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532 nm,光斑大小50～300μm,曝光时间0.2～0.25 s.功率100～300 mW.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.     

中高度近视选择LASEK术前的预防性视网膜光凝的疗效观察

目的:评价中、高度近视选择LASEK术前的预防性视网膜光凝的疗效。方法:对中、高度近视患者279例551眼术前美多丽滴眼液充分散瞳后,用90D裂隙灯前置镜或三面镜详细检查眼底,明确有视网膜变性(格子样变性、蜗牛样变性、囊样变性等)或(伴)有干性裂孔共18例26眼,行倍频Nd:YAG532nm激光治疗并选择LASEK手术矫正近视。结果:对18例26眼行预防性倍频Nd:YAG532nm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。LASEK术后6～18mo随访,没有发生孔源性视网膜脱离。结论:对明确有视网膜变性或(伴)干性裂孔预防性行倍频Nd:YAG532nm激光光凝术及选择LASEK术矫正近视是预防准分子激光术后出现孔源性视网膜脱离的重要措施。     

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。     

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。     

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。     

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。     

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。     

激光光凝辅助角膜原位磨镶术前眼底

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。     

视网膜脱离复位术后对侧眼视网膜变性的激光治疗疗效观察

目的:探讨1眼视网膜脱离复位术后,对侧眼有周边视网膜变性或伴有干性裂孔的患者进行预防性视网膜激光光凝术的疗效观察。方法:对符合上述条件的患者,常规行散瞳三面镜或间接眼底镜检查,对明确有对侧眼周边视网膜变性(格子样变性、霜样变性、囊样变性等)或伴有干性裂孔的192例行预防性视网膜激光光凝术。结果:接受预防性视网膜激光光凝术的192例患者对侧眼的眼底周边视网膜变性区或干性裂孔区封闭良好,色素斑形成明显。光凝术后随访6～18mo,所有患者均无发生孔源性视网膜脱离。结论:对眼底有周边视网膜变性或伴有干性裂孔的患者行预防性视网膜激光光凝术能有效防止视网膜脱离的发生。     

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 after retinal detachment surgery

AIM: To assess the efficacy and safety of laser in situ keratomileusis (LASIK) for correction of myopic refractive errors in eyes which have previously undergone retinal detachment surgery. METHODS: In a prospective, non-comparative case series, 10 eyes of nine patients who had a myopic refractive error and had previously undergone retinal detachment surgery underwent LASIK surgery according to the standard surgical protocol. The surgery could be completed in eight eyes and in two eyes it was aborted intraoperatively. The parameters evaluated included the uncorrected visual acuity, best corrected visual acuity, refraction, detailed fundus evaluation with indirect ophthalmoscope, slit lamp biomicroscopy, and corneal pachymetry. Any intraoperative or postoperative complications were recorded. Follow up visits were scheduled at day 1, 1 week, 1 month, 3 months, and 6 months after LASIK. RESULTS: Eight eyes underwent successful LASIK surgery. The mean spherical equivalent before surgery was -5.436 (SD 1.6) dioptres (D), which was reduced to +0.42 (0.65) D, -0.07 (1.32) D, -0.06 (1.39) D, and -0.06 (0.65) at 1 week, 1 month, 3 months, and 6 months respectively after LASIK. The uncorrected visual acuity improved in all the eyes and the best corrected visual acuity improved or remained same in all the eyes. There was no retinal complication after LASIK. CONCLUSION: LASIK may be used to correct refractive errors in eyes that have undergone retinal detachment surgery. However, scarred conjunctiva in such cases may prevent generation of optimal suction for the microkeratome.     

Combined refractive lensectomy and laser in situ keratomileusis to correct extreme myopia

Refractive lensectomy followed by laser in situ keratomileusis (LASIK) was performed in both eyes of a severely myopic patient. An uncorrected visual acuity of 20/20 was achieved in the right eye with a manifest refraction of plano -0.25 x 65. Intentional monovision correction of the left eye left a manifest refraction of -0.75 diopter. Best corrected visual acuity improved by 1 Snellen line to 20/20 in both eyes. Follow-up evaluation will be required to assess the long-term refractive stability and the incidence of retinal detachment after combined refractive lensectomy and LASIK.     

Gas tamponade and macular grid laser photocoagulation in the management of recurrent retinal detachment

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes. PATIENTS AND METHODS: Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied. RESULTS: Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients. CONCLUSION: Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.     

Acute macular hole and retinal detachment in highly myopic eyes after neodymium:YAG laser capsulotomy

We report 2 cases of acute onset of macular hole and retinal detachment (MHRD) in highly myopic eyes after uneventful neodymium:YAG (Nd:YAG) laser posterior capsulotomy. Case 1 was a 76-year-old highly myopic woman who had decreased vision 4 days after Nd:YAG capsulotomy. Macular hole and retinal detachment were detected, and vitrectomy was performed. Case 2 was a 62-year-old highly myopic woman who reported visual loss 1 week after Nd:YAG capsulotomy. Macular hole and retinal detachment were detected, and vitrectomy was performed and the retina reattached. The developmental mechanisms of MHRD after Nd:YAG capsulotomy are discussed.     

准分子激光原位角膜磨镶术后视网膜脱离分析

目的 探讨准分子激光原位角膜磨镶术(LASIK)后视网膜脱离的临床特征及治疗。方法 回顾性分析了我院收治的LASIK术后视网膜脱离17例，观察其临床特点及手术治疗方式及效果。结果 17例中圆形裂孔13例(76．47％)，17例中16例行单纯巩膜外加压或联合环扎术，一次手术视网膜解剖复位16例(94．12％)。术后视力较术前提高者13例(76．47％)，矫正视力≥0．4者7例(41．18％)。结论 LASIK术后视网膜脱离巩膜扣带术手术成功率高，手术难度不大。但术后可再次造成近视，因此预防LASIK术后视网膜脱离至关重要。     

FD Nd:YAG激光光凝治疗视网膜裂孔

目的：探讨激光在视网膜裂孔的光凝治疗中的作用，以及视网膜脱离术后行眼底激光光凝治疗对其手术的补充作用和在光凝中的技术问题。方法：对36例视网膜裂孔的患者用FD Nd：YAG(532nm)激光进行视网膜光凝治疗。结果：36眼视网膜裂孔的患者中，治疗有效28眼，占77．8％。结论：用FD Nd：YAG(532nm)激光对视网膜裂孔的患者进行视网膜光凝治疗效果显著。     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的 探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。 方法 高度近视黄斑裂孔视网膜脱离患者35例38只眼，11例12只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；24例26只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作6个月以上的随访(平均随访时间21．7个月)。 结果 非光凝组5只眼黄斑裂孔性视网膜脱离复发，占41．7%，术后0．1以上视力6只眼，占50.0%；光凝组2只眼黄斑裂孔复发，占7.7%，1只眼因周边新裂孔形成而复发视网膜脱离，术后有13只眼视力在0.1以上，占50.0%。统计学检验两组黄斑裂孔复发率概率P=0.024,视网膜脱离复发率概率P=0.0487。两组患者术后视力无显著差异。 结论 玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。 (中华眼底病杂志,1998,14:199-201)     

Early rhegmatogenous retinal detachment following laser in situ keratomileusis for high myopia

PURPOSE: Four eyes had early rhegmatogenous retinal detachment within 3 months of laser in situ keratomileusis (LASIK) for correction of high myopia using the microkeratome, Clear Corneal Molder. METHODS: In two eyes, retinal detachment resulted from horseshoe tears, one occurring in an otherwise normal region of the retina and the other at the margin of an area of lattice degeneration detected during preoperative examination. The first eye was treated with retinopexy using a 287 encircling scleral exoplant, drainage of subretinal fluid, and laser photocoagulation by indirect ophthalmoscopy. The other eye was treated with pneumatic retinopexy and cryotherapy. In the other eyes, retinal detachment was the result of giant tears with no evidence of prior retinal degeneration. These eyes were treated with pars plana vitrectomy, fluid-gas exchange with 15% perfluoropropane (C3F8), endolaser photocoagulation, and a 42 encircling scleral exoplant. RESULTS: After treatment, the first two eyes achieved spectacle-corrected visual acuity of 20/40. In the last two eyes, final spectacle-corrected visual acuity was 20/400 in one eye and light perception in the other. CONCLUSIONS: Although no cause-effect relationship between LASIK and retinal detachment can be stated, these cases suggest that LASIK may be associated with retinal detachment, particularly in highly myopic eyes. Further studies are necessary to determine high-risk patient characteristics.     

Acute rhegmatogenous retinal detachment immediately following laser in situ keratomileusis

We report a case of acute rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) surgery in a highly myopic patient. Fourteen hours postoperatively, the uncorrected visual acuity was counting fingers in the left eye. Slitlamp examination revealed significant anterior chamber reaction with fibrin-like material. Fundus examination revealed 2 inferior retinal horseshoe tears associated with an RD. Preoperative fundus examination with scleral depression may detect predisposing retinal lesions in highly myopic patients. Further study is required to evaluate the relationship between LASIK, acute postoperative RRD, and predisposing factors.