高度近视眼底病变对LASIK手术疗效的影响

The effects of LASIK on high myopia associated with fundus pathological change

目的观察高度近视眼底病变对准分子激光原位角膜磨镶术(LASIK)手术疗效的影响,探讨其安全有效性。方法对162例(318眼)屈光度在6.00D以上的高度近视患者行LASIK治疗,对患者高度近视程度、眼底病变程度与术后视力、眼底并发症等进行比较分析。结果术后超高度近视组的矫正视力低于普通高度近视组(P<0.05)。手术前后较严重眼底病变组的矫正视力均低于普通眼底病变组(P<0.05)。术后1年内较严重眼底病变组出现的眼底并发症多于普通眼底病变组(P<0.01)。术后出现眼底病变组的矫正视力低于未出现眼底病变组(P<0.05)。结论对高度近视眼行LASIK是安全有效的,但高度近视程度和眼底病变程度会影响手术疗效,术前应做详尽的眼底检查及相应的预防性治疗,必要时可行荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查及预防性光凝治疗。

Objective Fundus status is of great influence for rehibitation of vision after excimer laser in situ keratomileusis （LASIK） for myopia. Present study aim to assess the effects of LASIK on high myopia associated with fundus degeneration. Methods 318 eyes of 162 patients with high myopia 〉 6.00 D were inspected by mydriatic fundus examination before LASIK, and 76 of 318 eyes received fluorescent fundus angiography （FFA） and indocynion green angiography （ICGA）. Relationship between curative effect, fundus complication and degree of high myopia or degree of fundus pathological changes were analyzed. Results LASIK in all 318 eyes were successfully. Thirteen eyes （4.09%） with peripheral retina degeneration and 21 eyes （6.60%） with choroidal neovasculature（ including 5 eyes confirmed only by ICGA） received photocoagulation prior to LASIK. Two eyes （0.63%） with fundus neovasculature, 36 eyes （ 11.32% ） with macular edema, 9 eyes （2.83%） with fundus hemorrhage and 2 eyes（0. 63% ） with retina detachment were cured 1 year after LASIK. The postoperative corrected visual acuity in snperhigh myopia group was significantly lower than that in high myopia group（ t = 3.68, P 〈 0. 05 ）. However, preoperative and postoperative corrected visual acuities in serious fundus changes group were significantly lower than that in mild fundus changes group（tpreope = 2. 28, tpost-op = 2.46, P 〈 0. 05 ）. The postoperative complication in serious fundus change group was significantly increased in comparison with mild fundus change group （X2 = 7.78, P 〈 0. 01 ）. The postoperative corrected visual acuity in complication group was significantly lower than that without complication group（t = 3.17,P 〈 0. 01 ）. Conclusion LASIK is a safe and effective treating way to high myopia. It is important to inspect fundus by FFA and ICGA or to perform retinal photocoagulation if necessary.