但仍然需要洗眼睛。 在这里，您可以看到液体的供应方式：
The next stage is the supply of saline directly into the cavity inside the cornea:
下一步是将盐直接供应到角膜内腔中：
As you can see, it will later flow out through the same incision through which the lenticule has been removed. Previously, a second incision was made opposite the first (at the other pole of the eye) to remove this fluid, but it turned out that there was no need for this. Moreover, the smaller the cut, the better.
如您所见，它稍后将通过切除小Kong的同一切口流出。 以前，在第一个切口的对面(在眼睛的另一极)开了第二个切口，以去除这种液体，但事实证明没有必要这样做。 而且，切口越小越好。
Smoothing to avoid micro-tabs:
平滑处理以避免出现小标签：
Then — removal of fixing films and the final. You can blink a couple of times. The patient rests for a few seconds, and then slowly gets up and walks into the corridor. In each clinic at the end of the corridor there are hours for control. Next is the dialogue to calm the worrying patient:
然后-去除定影膜并最后涂膜。 您可以眨眼几次。 病人休息几秒钟，然后慢慢起身走进走廊。 在走廊尽头的每个诊所，都有几个小时需要控制。 接下来是使令人担忧的患者平静下来的对话：
“What time is it there?”
“那里现在是几点呢？”
— Six minutes past eleven.
—十一点六分。
— And would you have distinguished the clock from such a distance?
—您能从这么远的距离区分时钟吗？
— Oh. For sure.
哦 当然。
— Well, everything is in order.
—好吧，一切都井井有条。
The patient calms down and goes to rest. After 2-3 hours, the eye does not feel anything. You cannot read, write, use a phone or tablet laptop for a day or two to promote fast healing (after all, reading is jogging for the eyes, then you cannot go to a hard sauna or swimming pool for two weeks (until the incision is completely healed to remove lenticules). did not get an infection). That's all.
病人冷静下来，休息。 2-3小时后，眼睛没有任何感觉。 一两天您不能阅读，书写，使用手机或平板电脑来促进快速康复(毕竟，阅读是在慢跑，因此，您不能在坚硬的桑拿浴室或游泳池中呆两周(直到切口)完全治愈以除去小Kong)(未感染)。 就这样。
I hope you have not run away in horror when you saw the spatula. Despite the frightening, I note that this is one of the easiest operations. Gathering the eyes piece by piece after an accident with taking out glass fragments and other side charms on a few hours l bo most precise manual work mikroskalpelem much more difficult and stressful.
希望您在看到锅铲时没有惊慌失措。 尽管令人恐惧，但我注意到这是最简单的操作之一。 事故发生后，在几个小时内将玻璃碎片和其他侧面饰物逐一聚拢起来，这是最困难且压力更大的最精确的手工操作。
On questions of exactly how pneumatic grip works, how you can precisely cut the lens of the desired shape and diameter, what happens to the cornea tissues at the cut border, and why are there such difficulties with cutting the lens inside the eye (and why it is safest). Plus, how the operating room is prepared, how the surgeon soothes the patient, how premedication is performed, what kind of protection there is against unforeseen situations (interruptions in food passing a truck), and so on, I will answer with the next big post. And about the promised comparison of lenses and operations, too, later. All this is a separate topic for discussion, and about them a little later, alas, does not come out much to write. In
关于以下问题：气动抓握的确切工作方式，如何精确切割所需形状和直径的晶状体，切割边界处的角膜组织会发生什么以及为何在眼内切割晶状体会有如此困难(以及为什么如此)最安全)。 另外，如何准备手术室，外科医生如何为患者提供安慰，如何进行预防用药，针对不可预见的情况(通过卡车的食物中断)提供何种保护，等等，我将在下一个大回答发布。 还有关于镜头和操作的预期比较。 所有这些都是一个单独的讨论主题，但是稍后，关于它们的讨论并不多。 在讨论the first post in the discussion, many topics are superficially affected.的第一篇文章中，许多主题都受到了肤浅的影响。

翻译自: https://habr.com/en/company/klinika_shilovoy/blog/500716/