作者：刘建国，万雅群，李 勇，许 恂，叶 璐
作者单位：中国陕西省西安市,第四医院眼科准分子激光中心
【摘要】 目的：了解准分子激光原位角膜磨镶术(LASIK)术前初诊患者视网膜病变的类型和程度，明确手术适应证选择，术前给予相应处理,进一步提高手术安全性。
方法：对LASIK术前初诊4 248眼屈光度 0.50D～18.00D，散光≤6.00D的近视患者散瞳三面镜检查眼底，详细绘图记录检查结果，并给予相应处理，对实施LASIK手术者随访10～20mo。
结果：被检4248眼中，发现各种视网膜变性778眼(18.31%)；其中格子样变性60眼(1.41%)，霜样变性432眼(10.17%)，囊样变性72眼(1.69%) ,薄变22眼（0.52%），有两种以上混合变性的71眼(1.67%),视网膜增殖121眼(2.85%),周边视网膜干性裂孔71眼(1.67%)。其中严重视网膜变性65眼，干性视网膜裂孔71眼行氩激光光凝治疗，视网膜脱离9眼,4眼视网膜脱离需行手术,5眼局限性脱离行光凝.所有LAS1K术后患者均未发现眼底病变加重或发生视网膜脱离。
结论：LASIK术前详细了解视网膜病变是必要的,它能够为明确手术适应证,把握手术时机提供重要的参考依据。
【关键词】 准分子激光原位角膜磨镶术；视网膜变性；适应证
Clinical treatment of fundus diseases before LASIK
JianGuo Liu, YaQun Wan, Yong Li, Xun Xu, Lu Ye
Excimer Laser Center, Department of Ophthalmology, the Fourth Hospital of Xian City, Xian 710004, Shaanxi Province, China
AbstractAIM: To investigate the type and degree of retinopathy before LASIK, definite the selection of operative indication in order to improve the security.
METHODS: The fundus of 4248 eyes, whose dioptre was 0.50D to 18.00D, astigmatism was ≤6.00D, were examined by threemirror contact lens under the condition of mydriasis. The results were recorded and the patients were given corresponding treatment. The followup time was 1020 months.
RESULTS: Various retinal degeneration were found in 778 eyes (18.31%), including lattice degeneration in 60 eyes (1.41%), frosted degeneration in 432 eyes (10.17%), cystoid degeneration in 72 eyes (1.69%), retina thinning in 22 eyes (0.52%) and two or more kinds of degenerations in 71 eyes (1.67%). There were 121 eyes (2.85%) presented retinal proliferation, of them, 65 eyes with serious retinal degeneration and 71 eyes with peripheral retinal holes were treated by Argon laser photocoagulation. Nine cases were retinal detachment, in which, 4 cases needed operation and 5 cases with localized detachment underwent photocoagulation. Postoperatively, all eyes were not presented lesions progressing or retinal detachment.
CONCLUSION: It is necessary to know the retinopathy before operation, which can help us to clear the operative indication and grasp the operation opportunity.
KEYWORDS: fundus diseases; LASIK
Liu JG, Wan YQ, Li Y, et al. Clinical treatment of fundus diseases before LASIK. Int J Ophthalmol(Guoji Yanke Zazhi) 2008;8(10):23462347
0引言
准分子激光角膜原位磨镶术(laser in situ keratomileusis, LASIK)是目前矫正屈光不正最普遍的屈光性角膜手术[1]。其视觉质量和安全性一直是广大患者和医师关注的焦点。随着准分子屈光手术的设备、技术不断创新发展，对LASIK术前的眼底情况进行全面了解和正确处理,是保证手术效果、预防术前或减少术后并发症的重要的措施。我中心将眼底三面镜检查作为手术前常规检查，及时处理发现的问题，在保证术后视力、预防术后并发症方面,取得了一定的成效。现将我中心自2006 01/200612术前初诊4248眼散瞳三面镜检查结果、及其处理效果追踪随访进行总结分析，结果报告如下。
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