准分子激光原位角膜磨镶术治疗高眼压近视眼的临床观察

Clinical observation of LASIK for myopia with high intraocular pressure

目的 探讨准分子激光原位角膜磨镶术（LASIK）矫治伴有高眼压和早期青光眼的近视患者的效果和安全性。方法 眼压21～25mmHg（平均21．8mmHg±0．84mmHg，1kPa=7．5mmHg）的33例（48眼）近视患者接受了LASIK手术。术前平均等值屈光不正度为-5．87D6±2．37DS，平均角膜中央厚度577．3μm±32．4μm，裸眼视力0．04～0．4。其中视野正常44眼，生理盲点扩大4眼，30眼C/D≥0．6，视盘周围或颞侧有萎缩斑34眼。有开角青光眼家族史者4例。设置LASIK的矫正量比术眼屈光不正度高15％．术后不用激素眼液。结果 术后第6月的平均角膜厚度为490．6μm±36．5μm，术后1a视野、杯盘比（C／D）无改变。术后1～12月的平均视力在1．32±0．22以上，平均眼压在13．8mmHg±1．5mmHg以下，平均等值屈光不正度为0．30～0．43DS。与术前相比，术后眼压、角膜厚度和等值屈光不正度显著下降（P〈0．01），裸眼视力显著提高（P〈0．01）。结论 伴有高眼压或早期开角青光眼的近视患者可以试行LASIK手术。

Objective To explore the safety and efficacy of LASIK for correcting myopia with high intraocular pressure （IOP） and glaucoma. Methods Thirty-three patients with myopia（48 eyes） with IOP of 21-25mmHg（21.8mmHg ±0.8 mmHg, 1kPa = 7.5 mmHg） were performed LASIK. The preoperative average equivalent diopter （ED） and central corneal thickness （CCT） were - 5.87 DS ± 2.37 DS and 577.3μm ± 32.4μm, respectively. Before the surgery they had uncorrected visual acuity （UVA） 0.04-0.4. In all patients, 44 eyes had normal visual field, 4 eyes had larger physiological blind spot, 30 eyes were C/D≥0.6,34 eyes had atrophy at the temporal side of the optic disc or surrounding the disc, 4 patients had open angle glaucoma family history. Corrected diopter was larger than refractive error by 15%. No corticesteroid was given after the surgery. Results Mean postoperative CCT was 490.6μm ±36.5μm at 6 month. No changes of visual field and C/D ratio were found in the 12th month after the surgery. UVA was over 1.32 ± 0.22,average IOP was below 13.8 mmHg±1.5 mmHg, ED was 0.30 - 0.43 DS. Comparing with pretreatment, IOP, CCT, and ED significantly reduced（P 〈 0.01 ）, and UVA significantly increased （ P 〈 0.01 ） after the surgery. Conclusion Myopia with high IOP and open angle glaucoma can be performed LASIK prudentially.