准分子激光原位角膜磨镶术对视网膜神经纤维层厚度的影响

Influence of eximer laser in situ keratomileusis on retinal nerve fibre layer

目的研究准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)对视网膜神经纤维层(retinal nerve fibre layer,RNFL)厚度的影响。方法选择拟行LASIK患者90例90眼,根据术前屈光程度分为3组:轻度、中度、高度近视组。分别于术前及术后1d、3d、1周、1个月进行光学相干断层扫描检查,测量视盘周围RNFL厚度。结果轻度组术前及术后1d、3d、1周、1个月RNFL平均厚度分别为(114·95±11.61)μm、(97.63±13.81)μm、(97.62±14.00)μm、(112.28±13.58)μm、(112.33±13.72)μm;中度组各时间点RNFL平均厚度分别为(113.75±13.74)μm、(107.54±10·03)μm、(111.27±11.34)μm、(114.34±10.51)μm、(114.84±9.79)μm;高度组各时间点RNFL平均厚度分别为(107.80±14.71)μm、(100.91±15.31)μm、(102.34±14·00)μm、(109.70±15.19)μm、(108.94±14.24)μm。3组术后1d、术后3dRNFL平均厚度较术前减少,差异有统计学意义(P<0.05);术后1周、1个月RNFL平均厚度与术前比较差异无统计学意义(P>0.05)。术后1d、3d3组间RNFL平均厚度变化比较差异无统计学意义(F=0.006,P>0.05;F=0·438,P>0.05)。结论LASIK术后早期RNFL减少,以后逐渐恢复,1周恢复至正常水平。从远期效果来看此手术是安全的。

Objective To study the influence of laser in situ keratomileusis （LASIK） on retinal nerve fibre layer （RNFL）. Methods Ninety patients （ 90 eyes） undergoing LASIK were divided into three groups according to preoperative spherical equiralent： mild myopia group, medium myopia group and high myopia gronp. RNFL thickness was measured using optical coherence tomography （OCF） -3 Stratus preoperation and at one day, three days, one week and one month postoperatively. Results The RNFL average thickness at preoperation and at one day, three days, one week and one month postoperatively were （ 114.95 ± 11.61 ） μm, （97. 63 ± 13.81 ） μm, （97.62 ± 14.00） μm, （112.28 ± 13.58） μm and（ 112.33 ± 13.72） μm in mild myopia group, were （113.75 ± 13.74） μm, （107.54 ± 10. 03） μm, （ 111.27 ± 11.34） μm, （ 114.34 ± 10.51 ） μm and （ 114.84 ± 9.79 ） μm in medium myopia group ,were （107.80 ± 14.71 ） μm, （ 100.91 ± 15.31 ） μm, （ 102.34± 14. 00 ） μm, （ 109.70 ± 15.19 ） μm and （ 108.94 ± 14.24 ） μm in high myopia group. The RNFL average thickness obtained by OCT-Master at one day and three days postoperatively were significantly lower than preoperative values in either of the studied groups （P 〈 0.05 ） ; The RNFL average thickness was not significantly difference at one week and one month than preoperative values （ P 〉 0.05 ）. There was no statistical difference between one day and three days postoperative RNFL average thickness in the three groups （F = 0. 006,P〉0. 05;F=0. 438,P〉0.05 ）. Conclusion RNFL may decrease at the early stage after LASIK, and increase to normal level at one week after the operation. LASIK is safe at the long-term effectiveness.