准分子激光原位角膜磨镶术治疗高度近视疗效分析

目的观察高度近视性眼底病变对LASIK手术疗效的影响,探讨其安全有效性。方法对162例（318只眼）屈光度在-6.00D以上的高度近视患者进行散瞳眼底检查,对其中38例（76只眼）进行了FFA和ICGA,并就患者高度近视程度、眼底病变程度与患者手术后视力、眼底并发症等进行比较分析。结果①所有患者（318只眼）都接受了LASIK手术治疗。手术前检查发现有13只眼（4.09%）周边视网膜变性及微小裂孔,有21只眼（6.60%）脉络膜新生血管,其中5只眼（1.57%）FFA检查阴性而ICGA检查阳性。都先进行了眼底激光治疗;手术后1年内有2只眼（0.63%）出现新生血管,有36只眼（11.32%）出现了黄斑水肿,有9只眼（2.83%）出现了眼底出血,有2只眼（0.63%）出现了视网膜脱离,经对症治疗后痊愈。②手术后超高度近视组的矫正视力低于普通高度近视组,差异具有显著性意义（t=3.68,P〈0.05）。③手术前及手术后较严重眼底病变组的矫正视力均低于普通眼底病变组,差异具有显著性意义（t手术前=2.28,t手术后=2.46,P〈0.05）。④手术后1年内较严重眼底病变组出现的眼底并发症多于普通眼底病变组,差异具有显著性意义（χ2=7.78,P〈0.01）。结论对高度近视眼行LASIK手术是安全有效的,但其高度近视程度和眼底病变程度会影响手术疗效,手术前应做详尽的眼底检查及相应的预防性治疗,必要时可行FFA和ICGA检查及预防性光凝治疗。

Effects of LASIK for high myopia with fundus pathological changes

Objective To study the effects of excimer laser in situ keratomileusis （LASIK） for high myopia with fundus degeneration.Methods Eyes of 162 patients with high myopia〉6.00 D were inspected by mydriatic 318 fundus examination before LASIK,including 76 eyes of 38 patients with FFA and ICGA examination. Relationship between curative effects,fundus complications and degree of high myopia, degree of fundus pathological changes were analyzed. Results （1）All 318 eyes were operated successfully. 13 eyes （4.09%） with peripheral retina degeneration and 21 eyes （6.60%） with choroidal neovasculature including 5 eyes （1.57%） confirmed only by ICGA were treated by fundus laser preoperation. 2 eyes（0.63% ） with fundus neovasculature and 36 eyes（11.32% ） with macular edema and 9 eyes（2.83% ） with fundus hemorrhage and 2 eyes（0.63%） with retina detachment were cured 1 years later after operation.（2）After operation the corrected visual acuity in super high myopia group was significantly lower than that in normal high myopia group （t=3.68,P〈0.05）. （3）However preoperation and after operation the corrected visual acuity in serious fundus pathological changes group is significantly lower than that in normal fundus pathological changes group （tpreoperation=2.28, tafteroperation=2.46,P〈0.05 ）. （4）After operation complication in serious fundus pathological changes group was significantly more than that in normal fundus pathological changes group （X2=7.78,P〈0.01）.Conclusion It was safe and efficient to treat high myopia by LASIK though affected by degree of myopia and fundus degeneration. It was important to inspect fundus and prepare treatment carefully including FFA and ICGA and retina photocoagulation if necessary.