高度近视准分子激光角膜原位磨镶术后并发开角型青光眼的早期诊断

目的探讨高度近视行准分子激光角膜原位磨镶术（LASIK）后开角型青光眼患者的临床特征。方法回顾性分析2008年7月-2009年6月以屈光回退或眩光为主诉复诊的高度近视行LASIK术后患者13例25眼的临床资料；所有患者屈光回退现象均发生存术后2a，其中男8例，女5例；平均年龄30．1岁，均进行视力、屈光度、角膜地形图、Goldman眼压、眼轴、视野及OCT检查，原发性开角型青光眼的诊断依据全国青光眼学组建议的诊断标准，所有患者术前均签署知情同意书。结果12例23眼中，术后平均回退屈光度为（-1．57±0．36）D，裸眼视力0．42±0．14；1例患者双眼眩光加重，瞳孔散大，直径为4．5～5．0mm，夜间瞳孔直径为5．8～6．1mm；6例12眼术后校正眼压为21—26mmHg，合并有视网膜神经纤维层（RNFL）变薄及相应的青光眼典型视野改变；7例13眼屈光回退者中OCT检查RNFL变薄者3例5眼，用眼过度致视疲劳者4例8眼。结论高度近视患者行LASIK 2a后出现视力下降及眩光现象，且单纯以屈光回退及光学区过小无法解释者，要考虑到并发开角型青光眼的可能。

Early diagnosis of primary open-angle glaucoma in patients with high myopia after laser in situ keratomileusis

Background Laser in situ keratomileusis （LASIK） have been proved to be effective for refractive error eye. However,its safety and stability in high myopia eye is still a controversy. Clinically, one of reasons of regression after LASIK is primary open-angle glaucoma. Objective The present study was to discuss the early diagnosis of primary open-angle glaucoma in patients with high myopia after LASIK. Methods The clinical data was retrospectively analyzed from 25 eyes of 13 patients with high myopia received LASIK. The regression occurred after 2 years following the LASIK. Visual acuity, diopter, Orbsean, aberration,contrast sensitivity, intraocular pressure （Goldman IOP） , optic axis, visual field and OCT were examined before and after LASIK. Primary glaucoma was diagnosed based on the criteria of National Glaucoma Group. Written informed consent was obtained from each patient before operation. Results Refraction regression occurred in 23 eyes of 12 patients with the average regression equivalent （ - 1.57± 0.36） D. The average uncorrected visual acuity was （0.42 ± 0. 14）. Two eyes of 1 patient appeared the glaring symptom with the diameter of pupil 4 - 4.5 mm at daytime and 5.8 - 6.0 mm at night. Twelve eyes of 6 cases presented the post-correct IOP 21 -26 mmHg with the thinner nerve fiber layer and glaueomatous visual field alteration. The other causes of regression included suspect glaucoma in 5 eyes of 3 patients and asthenopia in 8 eyes of 4 patients. Conclusion The eyes received LASIK for high myopia is likely to occur refraction regression or dazzling,especially in 2-year duration after LASIK. Concurrent primary open-angle glaucoma may be one of reasons of regression. The glaucoma excluding test should be performed in the patients with refractive regression after LASIK.