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。

Preventive retinal photocoagulation before femtosecond LASIK operation

Objective To investigate the effects of preventive retinal photocoagulation for low, mod- erate and high myopia with peripheral retinal degeneration or tear befor femtosecond laser LASIK. Methods 2000 eyes of 1000 cases with myopia , aged 18 -50 years old with - 1.00 ～- 13.00D myopia refraction and -0.50 ～-4.00D astigmatism were enrolled in this study. The cases were divided into 3 groups according to preoperative refraction. In group I , there were 350 cases （700 eyes） with refraction - 1.00 N - 3.00D ; The group II , included 360 cases（720 eyes） with refraction - 3.25 ～- 6.00D; The group 111 included 290 cases（580 eyes） with refraction -6.25～-13.00D. All cases were examined with 90D preset lens before LASIK. Results The severe peripheral retinal degeneration and tears were found in 100 eyes, with 20 eyes in group I ,44 eyes in group 11 , 36 eyes in group 11I, and most of which occurred in the temporal side. The rates of severe peripheral retinal degeneration and tears of group lI and m were higher than group I. One hundred eyes with peripheral retinal degeneration or retinal tear were treated with 532nm laser photocoagula- tion before LASIK. One month after laser photocoagulation, the retinal tears were sealed well and retinal condition was good. Pigment spots were obviously formed . Patients were followed up for six months to one year, and no rhegmatogenous retinal detachment was found. Conclusion Preventive 532 nm laser photoco- agulation for myopia with peripheral retinal degeneration or retinal tear before LASIK is safe and effective. It can reduce or avoid the occurrence of postoperative retinal detachment to secure postoperative results.