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。

Characteristics and management of retinopathies in myopic eyes before LASIK

AIM:To analyse the characteristics of retinal lesions in myopic patients scheduled for laser in situ keratomileusis(LASIK),then to assess the efficacy and safety of prophylactic laser coagulation for retinal lesions in these myopic eyes·METHODS:Retrorespective clinical research.LASIK were performed in 1100 continuous patients(2190 eyes).Before operation,the fundus was examined with direct and indirect ophthalmoscope and three mirror contact lens.The laser photocoagulation was performed in order to strengthen the retina with severe peripheral degeneration·RESULTS:Peripheral fundus abnormalities and holes both increased while refraction diopter increased,and there were statistically significant differences among groups(P<0.05).And the abnormalities were usually in the temporal fundus.A total of 2190 eyes were examined.Among them,132 eyes(6.07%) were found to have peripheral retinal degeneration:64 eyes(48.48%) had lattice degeneration,37 eyes(28.03%) had cystoid degeneration,54 eyes(40.91%) had snail track degeneration,34 eyes(25.76%) had white non-pressure change,12 eyes(9.09%) had cobblestone degeneration,14 eyes(10.61%) had retinal dry holes,4 eyes(3.03%) had hole and localized shallow detachment.The pathological changes in 43 cases(78 eyes) were treated effectively by laser photocoagulation for more than three weeks,and eventually the holes were firmly closed and the lattice degeneration,the cystoid degeneration were photocoagulated reliably.No new holes and retinal detachment occurred·CONCLUSION: It’s necessary to examine the fundus of the two eyes with the three-mirror contact lens before LASIK.To prevent retinal detachment effectively,laser photocoagulation should be performed in time on the peripheral retinal degeneration of myopia.