高度近视准分子激光术后黄斑出血分析

目的比较及分析该院高度近视准分子激光角膜切削术(PRK)、激光原位角膜镶磨术(LASIK)术后黄斑出血的相关原因。方法选择该院1997~2012年治疗的高度近视患者2 170例(4 302只眼),其中PRK组2152只眼,LASIK组2 150只眼,采用3种角膜瓣制作技术,包括角膜上皮瓣下磨镶术(LASEK组)605只眼,前弹力层下准分子激光原位角膜磨镶术(SBK组)957眼,飞秒激光角膜瓣准分子激光原位角膜磨镶术(Femtosecond laser组)588只眼,采用常规观察最佳矫正视(BCVA),眼内压,眼底改变等,全部患者随访8~12个月。结果 2 170例4 302只眼,有14只眼发生黄斑出血,黄斑出血率0.33%,其中PRK组2 152只眼,12只眼黄斑出血,黄斑出血率为0.56%;LASIK组2 150只眼,2只眼黄斑出血(LASEK发生1只眼,SBK发生1只眼,Femtosecond laser无),黄斑出血率为0.09%,PRK组黄斑出血率高于LASIK组黄斑出血率,两组比较差异有统计学意义(χ2=7.88,P0.05)。PRK组12只眼黄斑出血时,其平均眼压为(24.38±5.63)mm Hg,比术前平均眼压(16.58±4.28)mm Hg高。结论皮质激素性高眼压波动可能是高度近视PRK术后黄斑出血的主要原因,LASIK术是避免高度近视术后黄斑出血的最好方法,3种角膜瓣制作技术与黄斑出血无明显关系。

Analysis of macular hemorrhage after photorefractive keratectomy in high myopia

Objective To compare and analyze the related reasons of macular hemorrhage after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in high myopia .Methods 2 170 cases (4 302 eyes) of high myopia treated by PRK and LASIK in our hospital from 1997 to 2012 were researched ,including 2 152 eyes in the PRK group and 2 150 eyes in the LASIK group .Three kinds of corneal flap preparation technology were adopted , including corneal subepithelial keratomileusis (LASEK group) in 605 eyes ,bowman layer of excimer laser in situ ker‐atomileusis (SBK group) in 957 eyes and femtosecond laser flap excimer laser in situ keratomileusis (Femtosecond la‐ser group) in 588 eyes .The routine observation of best corrected visual acuity(BCVA) ,intraocular pressure(IOP) and fundus changes were adopted and all cases were followed up for 8 -12 months .Results Among 4 302 eyes in 2 170 cases ,14 eyes developed macular hemorrhage with the macular hemorrhage rate of 0 .33% ,in which 12 eyes were in the PRK group with the macular hemorrhage rate of 0 .56% and 2 eyes in the LASIK group (1 eye in LASEK and 1 eye in SBK ,no case in Femtosecond laser) with the macular hemorrhage rate of 0 .09% ,the macular hemorrhage rate in the PRK group was higher than that in the LASIK group ,the difference was statistically signifi‐cant(χ2 =7 .88 ,P<0 .05) .In the macular hemorrhage for 12 eyes in the PRK group ,the average IOP was (24 .38 ± 5 .63)mm Hg ,which was higher than(16 .58 ± 4 .28)mm Hg before operation .Conclusion Corticosteroid‐induced oc‐ular hypertension maybe a main reason of macular hemorrhage after PRK in high myopia ,LASIK is a best method for avoiding postoperative macular hemorrhage in high myopia .The three kinds of corneal flap preparation technology has no obvious relation with macular hemorrhage .