摘要
目的:探讨激光屈光术前视网膜病变的及早诊断和处理方法及屈光手术方式的选择和疗效。方法:对预施准分子激光屈光手术的患者,扩瞳行三面镜检查,对有视网膜严重病变如裂孔伴格子样变性和囊样变性等的患者进行治疗,并随访后决定是否行屈光手术及选择何种术式。屈光术后随访24mo以上。结果:共检查648眼,52眼有视网膜裂孔及伴需处理的格子样变性或囊样变性区,占8.0%,有5眼因为视网膜病变严重,在处理眼底病变并随访后,未行准分子激光屈光手术。其余47眼在行激光处理视网膜病变后3wk以上,或冷凝手术3mo以后,查眼底原有视网膜裂孔牢固闭合、格子样变性囊样变性区激光光凝包绕确切并无新裂孔出现且视网膜无脱离,对其中26眼行LASEK手术、21眼行LASIK手术。结论:屈光手术不可忽视视网膜病变,应该将眼底的三面镜检查作为术前的常规检查项目。一旦发现格子样变性、囊样变性区和裂孔等病变,应及时采取预防性激光光凝等治疗,定期随访,如需行近视矫治手术应考虑手术的方法与时机。
AIM： To explore the methods of early diagnosing and treating pathological changes on retina before refractive surgery and to choose the style of excimer laser refractive surgery.
METHODS： The examination of fundus by three mirror contact lens through dilated pupfl was conducted for patients who wanted to undergo excimer laser surgery. The severe pathological changes such as lattice degeneration ,cystoid degeneration, and retinal holes which had been found out by the examination must be treated. After a period of follow-up, the derision should be made that whether the refractive surgery could be done and that which kind of surgery would be chosen. After excimer surgery, a follow-up of more than 24 months was also conducted.
RESULTS： A total of 648 eyes were examined. Among them, 52 eyes （8.0%） were found to have peripheral retinal holes in some part accompanied by lattice degeneration and/or cystoid degeneration that should be dealt with. The pathological changes were treated effectively by laser photocoagulation for more than 3 weeks or by cryoretinopexy and sderal budding for more than 3 months, and eventually the former holes were firmly dosed and the lattice degeneration, the cystoid degeneration were photocoagulated reliably, and no new holes and retinal detatchment occurred. Then 47 eyes were carried out the refractive surgery （26 eyes in LASEK, and 21 eyes , LASIK）. 5 eyes did not undergo refractive surgery because the lesions were so severe that the refractive treatment had no benefit even if the management of pathological changes had been well finished.
CONCLUSION： The severe retinal pathological changes can not be ignored in refractive surgery. The examination of fundus by three-mirror contact lens should be regarded as a routine. As soon as lattice degeneration, cystoid degeneration, tears and holes were found in retina, some measures such as prophylactic laser photocoagulation should be applied. Then follow-up should be taken periodically. If the refractive surgery is necessary, the methods and time of the operation should be taken into account.
出处
《国际眼科杂志》
CAS
2007年第4期1046-1048,共3页
International Eye Science
关键词
视网膜病变
屈光手术
手术方式
retinal pathological changes
refractive surgery
