LASIK术前无症状视网膜病变特征分析与氩激光疗效评价

Characteristics and management of asymptomatic retinopathies in myopic eyes before LASIK

目的:分析LASIK术前检查发现的近视患者无症状视网膜病变的特征,评价眼底氩激光光凝治疗的疗效与安全性。方法:对LASIK术前检查发现视网膜病变的近视患者127例(135眼)扩瞳,应用三面镜进行眼底检查,详细记录视网膜病变的类型、部位。根据患者等效球镜度数分为低度组(≤3.00D),中度组(-3.00^-6.00D)和高度组(≥-6.00D);依据周边部视网膜病变特点分为单纯变性、变性合并干性裂孔,以及裂孔合并视网膜局限性浅层脱离3组。比较各组间视网膜病变分布情况,分析视网膜裂孔的特点。数据应用SPSS12.0进行χ2检验。氩激光光凝(100~400mW,0.03~0.1s,200~500μm),术后随访3mo^1a,定期检查视网膜情况,记录。结果:视网膜病变及视网膜裂孔的发生率均随屈光度增加而提高,组间有显著性差异(P<0.05),颞侧病变比例高于鼻侧。视网膜裂孔中圆形萎缩孔占81.1%,单一裂孔占54.4%,裂孔位置以正上方和颞上方最多。眼底氩激光治疗术后病情稳定,未发生视网膜脱离。结论:近视患者无症状视网膜裂孔中圆形变性萎缩孔最常见,其发生率随着屈光度的增加而明显上升。氩激光对干性视网膜裂孔和局限性孔源性视网膜脱离疗效较好。

AIM： To analysis the characteristics of retinal lesions in asymptomatic myopic patients scheduled for laser in situ keratomileusis （LASIK）, then to assess the efficacy and safety of prophylactic laser photocoagulation for retinal breaks in these myopic eyes. METHODS： Before LASIK, 127 patients （135 eyes） with retinal lesions were divided into there groups according to PSER： low myopia （≤-3.00D）, medium myopia （-3.00 to -6.00D）and high myopia （≥-6.00D）. Peripheral fundus abnormalities included simple degenerations, coexisted retinal breaks, and holes coexisted with localized light retinal detachment. We compared various retinal lesions in different groups and analyzed the characteristics of asymptomatic retinal breaks. The difference was analyzed using a chi-square test. All patients with retinal breaks underwent argon laser photocoagulation to seal the breaks. Post-operatively, patients were followed-up for a period of 3 months to 1 year. RESULTS： Peripheral fundus abnormalities and holes both increased while refraction diopter increased, and there were statistically significant differences among groups （P〈0.05）. And the abnormalities were usually in the temporal fundus. Single atrophic holes was the most common type and usually localized in superotemporal and supra-peripheral fundus. During a mean 6 months followup, none of the patients developed retinal detachment. CONCLUSION： The most frequent asymptomatic retinal ruptures are the atrophic holes in myopic patients. The incidences of the retinal ruptures are obviously increased with diopter of myopia. Argon laser is a good method for closing these breaks.