飞秒激光制瓣LASIK术前预防性视网膜光凝

目的观察低、中、高度近视飞秒激光制瓣准分子激光原位角膜磨镶术（LASIK）术前周边视网膜变性和裂孔进行预防性光凝的效果。方法近视1000例（2000眼）,年龄18—50岁,屈光度-1．00～-13．00D,散光-0．50～-4．00D。术前按屈光度分组：组I,-1．00～-3．00D,350例（700眼）;组Ⅱ,-3．25～-6．00D,360例（720眼）;组Ⅲ,-6．25～-13．00D,290例（580眼）。LASIK术前常规散瞳行90D前置镜眼底检查。结果发现严重周边视网膜变性和裂孔100眼,其中组I20眼,组Ⅱ44眼,组Ⅲ36眼,多发生于颞侧。组Ⅱ和组Ⅲ发生率高于组I。对此100眼进行532nm激光预防性光凝。光凝术后1个月复查,变性和裂孔区激光封闭良好,色素斑形成,遂行飞秒激光制瓣LASIK。术后6个月-1年随访,未发现孔源性视网膜脱离。结论LASIK术前眼底检查,对明确有严重视网膜变性或有裂孔者预防性激光光凝是安全有效的,能够减少或避免术后视网膜脱离的发生,保障术后效果。     

中高度近视LASIK术前的预防性视网膜光凝疗效观察

目的:观察中高度近视患者LASIK术前行预防性氪激光光凝效果。方法:中高度近视患者LASIK术前行直接眼底镜、间接眼底镜、三面镜检查。对明确有发生原发性视网膜脱离的高危变性及裂孔者50例(53眼)行氪激光光凝治疗。结果:行氪激光光凝1mo后,裂孔封闭良好,变性区无扩大。色素较多时行LASIK手术,术后回访6～12mo,无孔源性视网膜脱离发生。结论:LASIK术前视网膜变性及干孔的近视患者行预防性氪激光光凝手术是一种安全、有效预防中高度近视LASIK术后视网膜脱离的手段。     

高度近视周边视网膜变性的预防性激光治疗

目的 观察高度近视眼的周边视网膜变性和/或裂孔进行预防性光凝的疗效。 方法 散瞳检查高度近视眼眼底,发现周边视网膜变性和/或裂孔206只眼,予以预防激光治疗。 结果 实行视网膜变性预防性光凝的患者,接受LASIK手术后,随访一年无一例发生视网膜脱离,矫正视力没有变化。 结论 视网膜变性激光预防性光凝对预防视网膜脱离至少在角膜屈光手术后近期观察中是安全有效的方法。 (中华眼底病杂志, 1999, 15: 135-136)     

LASIK术前视网膜变性区预防性激光凝固术临床观察

目的:探讨LASIK术前周边视网膜变性区行预防性激光凝固术(光凝)治疗的必要性。方法:对831例1631眼进行LASIK术前常规检查,发现患有严重周边视网膜变性49眼,其中裂孔17眼、格子样变性15眼、囊样变性26眼,均行532nm固体激光预防性光凝治疗。结果:光凝术后1mo视网膜光凝斑形成有效色素沉着后行LASIK手术。术后经3～36mo随访未发现变性灶扩大及治疗区域以外裂孔形成。结论:LASIK术前对所有患者进行详细的眼底检查是必要的,当发现严重周边视网膜变性进行预防性光凝是安全、有效的。     

准分子激光原位角膜磨镶术前视网膜变性预防性光凝的临床观察

目的 观察准分子激光原位角膜磨镶术（LASIK）术前视网膜变性预防性氩离子激光光凝对术后视网膜稳定性的影响。方法 LASIK术前对近视眼患者常规行直接检眼镜、三面镜检查，对视网膜干性裂孔或严重视网膜变性的144例（168眼）患者行氩离子激光光凝，作为治疗组；另外108例（126眼）轻度视网膜变性的患者不予氩离子激光光凝，作为对照组；LASIK术后密切观察视网膜病变情况，必要时补行氩离子激光。结果 LASIK术后随诊12个月，治疗组视网膜情况稳定。对照组有6眼于LASIK术后视网膜变性范围扩大，病情加重，补行氩离子激光光凝；1眼出现孔源性视网膜脱离，给予视网膜脱离复位手术。结论 LASIK术前对明确有视网膜变性或伴视网膜干性裂孔的近视眼患者预防性行氩离子激光光凝治疗，是预防LASIK术后孔源性视网膜脱离及保障LASIK手术成功的重要方法。     

激光光凝辅助角膜原位磨镶术前眼底病变分析及治疗

目的探讨近视LASIK术前眼底病变及治疗方法.方法对385例(721只眼)LASIK术前患者行散瞳眼底三面镜检查并作详细眼底记录.结果发现各种视网膜变性136只眼(18.86%),视网膜干性裂孔16只眼(2.22%),亚临床视网膜脱离(RD)5只眼(0.69%).其中37只眼严重视网膜变性、16只眼干孔和4只眼亚临床RD行氩激光光凝治疗,仅1例亚临床RD需行视网膜脱离手术.结论近视LASIK术前及术后眼底常规检查和病变治疗是必要的.同时本文提出眼底病变光凝的指征.     

近视眼周边视网膜变性的特点及预防性光凝

目的 探讨近视眼周边视网膜变性的特点以及氩离子激光预防性光凝的效果.方法 近视眼503例(984眼).充分散瞳后验光,并依近视程度分为3组,用检眼镜以及裂隙灯显微镜联合三面镜或全视网膜镜详细检查眼底,记录周边部视网膜变性病灶的数量、特点和位置,并进行统计分析,对伴严重视网膜变性者予以氩离子激光光凝.结果 984眼中周边部视网膜变性155眼(15.75％),周边部视网膜变性百分率:Ⅰ组为8.36％;Ⅱ组为15.90％;Ⅲ组为22.75％.双眼的变性区分布有对称性,百分率为60.65％.变性区以不压变白和树枝样变性多见.对视网膜变性较严重者施行了眼底激光光凝.复诊时见激光斑反应明显、裂孔稳定,局限性浅脱离者经2～4次激光光凝后视网膜完全平复,在2年内复诊中无1例视网膜脱离发生.结论 近视眼周边视网膜变性的检出率随近视屈光度的增加而增高,且有对称性,对周边视网膜变性进行激光光凝可以防止视网膜脱离的发生.     

LASIK术前的眼底检查及预防性光凝

目的:观察中高度近视患者LASIK术前对周边视网膜变性和裂孔进行预防性激光光凝的疗效。方法:LASIK术前对中高度近视患者常规行直接眼底镜、三面镜和间接眼底镜检查,对明确有周边视网膜变性或伴干性裂孔的42眼进行532nm激光光凝治疗。结果:患者激光光凝术后,周边视网膜变性及干性裂孔区封闭良好,色素斑形成明显。LASIK术后6mo随访,未发生裂孔源性视网膜脱离。结论:LASIK术前对明确有视网膜变性或伴干性裂孔的高度近视患者预防性532nm激光光凝治疗是安全和有效的。     

近视LASIK术前倍频Nd：YAG激光预防性视网膜光凝的临床观察

目的对准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）术前检查明确有视网膜变性和（或）裂孔的近视患者行预防性倍频Nd：YAG激光光凝,分析其临床效果。方法LASIK术前行散瞳后详细的眼底检查,对有发生孔源性视网膜脱离的高危变性和（或）伴有裂孔者72例（86眼）行倍频Nd：YAG激光光凝治疗。激光波长532nm,光斑大小50～300μm,曝光时间0.2～0.25s,功率100～300mW。激光光凝后1个月,检查眼底周边激光光斑反应情况,并行常规LASIK手术。术后随访9～12个月,复查眼底、视力等情况。结果行倍频Nd：YAG激光光凝1个月后,病变区周围激光光斑反应良好,无中心视力下降。LASIK术后1年,未发现视网膜变性加重和孔源性视网膜脱离。1年后裸眼视力4.6～4.8者4眼,4.9～5.0者82眼。结论LASIK术前视网膜变性及干孔的近视患者行预防性倍频Nd：YAG激光光凝是一种安全的方法,可有效地预防术后视网膜脱离的发生。     

LASIK术前近视性视网膜病变特征分析与氩激光疗效评价

目的:分析LASIK术前检查发现的近视患者视网膜病变的特征,评价眼底氩激光光凝治疗的疗效与安全性。方法:回顾性研究,分析了施行LASIK术的连续性病例1 100例(2 190眼)的术前资料,在对所有患者术前扩瞳后以检眼镜、三面镜详细检查眼底周边视网膜情况并记录,对严重的视网膜病变如格变、囊样变、干性裂孔、视网膜浅脱离等予以氩离子激光光凝治疗,经随访稳定有效后再择期行LASIK手术。结果:视网膜病变及视网膜裂孔的发生率均随屈光度增加而提高,组间有显著性差异(P<0.05),颞侧病变比例高于鼻侧。在全部患眼的检查中,发现各类视网膜变性132眼,64眼发现格子样变性(48.48%)、37眼发现囊样变性(28.03%)、54眼发现霜样变性(40.91%)、34眼发现不压白变(25.76%)、12眼发现铺路石样变性(9.09%)、14眼发现干性裂孔(10.61%)、4眼发现裂孔伴局限性浅脱离(3.03%)。对出现较严重视网膜病变的43例患者(78眼)施行了眼底氩激光治疗。复诊时见激光斑反应明显、干性裂孔稳定,局限性浅脱离患者经2～4次激光,光凝后视网膜完全平复。对眼底经光凝后行LASIK的患者,在3～6mo复诊中无1例视网膜脱离发生。结论:LASIK术前对全部患者进行常规三面镜详查眼底是十分有必要,对发现的周边视网膜严重变性及时予以激光光凝能够有效防止视网膜脱离的发生。     

Prophylactic laser photocoagulation for retinal breaks before laser in situ keratomileusis

PURPOSE: To determine the efficacy and safety of prophylactic laser photocoagulation for retinal breaks in myopic patients undergoing laser in situ keratomileusis (LASIK). METHODS: Between August 1998 and August 2002, a total of 1931 eyes in 1006 patients requesting LASIK received a fundus examination with indirect ophthalmoscopy before surgery. For analysis, patients were divided into two groups according to the presence or absence of retinal breaks. All patients with retinal breaks underwent prophylactic laser photocoagulation to seal the breaks, even though they were asymptomatic. RESULTS: Patient age ranged from 18 to 68 years (30.8 +/- 7.4 yr). Mean preoperative spherical equivalent refraction was -7.55 +/- 3.72 D (range -1.87 to -34.50 D). Retinal breaks were identified and treated in 39 eyes (2.02%) of 32 patients (3.2%); 1892 eyes of 974 patients had no retinal breaks. No statistically significant difference was found in age (P=.87) or gender (P=.91) between the two groups. However, a significantly higher preoperative spherical equivalent refraction was noted in patients with retinal breaks (-9.41 +/- 4.15 D) compared with those without (-7.52 +/- 3.71 D) (P=.017). During a mean 19-month follow-up, none of the patients developed retinal detachment except for one in a patient without retinal breaks who sustained ocular trauma 19 months after LASIK. This patient was treated with scleral buckle and the retina was attached after surgery. CONCLUSIONS: Retinal breaks were identified and treated by photocoagulation in 2% of 1931 eyes before LASIK for myopia.     

LASIK术前无症状视网膜病变特征分析与氩激光疗效评价

目的:分析LASIK术前检查发现的近视患者无症状视网膜病变的特征,评价眼底氩激光光凝治疗的疗效与安全性。方法:对LASIK术前检查发现视网膜病变的近视患者127例(135眼)扩瞳,应用三面镜进行眼底检查,详细记录视网膜病变的类型、部位。根据患者等效球镜度数分为低度组(≤3.00D),中度组(-3.00~-6.00D)和高度组(≥-6.00D);依据周边部视网膜病变特点分为单纯变性、变性合并干性裂孔,以及裂孔合并视网膜局限性浅层脱离3组。比较各组间视网膜病变分布情况,分析视网膜裂孔的特点。数据应用SPSS12.0进行χ2检验。氩激光光凝(100~400mW,0.03~0.1s,200~500μm),术后随访3mo~1a,定期检查视网膜情况,记录。结果:视网膜病变及视网膜裂孔的发生率均随屈光度增加而提高,组间有显著性差异(P<0.05),颞侧病变比例高于鼻侧。视网膜裂孔中圆形萎缩孔占81.1%,单一裂孔占54.4%,裂孔位置以正上方和颞上方最多。眼底氩激光治疗术后病情稳定,未发生视网膜脱离。结论:近视患者无症状视网膜裂孔中圆形变性萎缩孔最常见,其发生率随着屈光度的增加而明显上升。氩激光对干性视网膜裂孔和局限性孔源性视网膜脱离疗效较好。     

准分子激光原位角膜磨镶术后视网膜脱离

目的：分析LASIK治疗近视术后发生视网膜脱离的临床特征和处理原则。方法：回顾性分析LASIK术后发生视网膜脱离的3只眼（3例患者）。结果：术前平均屈光度（等值球间，下同）为－9．3D（范围－7．37－－11．50D）。LASIK与网脱发生的间隔时间为0．5－26个月（平均11．8个月）。视网膜裂孔类型和数目：1例为马蹄形，1个；1例为锯齿缘断离；1例为小圆形裂孔，3个，裂孔位置；3例均在赤道部前方，3例通过一次手术后即成功复方。结构：具有视网膜病变的高度近视病在LASIK术后易发生视网膜脱离。     

Retinal detachment following laser in situ keratomileusis

OBJECTIVE: To report the clinical characteristics, surgical management and outcome of retinal detachment following laser in situ keratomileusis (LASIK) in myopic patients. PATIENTS AND METHODS: Retrospective review of 10 eyes of 10 myopic patients with retinal detachment who had previously undergone LASIK surgery were analyzed. Included in the study were 7 males and 3 females, aged 22 to 68 years (35.2+/-2.8). RESULTS: Mean spherical equivalent refraction was -10.51+/-3.90 D (ranging from -6.37 D to -17.00 D) before surgery. The time interval between the LASIK procedure and the development of retinal detachment varied from two months to nine months (5.2 +/- 2.78 months). The number of retinal breaks was one in 7 patients, two in 2 patients and three in 1 patient. The type of retinal breaks included 7 patients with horse shoe tears, 1 patient with a retinal hole, 1 patient with a giant retinal tear, and 1 patient with retinal dialysis. Retinal breaks were located anterior to the equator in 9 patients and posterior to the equator in 1 patient. Retinal reattachment was achieved with one operation in 8 eyes (80%) and the remaining 2 eyes required a second surgery for the reattachment of the retina. CONCLUSION: This study suggests the possible association between retinal detachment and LASIK procedure in patients with myopia. Clinicians should be aware of retinal pathology predisposing to retinal detachment in patients undergoing LASIK.     

Retinal complications after laser-assisted in situ keratomileusis (LASIK)

PURPOSE OF REVIEW: This paper reviews the retinal complications that may occur after laser-assisted in situ keratomileusis (LASIK). RECENT FINDINGS: During the review period (1 year), several nonrandomized retrospective studies and case reports/series were published. One study was performed to determine the efficacy and safety of prophylactic laser photocoagulation for retinal breaks in patients with myopia undergoing LASIK. Retinal breaks were identified and treated in 39 eyes (2%). None of the patients developed a rhegmatogenous retinal detachment (RRD) (except one trauma case). Another group studied retinal disease observed in 9239 consecutive eyes after refractive surgery (including LASIK) and found RRD in 11 eyes (0.36%) and choroidal neovascularization (CNV) in 10 eyes (0.33%). Three reports described a total of 16 patients with a previously placed encircling scleral buckle for a RRD who had LASIK to correct myopia. In all patients, the visual acuity (VA) improved. Another study reported the characteristics and surgical outcomes of RRD in myopic eyes after LASIK (33 eyes of 27 patients; frequency 0.08% [33/38, 823]). They found that 45.8% lost two or more lines of VA after vitreoretinal surgery. Two letters described the characteristics and potential mechanisms of a macular lacquer crack (one with subsequent development of subfoveal CNV) in a myopic patients corrected by LASIK. SUMMARY: Serious complications after LASIK are infrequent. A dilated fundus examination is very important before LASIK and in every patient whose VA after LASIK is not as good as expected to avoid delayed referral to a vitreoretinal specialist if necessary. Only prospective studies can determine whether the procedure exacerbates myopic pathology.     

LASIK术前预防性激光光凝对术后视网膜稳定性的影响

目的 :观察LASIK术前预防性氪离子激光光凝对术后视网膜稳定性的影响。方法 :LASIK术前 ,间接检眼镜检查眼底 ,对视网膜裂孔或病变大于 2PD的 658例 (688只眼 )患者行氪离子激光光凝 ,观察其视网膜稳定情况 ;对视网膜病变小于 2PD的 71 2例 (756只眼 )患者密切观察其视网膜病变的变化 ,必要时于LASIK术后补行氪离子激光。结果 :LASIK术后 6个月随诊 ,术前行氪离子激光光凝的 2 38只眼 ,术后视网膜情况稳定 ;术前视网膜病变范围小于 2PD有 2 70只眼 ,有 5只眼于LASIK术后补行氪离子激光光凝。结论 :LASIK术前 ,对视网膜裂孔或病变 >2PD的患者应行激光光凝治疗 ,而对视网膜变性 <2PD的患者可暂不行激光光凝治疗 ,密切随诊其视网膜病变情况。     

LASIK术前视网膜变性及裂孔预防性光凝治疗

目的:观察LASIK术前对视网膜变性或伴裂孔等进行预防性光凝治疗的疗效。方法:LASIK术前散瞳三面镜检查,对明确有视网膜变性或伴裂孔等86例116眼进行视网膜光凝治疗。结果:视网膜光凝后,视网膜变性及裂孔封闭良好,色素斑形成明显。LASIK术后经6～12mo随访,未发生视网膜脱离。结论:LASIK术前对有明确视网膜变性或伴裂孔等进行预防性视网膜光凝治疗,可以预防术后视网膜脱离的发生。