LASIK术前眼底周边视网膜病变检查及处理的价值

目的观察准分子激光原位角膜磨镶术（LASIK）术前对视网膜变性或伴裂孔等进行预防性治疗的价值。方法对LASIK术前1260只眼扩瞳后行眼底检查并作详细记录,对明显视网膜变性或伴裂孔15只眼进行视网膜光凝治疗。结果15只眼光凝3～4周,行LASIK手术,术后随访6个月,无1例发生视网膜脱离。结论对拟行LASIK手术的患者进行详细眼底检查,并对周边视网膜变性严重和视网膜裂孔者实施预防性光凝治疗可大大降低术后视网膜脱离的发生率。     

90D前置镜在准分子激光原位角膜磨镶术术前眼底检查中的应用

目的探讨使用90D前置镜进行准分子激光原位角膜磨镶术（LASIK）术前检查的意义。方法对准备施行LASIK术前检查的患者充分扩瞳后,分别使用90D前置镜和双目间接眼底镜检查眼底,详细记录检查结果。对比检查结果。结果 276眼（138例）中,90D前置镜组发现视网膜干性裂孔12眼4.35%,视网膜裂孔伴有浅脱离3眼1.09%,格子样变性23眼8.33%;双目间接检眼镜组发现视网膜干性裂孔11眼3.99%,视网膜裂孔伴有浅脱离2眼0.72%,格子样变性23眼8.33%,对两种检查法的视网膜裂孔发现率采用x~2检验分析,P〉0.05。1眼视网膜裂孔浅脱离行巩膜外冷凝＋外填压术。其余病例均行氩离子激光光凝术封闭裂孔。结论使用90D前置镜进行LASIK术前眼底检查检出率高,且安全无创伤,方便和快速。     

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。     

LASIK术前常规眼底检查发现周边视网膜裂孔的临床意义

目的探讨LASIK术前常规眼底检查发现周边视网膜裂孔的临床意义。方法对577例(1154只眼)近视患者行LASIK术前常规眼底检查,发现周边视网膜裂孔20例(22只眼)。结果视网膜裂孔在术前检查人群中的发生率为3.47%,在术前检查眼中的发生率为1.91%,双眼发病率为0.35%。裂孔多发生于颞侧,常伴有格子样变性,与屈光度存在正相关关系。结论一部分患者在LASIK术前就已存在周边视网膜裂孔,特别是高度近视患者强调术前眼底检查的重要性。     

LASIK术前近视人群视网膜格子样变性的观察

目的观察接受LASIK术前常规眼底检查人群中周边视网膜格子样变性的发生及其特点。方法对577例1154眼中检查发现视网膜格子样变性的33例44眼的相关情况作一分析。结果视网膜格子样变性在术前检查人群中的发生率为5．72％,双眼发病率为33．33％,20．45％的眼伴有裂孔。格子样变性多发生在颞侧,与屈光度存在正相关关系。结论一部分患者在LASIK术前就已存在周边视网膜格子样变性这一视网膜脱离的高危因素,强调术前眼底检查的重要性。     

准分子激光原位角膜磨镶术后患者玻璃体视网膜病变观察

目的观察近视性屈光不正患者行准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)后的玻璃体视网膜病变情况.方法对995例(1 981只眼)近视性屈光不正患者,于LASIK术前1 d,术后1、3及12个月进行扩瞳,以间接检眼镜、三面镜及Volk视网膜镜等详细检查玻璃体和视网膜改变,术后1年进行不定期复查.结果发生玻璃体视网膜病变者13例(16只眼),占0.81%;术前屈光度数为(-9.45±2.61) D.其中表现为视网膜格子样变性或原病变区扩大者6只眼,占0.30%;单纯玻璃体后脱离2只眼,占0.10%;黄斑出血2只眼,占0.10%;视网膜干孔2只眼,占0.10%;孔源性视网膜脱离4只眼,占0.20%.患者出现病变距LASIK术后1～24个月不等,平均(10.38±6.20)个月.患者术前屈光度数≥-6.00 D者与＜-6.00 D者比较,两组术后玻璃体视网膜病变的发生率差异有显著意义(χ2=60.78,P＜0.01);术前有或无视网膜格子样变性及干孔病灶患者间,术后视网膜格子样变性及干孔病灶的发生率差异有显著意义(χ2=138.64,P＜0.01).结论与近视性屈光不正眼部病理改变的发展规律比较,尚无证据说明LASIK与术后患者玻璃体视网膜病变有直接关系,术前详细检查眼底、严格病例筛选及长期随访观察十分必要.     

LASIK前眼底三面镜检查及其意义

目的：探讨散瞳眼底三面镜检查在LASIK术前的重要意义。方法：对385例（721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眼（18.86%),视网膜干性裂孔（干孔）16眼（2.22%）,亚临床视网膜脱离（RD）5眼（0.69%)。其中37眼严重视网膜变性、16眼干孔和4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：将散瞳眼底三面镜检查作为LASIK术前常规检查是必要的,同时提出眼底病变光凝的指征。     

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。     

LASIK术后视网膜脱离

目的 :探讨准分子激光原位角膜磨镶术 (LaserinsituKeratomileusis ,LASIK )后视网膜脱离的临床特点及治疗方法。方法 :对我院 1996年 7月至 1998年 10月的 2 836例 (5 60 9只眼 )LASIK手术后发生视网膜脱离的 6例 (6只眼 ) (A组 )和1998年 11月至 2 0 0 0年 12月行LASIK手术 2 160例 (4165只眼 )无视网膜脱离发生 (B组 )进行回顾性分析。结果 :A组 6只眼LASIK术前平均屈光度为 -8 375± 2 761D (-5 2 5～ -12 2 5D)视网膜脱离发生在LASIK术后平均 12±6 2 3个月 (3～ 2 0个月 ) ;5只眼进行巩膜环扎加外加压术 ,1只眼进行了玻璃体切除、 18%C2 F6 气体填充联合巩膜环扎术 ,6眼均一次手术成功 ,视网膜复位。LASIK术后、视网膜脱离前平均最佳矫正视力为 0 97± 0 2 3(0 6～ 1 2 ) ,脱离经治疗后平均最佳矫正视力为 0 5 8± 0 31(0 1～ 1 0 ) ,LASIK术后视网膜脱离前平均屈光度为 -0 875± 0 48D (-0 2 5～ -1 5 0D) ,治疗后为 -3 0 4± 0 62D (-2 0 0～ -3 75D)。结论 :LASIK术后视网膜脱离与近视眼本身易发生视网膜脱离有关 ,与LASIK手术无直接关系 ,常规巩膜环扎术及玻璃体切割术能有效治疗LASIK术后视网膜脱离但能增加近视度数 ,所以行LASIK手术前应使用间接眼底镜及三面镜详细检查眼底     

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.     

高度近视眼LASIK术后早期黄斑部视网膜厚度变化的研究

目的探讨准分子激光角膜原位磨镶术（excimer laser in situ keratomileusis,LASIK）对高度近视眼黄斑区视网膜神经纤维层厚度的影响及其影响因素。方法随机选择接受LASIK手术矫正视力≥1.0高度近视眼患者18例36眼。采用Zeiss-Humphrey光学相干断层成像仪（Optical Coherence Tomography,OCT）第三代测量近视眼LASIK术前,术后1天、1周眼底以黄斑中心凹为中心3mm半径内的视网膜平均厚度,以地形图分9个区域显示。结果18例36眼高度近视患者LASIK术后1天、1周测量黄斑区视网膜厚度包括黄斑中心凹最小值、黄斑中心凹平均值、内圈平均值、外圈平均值和黄斑区6mm直径范围的视网膜体积与术前值相比均无显著差异（p〉0.05）,术后2次测量值间也无显著差异。结论LASIK对高度近视眼患者术后早期的黄斑区视网膜厚度无明显影响。     

Laser in situ keratomileusis enhancement after photorefractive keratectomy

OBJECTIVE: To describe the safety, effectiveness, and predictability of laser in situ keratomileusis (LASIK) for correcting residual myopia after primary photorefractive keratectomy (PRK). DESIGN: A retrospective, noncomparative case series. PARTICIPANTS AND INTERVENTION: Thirty-six consecutive eyes of 30 patients underwent LASIK after primary PRK. A Multiscan Schwind excimer laser was used for LASIK enhancement. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity, refraction, videokeratography, and complications were determined before and after LASIK retreatment. Follow-up was at least 12 months. RESULTS: Before LASIK, 11.11% of eyes showed a UCVA of 20/40 or better. This increased to 94.44% 12 months after LASIK. A UCVA of 20/25 or better was achieved in 0% before and in 72.22% after retreatment. Refraction +/-0.5 diopters (spherical equivalent) represented 0% of eyes before and 77.78% of eyes after enhancement. Before LASIK, two eyes had significant haze. Haze remained in these two eyes and appeared in another eye. CONCLUSIONS: Laser in situ keratomileusis proved to be safe and effective for treating residual myopia after PRK. Care must be taken when considering LASIK retreatment in patients with significant haze after primary PRK.     

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。     

Retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.     

LASIK治疗近视术中并发症临床分析与处理

目的：探讨准分子激光角膜原位磨镶术（LASIK）治疗近视的安全性和有效性。方法：回顾性分析LASIK治疗581只眼近视的术中并发症。结果：术后裸眼视力与术前相比,99．3％达到或超过术前最佳矫正视力。术中并发症的发生率为不完全角膜瓣占0．52％,游离角膜瓣占0．52％,角膜瓣偏位占0．34％,角膜缘出血占7．3％。结论：LASIK治疗近视安全有效,熟练掌握手术技术和有效及时处理各种并发症是保证手术成功的关键。     

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术中负压吸引对家兔视网膜氨基酸含量的影响

目的研究准分子激光角膜原位磨镶术（LASIK）术中瞬时高眼压对视网膜氨基酸质量浓度的影响。方法60只健康新西兰大耳白兔随机分为对照组、负压吸引20S组、负压吸引45s组和负压吸引3min组,制作瞬时高眼压模型。对照组只进行激光治疗;负压吸引组用负压发生器吸引兔眼角巩膜缘,分别持续20S、45S及3min,在术后不同修复期采用高效液相色谱分析仪检测视网膜4种氨基酸质量浓度的变化,并与对照组进行比较。结果负压吸引20S组及45s组视网膜氨基酸质量浓度与对照组比较差异无统计学意义（P〉0．05）。负压吸引3rain组视网膜中4种氨基酸质量浓度与对照组比较差异有统计学意义（P〉0．05）。术后即刻（0d）谷氨酸（Glu）质量浓度与对照组比较差异无统计学意义（t=-2．165,P=0．083）;术后7、10、14、28d与对照组比较差异均有统计学意义（t=-22．984,P=0．000;t=-61．437,P=0．000：t=-15．957,P=0．000;t=-21．336,P=0．000）。术后即刻（0d）和7d谷氨酰胺（Glune）、色氨酸（Try）、苯丙氨酸（Phe）质量浓度与对照组比较差异均无统计学意义（P〉0．05）;术后10、14、28d与对照组比较差异均有统计学意义（P〈0．01）。结论LASIK术中负压吸引引起的眼压急剧升高可引起视网膜中4种氨基酸水平的可逆性升高,负压吸引时间越长改变越明显。