军事飞行人员激光角膜屈光手术评估和放飞方案建议

目的分析我军现役飞行人员激光角膜屈光手术病例, 结合国内外军事飞行人员屈光手术研究进展, 提出我国军事飞行人员激光角膜屈光手术评估和放飞方案建议。方法回顾性分析2012年1月至2021年12月于空军特色医学中心完成的12例飞行人员激光角膜屈光手术[包括准分子激光角膜切削术(photorefractive keratectomy, PRK)和准分子激光上皮瓣下角膜磨镶术(laser subepithelial keratomileusis, LASEK)]病例, 并复习相关文献资料。结果 5例飞行人员术后7 d远视力≥1.0, 术后1个月共有7例远视力≥1.0, 术后2个月12例远视力均≥1.0。12例飞行人员术后2～3个月时远视力已基本稳定, 屈光度在术后1个月即趋于稳定。12例飞行人员均于术后2～6个月顺利放飞。结论对屈光不正的军事飞行人员推荐采用PRK和LASEK矫正近视, 通过定期航空医学评估后, 放飞时间为术后2～3个月较为适宜。     

军事飞行员屈光性角膜手术后飞行二例

一、临床资料例1,男性,30岁,直-9飞行员,飞行时间700 h.原双眼视力0.3,近视约3.00 D,于2001年行双眼准分子激光屈光性角膜切削手术(photorefractive keratectomy,PRK).术后有眼干史,2个月后消失.术后视力双眼均1.2.参加2002年度招飞体检,顺利通过.飞行6年余,未出现影响飞行安全的视觉问题.     

准分子激光原位角膜磨镶术治疗儿童远视性屈光参差

目的 评价准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis,LASIK)治疗儿童远视性屈光参差的疗效.方法 使用美国Summit公司的SVS Apex plus准分子激光系统及Moria公司的微型板层角膜切割系统(LSK),对8例9～14岁远视性屈光参差患者进行LASIK手术,术后进行双眼视训练和系统的弱视治疗.结果 术后裸眼视力和矫正视力明显提高,术前平均最佳矫正视力0.23,术后6个月平均最佳矫正视力0.65;屈光度明显降低,但平均仍残留 2.81D;8例患者全部建立同时视和融合功能,6例有立体视功能.结论 LASIK治疗儿童远视性屈光参差安全有效,可明显提高视力,恢复和建立双眼视功能.     

准分子激光治疗中度近视临床疗效分析

目的　评价准分子激光治疗中度近视的有效性和预测性。方法　分别应用准分子激光屈光性角膜切削术和准分子激光原位角膜磨镶术对中度近视共 10 85眼进行治疗和临床疗效对照分析。结果　术前准分子激光屈光性角膜切削术组和准分子激光原位角膜磨镶术组平均裸眼视力分别为 (0 .11± 0 .0 5 )和 (0 .0 6±0 .0 4 ) (P <0 .0 5 ) ,平均等值球镜屈光度分别为 (- 3.6 3± 1.5 5 )、(- 4 .87± 0 .93)D(P <0 .0 5 ) ;术后 6个月准分子激光屈光性角膜切削术组平均裸眼视力为 (1.12± 0 .2 3) ,等值球镜屈光度为 (- 0 .4 9± 0 .4 3)D ,而准分子激光原位角膜磨镶术组平均裸眼视力为 (1.18± 0 .17) (P >0 .0 5 ) ,等值球镜屈光度为 (- 0 .5 8± 0 .4 0 )D(P >0 .0 5 )。结论　准分子激光屈光性角膜切削术和准分子激光原位角膜磨镶术两种方法治疗中度近视均具有准确性高、预测性良好的特点。     

美国空军飞行人员角膜屈光手术的特许评估

鉴于美国空军飞行人员屈光不正的高发生率及戴镜飞行的安全隐患，经过大量前期实验研究与评估，美国空军批准应用角膜屈光手术（corneal refractive surgery，CRS）改善现役飞行员视力状况。从2000年8月批准在航空和特种作业人员中实行准分子激光屈光性角膜切削术（photorefractive keratectomy，PR K）项目[1]，2001年项目全面展开[2]。从2006年开始对部分机种飞行人员获准实行准分子激光原位角膜磨镶术（laser assisted in situ keratomileusis，LASIK），2007年后对所有飞行人员实行LASIK特许[3]。     

准分子激光角膜屈光手术后常见并发症的护理

准分子激光角膜屈光手术因具有安全性、有效性和可预测性等优点而广泛运用临床。近年来，随着准分子激光角膜屈光手术的普遍开展．其术后并发症也时有发生。我院近年实施准分子激光角膜屈光手术1248例，屈光度-1．3DS-14．0DS，经过精心的手术和护理效果满意。现将施行准分子激光角膜屈光手术常见并发症及护理体会报告如下。     

准分子激光原位角膜磨镶术矫正近视的临床研究

目的:探讨准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis,LASIK)治疗低、中、高度近视的疗效。方法:应用波长193nm的ArF准分子激光对147例(289眼)屈光度在-1.00D～-20.00D的近视及近视散光患者行LASIK治疗。结果:对289眼随访6～1O个月,92％的患者术后裸视达到或超过术前矫正视力,10％的裸视达2.0,89.6%的术后屈光度在±1.00D之间,欠矫25眼,欠矫率仅为8.7％,术中术后无严重并发症。结论:LASIK手术矫正近视及近视散光优于PRK手术,是一种更加准确、有效和安全的屈光手术方法。     

准分子激光角膜屈光手术对不同类型屈光不正的矫治效果

目的 评价准分子激光角膜屈光手术对各种类型屈光不正的矫治效果。方法 使用Keratom-F/Schwind准分子激光治疗仪对3221只不同类型的屈光不正眼行角膜光学屈光切削术或角膜原位磨镶术。随访8个月到3年。比较术前术后裸高力变化程度和观察手术并发症种类及发生率。结果 全部3221只眼术后裸眼视力达到术前矫治最佳视力为76％，小于50％最佳矫正视力仅占0.4%。近视组术后裸眼视力达到术前最佳视力为77％，远视组30cm近视力为88.2%，散光组为53.8%。并发症总发生率0.34%，包括角膜雾浊、各种角膜瓣并发症、眼底出血、视网膜脱离。结论 准分子激光手术有效提高屈光不正眼的裸眼视力。绝大多数近视，远视，散光的患者经治疗后可以达到无需眼镜正常生活和工作的目的。准分子激光手术并发症少，是一种低风险屈光矫治手术。     

准分子激光角膜原位磨镶术前后眼压临床分析

准分子激光角膜原位磨镶术(LASIK)治疗近视及近视散光是近年来角膜屈光手术一大进展，同PRK相比，它具有更高安全性、稳定性和术前可预测性，因此被越来越多的人们所接受，Lasik术后常规使用皮质类固醇激素以稳定屈光度，但长期使用有可能引起激素性高眼压，甚至造成类固醇青光眼，因此术后眼压监测非常重要，在接受Lasik手术的中高度近视患者160例做了术前术后的观察，现报告如下：     

低度近视眼准分子激光角膜屈光手术后视觉及相关角膜参数与飞行员正视眼的对比分析

目的检测中国歼击机飞行员视觉及相关角膜参数,并与低度近视眼行准分子激光角膜屈光手术后的数据进行对比分析,评估准分子激光角膜屈光手术在我空军应用的前景。方法选取进行准分子激光原位角膜磨镶术(LASIK)或角膜表面切削手术(PRK)的低度近视眼,分别观察裸眼视力、屈光状态、Astramax角膜地形图获得的波阵面像差,即总高/低阶像差、垂直彗差、水平彗差和球差,以及角膜前表面Q值、角膜曲率等角膜参数,与歼击机飞行员正视眼数据进行对比分析。结果PRK和LASIK治疗≤-3.00D轻度近视眼,术后裸眼视力达到飞行员的标准;屈光状态,即球镜度数、柱镜度数、等效球镜三组差异无统计学意义;手术组角膜的Q值没有改变;中央角膜曲率显著下降;术后总高/低阶像差和球差与飞行员组差异有统计学意义。LASIK术后球差的增加显著高于PRK。结论 低度近视眼行PRK或LASIK术后裸眼视力、屈光状态、角膜的Q值可以达到飞行员的标准。但总高阶像差、彗差和球差的增加可能严重影响视觉质量,LASIK较PRK对球差的影响更大。在选拔飞行员时,对做过角膜屈光手术的患者应该慎重。同时在屈光手术中如何减少和避免波阵面像差的改变,如何通过手术保持和提高视觉质量也是我们今后的课题。     

Visual and flight performance recovery after PRK or LASIK in helicopter pilots

INTRODUCTION: Refractive surgery, specifically photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), is becoming more accepted in the military environment. Determination of the impact on visual performance in the more demanding aviation environment was the impetus for this study. METHODS: A prospective evaluation of 20 Black Hawk pilots pre-surgically and at 1 wk, 1 mo, and 6 mo postsurgery was conducted to assess both PRK and LASIK visual and flight performance outcomes on the return of aviators to duty. RESULTS: Of 20 pilots, 19 returned to flight status at 1 mo after surgery; 1 PRK subject was delayed due to corneal haze and subjective visual symptoms. Improvements were seen under simulator night and night vision goggle flight after LASIK; no significant changes in flight performance were measured in the aircraft. Results indicated a significantly faster recovery of all visual performance outcomes 1 wk after LASIK vs. PRK, with no difference between procedures at 1 and 6 mo. Low contrast acuity and contrast sensitivity only weakly correlated to flight performance in the early post-operative period. DISCUSSION: Overall flight performance assessed in this study after PRK and LASIK was stable or improved from baseline, indicating a resilience of performance despite measured decrements in visual performance, especially in PRK. More visually demanding flight tasks may be impacted by subtle changes in visual performance. Contrast tests are more sensitive to the effects of refractive surgical intervention and may prove to be a better indicator of visual recovery for return to flight status.     

高性能战斗机大强度飞行对飞行员生理指标及飞行劳动负荷主观评价的影响

目的观察高性能战斗机大强度飞行对飞行员的生理指标及飞行劳动负荷主观评价的影响。方法5名健康男性高性能战斗机飞行员在1个飞行日内共进行22架次的大强度飞行。记录飞行过程中的心电信号,分析心率及心率变异性（heart rate variability,HRV）;飞行后进行飞行劳动负荷和疲劳程度主观评价。结果飞行员大强度飞行时,随着飞行负荷的降低,心率和HRV频域及时域指标呈现一定的规律性变化。心率在夜问较日问低;夜间校正高频功率（high frequency normalized unit,HFnu）高于日间,校正低频功率（low frequency normalized unit,LFnu）及低频高频比值（LF／HF）则低于日问。飞行员飞行劳动负荷及疲劳程度主观评价分值均较低,没有明显的主观疲劳感。结论高性能战斗机大强度飞行对飞行员生理指标有一定影响,但尚未引起飞行疲劳。合理的飞行安排及有力的航卫保障有利于飞行员身体机能的恢复,预防飞行疲劳,保障飞行安全。     

飞行员重症恶性疟疾伴并发症一例并文献复习

目的 探讨飞行员重症恶性疟疾的临床诊治及航空医学鉴定. 方法 结合1例飞行员重症恶性疟疾的临床诊断、抢救治疗、康复情况及健康鉴定情况,复习相关文献,对飞行员重症恶性疟疾的临床诊治及医学鉴定进行探讨. 结果 该飞行员有到非洲出访史,临床表现为发热、肝功能不全、急性肾功能衰竭、低血糖、急性溶血性贫血及溶血性尿毒综...     

颅脑损伤后癫痫发作的航空医学鉴定——附病例报告二例

目的 通过回顾性分析民航飞行员颅脑损伤病例及社区病例相关文献,探讨不同程度的颅脑损伤后不同时间段癫痫的发病率和颅脑损伤后癫痫发作的高危因素,以期指导民用航空人员颅脑损伤的医学鉴定.方法 获取并回顾相关颅脑损伤后癫痫发作的流行病学研究,获得社区颅脑损伤病例共9475例,其中重度605例,中度1955例,轻度6915例;民航飞行员重度颅脑损伤申请特许鉴定病例2例.分析并探讨颅脑损伤后癫痫发作的航空医学鉴定.结果 ①重度颅脑损伤后癫痫发病率高于中度,中度高于轻度.②颅脑损伤后随时间推移癫痫发作可能性逐步降低;轻度颅脑损伤1年后癫痫年发病率小于1%,中度颅脑损伤3年后癫痫年发病率小于1%,重度颅脑损伤8年后癫痫年发病率小于1%.③颅脑损伤后癫痫发作高危因素有:脑挫伤、硬膜下血肿、凹陷性骨折及意识丧失或损伤后遗忘大于24 h.④两名颅脑损伤飞行员经及时有效治疗后恢复良好,各项检查未见异常,密切随访期间未见癫痫发作.其中1名飞行员于伤后第4年特许合格,安全飞行2年(1800 h),未见癫痫发作;另1名于伤后第9年特许合格,安全飞行4年(1600 h),未见癫痫发作.结论 根据1%法则,颅脑损伤治愈后,若各项检查未见异常,轻度颅脑损伤1年后可评定为合格,中度3年后可评定为合格,重度8年后可考虑有或无限制的合格鉴定. Abstract： Objective To investigate the incidence of various grade of posttraumatic epilepsy in different time and risk factors by analyzing cerebral trauma cases of civil pilots and correlative literatures.The conclusion is expected to contribute to the aviation medical assessment for the civil pilot with posttraumatic epilepsy. Methods For analyzing epidemiology studies of posttraumatic epilepsy 9475 cases of civilians' posttraumatic epilepsy (include 605 severe, 1955 moderate and 6915 mild traumatic brain injury cases) were reviewed. Besides, 2 epilepsy cases of civil pilots with severe traumatic brain injury, who were specially applied for assessment, were also analyzed to investigate the application in aeromedical assessment. Results ①The severer traumatic brain injury the higher incidence of posttraumatic epilepsy. ②The possibility of posttraumatic epilepsy seizure was gradully diminished with time. The incidence of posttraumatic epilepsy could reduce to lower than 1% after 1, 3 or 8 years corresponding to the mild,moderate and severe traumatic brain injury. ③ The high risk factors of posttraumatic epilepsy included brain contusion, subdural hematoma, depressed fracture, loss of consciousness or post traumatic amnesia more than 24 h and early seizure. The close follow-up showed that 2 pilots well recovered by timely treatment and no more abnormities and seizure happened. One pilot was permitted for co-piloting at the 4th year of injury and had no epilepsy seizure in his safe flying for 2 years (1800 h). Another pilot returned to his qualified flight at the 9th year and had safely flied as pilot instructor for 4 years ( 1600 h) without seizure.Conclusions By applying 1% rule in aeromedical assessment, the mild traumatic brain injured pilot would be suggested to fit for flying by 1-year recovery and 3-year recovery for the moderate if no more abnormities were diagnosed. For the severe injured pilot, the flying qualification could be considered with or without limitation by 8-year recovery.     

战斗机飞行员准分子激光术后飞行14年一例文献复习

目的探讨准分子激光手术后对飞行工作的影响,了解研究现状及发展趋势。方法结合1例曾行准分子激光手术的男性战斗机飞行员飞行14年情况及复习文献,就准分子激光手术后对飞行的影响,以及国外军事飞行人员行准分子激光手术后的医学鉴定进行总结交流。结果该飞行员飞行14年未出现眼红、视力下降、眩光等视觉问题。2006年改新机种体检飞行合格,2011年度体检飞行合格。结论准分子激光手术的安全性逐步提高,根据我国目前的实际情况,可以考虑在满足一定条件下参加招飞体检和军事飞行人员准分子激光手术后无后遗症评定合格。     

招飞体检中低角膜曲率眼角膜地形图分析

目的探讨招飞体检中角膜地形图的应用。方法对招飞体检中发现的低角膜曲率23例46眼进行Astramax角膜地形图检查,分析角膜地形图获得的角膜形态及测量参数,包括中央角膜曲率、Q值(瞳孔中心4.5mm直径范围)、高阶像差数据等。结果确诊5例10眼进行过准分子激光角膜屈光手术,4例8眼可疑接受过角膜塑形术治疗。结论在招飞体检中角膜地形图检查是筛查异常角膜的有效方法之一。     

Medical histories of 61 aviation accident pilots with postmortem SSRI antidepressant residues

INTRODUCTION: Selective serotonin reuptake inhibitor (SSRI) antidepressants are popularly prescribed, but these drugs are not currently approved for use by U.S. civilian aviators. In a 2003 study, the presence of 4 SSRIs--citalopram, fluoxetine, paroxetine, and sertraline-was reported in 61 pilot fatalities of civil aviation accidents that occurred during 1990-2001. However, it was not known whether these pilots had disqualifying psychological conditions, including depression, and had properly reported the use of the antidepressants. METHODS: The aeromedical history of the pilots was retrieved from the Federal Aviation Administration's (FAA's) Aerospace Medical Certification Database; additional pilot medical information and the cause/factor of the accidents were obtained from the National Transportation Safety Board's (NTSB's) Aviation Accident Database. RESULTS: There were 59 pilots who had medical records in the FAA's Certification Database. Disqualifying psychological conditions were self-reported in the past examinations of only 7 (12%) of the 59 pilots, and the use of an SSRI was reported by 3 of the 7 pilots. In later examinations, 6 of the 7 indicated that they were free from the conditions and not taking SSRIs; thus, they were reissued medical certificates. Such conditions and/or drug use were not self-reported in the aeromedical records of the remaining 52 (88%) pilots. Nevertheless, the NTSB investigations revealed that 12 (20%) of the 61 pilots had a history of a psychological condition and/or an SSRI use, as suggested by their personal medical records. CONCLUSIONS: These findings reconfirm that SSRIs were used by the aviators but were not reported in their last aeromedical examinations.     

屈光不正的矫正与飞行

目的综述屈光不正的矫正方法及其与飞行关系的研究进展。资料来源与选择该领域的相关研究论文、研究报告与专著。资料引用国内外公开发表的论文和著作56篇。资料综合阐述屈光不正的各种矫正方法在飞行人员中应用的优缺点,着重阐述了对飞行人员进行角膜屈光手术的应用可行性。结论相对于其他矫正方法,对飞行人员进行角膜屈光手术具有较好的应用前景。目前国外民航飞行人员以准分子激光原位角膜磨镶术（1aser in situ keratomileusis,LASIK）为主,而军航飞行人员则以准分子激光角膜切削术（photorefractive keratectorny,PRK）为主;美国军航飞行人员已被允许进行飞秒激光LASIK手术,对我军飞行人员有借鉴意义。     

空军招飞学生角膜屈光力调查及应用价值探讨

目的 通过观察招飞体检中受检学生角膜屈光力及角膜散光的分布状况,探讨角膜屈光力检测在空军招飞体检中的应用价值. 方法 采用佳能RK F1型全自动验光/角膜曲率仪,测量参加招飞定选的2 586名高中毕业生5 172眼角膜水平及垂直子午线屈光力,计算平均角膜屈光力、角膜散光度、散光轴向及双眼角膜屈光力差值,描述其频数分布状况,比较双眼角膜散光度差异.结果 招飞学生平均角膜屈光力（42.64±1.23）D（范围：37.95～47.31 D）;同一个体双眼角膜屈光力差值的绝对值（0.20＋0.18）D（范围：0.00～2.53 D）;角膜教光度（0.98±0.45）D（范围：0.00～4.25 D）;角膜散光轴位：顺规性散光占总体的96.83％,逆规性散光占1.16％,斜向散光占2.01％;左眼角膜散光度为（1.00±0.46）D,较右眼（0.96±0.45）D稍大,差异有统计学意义（Z=-6.517,P＜0.05）. 结论 在空军招飞体检中,全自动验光/角膜曲率仪所采集的角膜屈光力作为筛查线索之一用于筛查角膜屈光,矫治后角膜和圆锥角膜需要其他筛查手段协助完成筛查和鉴别.16～20岁健康男性角膜散光以顺规散光为主.同一个体双眼角膜屈光力及散光在一定程度上具有对称性.     

Central serous retinopathy with permanent visual deficit in a commercial air transport pilot: a case report

This report describes a case of central serous retinopathy (CSR) in the right eye of a commercial air transport pilot which resulted in a permanent reduction in visual acuity and the loss of his license. The previously fit and well pilot developed sudden loss of central vision, which resolved spontaneously. He then went on to experience recurrent episodes of fluctuating visual acuity (down to 6/60) and visual dysfunction in the right eye. His left eye remained unaffected. Eventually his condition stabilized, and he was left with a permanent reduction in right visual acuity (6/36) with intact peripheral visual fields and a completely normal left eye. After a period of grounding of 12 mo, he sought to have his license reinstated. He was considered to be a functionally monocular pilot, and as such was granted a conditional Class 1 medical category. The aeromedical disposition of this pilot and the issues involved in determining the fitness to fly of pilots with permanent visual defects arising from CSR are discussed.