角膜屈光手术与青光眼(英文)

Keratorefractive surgery and glaucoma

角膜屈光手术改变了角膜厚度及曲率,影响术后眼压(in-trocular pressure,IOP)的测量,但动态轮廓眼压计(dynamiccontour tonometer ,DCT)不受此影响。激光原位角膜磨镶术(LASIK)中一过性的IOP升高,增加了视神经损害的风险。同时,功能性滤过泡的存在,影响屈光手术的选择和效果,甚至可能成为手术的禁忌。术后患者使用激素点眼,还可能导致激素性青光眼,故应严密监测术后眼压,并且注意角膜瓣层间积液可能掩盖高眼压。对于已接受屈光手术的青光眼患者,药物治疗方案与其他青光眼患者基本相同。本文就角膜屈光手术对眼压测量、青光眼相关特殊检查的影响、屈光手术并发症及其治疗、手术安全性等问题进行了详细综述。

Keratorefractive surgery changes the central corneal thickness （CCT） and corneal curvature, which could influence the Goldmann applanation tonometer （GAT） and non-contact tonometer （NCT） measurements of Intraocular pressure （IOP）, but not dynamic contour tonometer（DCT）. During the procedure of LASIK, there is a transient rise of lOP, which increases the risks of optic nerve damage, Meanwhile, the presence of functioning filtering blebs may affect the choice and outcome of refractive surgery, or even becomes a contraindication of surgery. Steroids are typically used after keratorefractive surgery, which could lead to IOP elevation. Hence it is important to monitor IOP after LASIK and to be aware of inaccurate IOP readings due to corneal flap interface fluid. Treating patients with postoperative elevated lOP after keratorefractive surgery is similar to that for patients with glaucoma, This review will address the issues surrounding the safety, relevant complications and implications of keratorefractive surgeries on glaucoma and relevant diagnostic tests.