LASIK术前近视眼周边视网膜病变的观察与治疗

Observation and treatment of peripheral retinal degeneration of myopia before LASIK

目的：观察准分子激光原位角膜磨镶术（LASIK）前近视眼周边视网膜变性的发生情况，以及氩离子激光预防性光凝治疗的疗效。方法：回顾性研究，分析了施行LASIK术的连续性病例550例（1100眼）的术前资料，在对所有患者术前扩瞳后以检眼镜、三面镜详细检查眼底周边视网膜情况并记录，对严重的视网膜病变如格变、囊样变、干性裂孔、视网膜浅脱离等予以氩离子激光光凝治疗，经随访稳定有效后再择期行LASIK手术。结果：在全部患眼的检查中，发现各类视网膜变性350眼（31．82％），其中，171眼发现格变（48．86％）、98眼发现囊变（28．00％）、144眼发现霜变（41．14％）、90眼发现不压白变（25．71％）、32眼发现铺路石样变（9．14％）、38眼发现干性裂孔（10．86％）、6眼则发现裂孔伴局限性浅脱离（1．71％）。其中191眼（54．57％）仅发现有一种视网膜变性，115眼（32．86％）发现有两种变性，44眼（12．57％）发现有3种或3种以上视网膜变性。视网膜周边各种退行性病变的分布位置，265眼（75．71％）中发现颞上象限病变，177眼（50．57％）中发现颞下象限病变，78眼（22．29％）中发现鼻上象限病变，59眼（16．86％）中发现鼻下象限病变。其中，207眼（59．14％）病变范围累及一个象限，92眼（26．29％）累及两个象限，51眼（14．57％）累及三个或四个象限。对出现较严重视网膜病变的43例患者（48眼）施行了眼底氩激光治疗。复诊时见激光斑反应明显、干性裂孔稳定，局限性浅脱离患者经2—4次激光光凝后视网膜完全平复。对眼底经光凝后行LASIK的患者，在3～6mo复诊中无1例视网膜脱离发生。结论：LASIK术前对全部患者进行常规三面镜详查眼底是十分有必要，对发现的周边视网膜严重变性及时予以激光光凝能够有效防止视网膜脱离的发生。

AIM： To observe the peripheral retinal degeneration of myopia before LASIK and the effect of treatment with Argon laser photocoagulation. METHODS： Retrorespective clinical research. LASIK were performed in 550 continuous patients （1100 eyes）. Before operation, the fundus was examined with direct and indirect ophthalmoscope and three-mirror contact lens. The laser photocoagulation was performed in order to strengthen the retina with severe peripheral degeneration. RESULTS： A total of 1 100 eyes were examined. Among them, 350 eyes （31.82%） were found to have peripheral retinal degeneration： 171 eyes （48. 86%） had lattice degeneration, 98 eyes （28.00%） had cystoid degeneration, 144 eyes （41.14%） had snail track, 38 eyes （10.86%） had retinal dry holes, 6 eyes had local retinal detachment. Most of eyes （306 eyes, 87.43% ） had one or two kinds of retinal degeneration. Most of the degenerations （299 eyes, 85.43%） had been founded in one or two quadrants and it＇s often founded in the quadrant of temporal. The pathological changes were treated effectively by laser photocoagulation for more than three weeks, and eventually the holes were firmly closed and the lattice degeneration, the cystoid degeneration were photocoagulated reliably. No new holes and retinal detachment occurred. CONCLUSION： It＇s necessary to examine the fundus of the two eyes with the three-mirror contact lens before LASIK, To prevent retinal detachment effectively, laser photocoagulation should be performed in time on the peripheral retinal degeneration of myopia.