准分子激光原位角膜磨镶术对黄斑及视网膜神经纤维层厚度的影响

Effect of Laser in Situ Keratomileusis on Macular and Retinal Nerve Fiber Layer Thickness Measured by Optical Coherence Tomography

【目的】探讨准分子激光原位角膜磨镶术(LASIK)对黄斑及视网膜神经纤维层(RNFL)厚度的影响。【方法】对拟行双眼LASIK手术的屈光不正患者30例进行检查,随机选取一眼入组研究。于LASIK术前1天及术后4周进行检查,检影验光比较术前后屈光度、OCT3测量并比较角膜厚度、黄斑中心凹厚度及RNFL厚度钟点值。【结果】LASIK术后,患者的屈光度明显减低(P=0.000),角膜厚度亦较术前显著变薄(P=0.000)。LASIK手术前后黄斑中心凹厚度分别为(141±7)μm及(141±8)μm,两者比较差异无统计学意义(P=0.261)。LASIK手术前后RNFL厚度均呈双峰状,于上、下方最厚,鼻、颞侧较薄。LASIK手术前上方、鼻侧、下方、颞侧RNFL厚度(象限值)分别为(136±7)μm,(77±15)μm,(123±11)μm,(84±16)μm;而术后4周分别为(135±9)μm,(80±12)μm,(123±12)μm,(83±8)μm,与术前比较差异无统计学意义(P=0.098～0.907)。而当按钟点值比较时,术后患者RNFL厚度测量除鼻侧3点方位(P=0.040)外,其余均较术前无明显变化(P=0.114～0.974)。【结论】常规LASIK手术对中、低度近视患者的RNFL厚度及黄斑厚度无明显影响。

[Objective] To study the effect of laser in situ keratomileusis （LASIK） on macular and retinal nerve fiber layer （RNFL） thickness measured by optical coherence tomography （OCT）. [Methods] Thirty subjects with bilaterial refractive errors which would undergo LASIK on both eyes were enrolled to this study. One eye of each subject was randomly chosen. Refraction before and after operation measured by retinoscopy optometry, corneal thickness, foveal thickness, and clockwise RNFL thicknesses examined by OCT3 were compared 1 d before and 4 weeks after LASIK. [Results] Refraction of patients was dramatically decreased after LASIK （P = 0.000）, and corneal thicknesses after LASIK were significantly thinner than those before LASIK （P = 0.000）. The foveal thicknesses before and after LASIK were （141 ± 7）μm and （141± 8）μm respectively, with no statistical significance （P = 0.261）. Before and after operation, the RNFL thicknesses both showed typical double-hump shape, which were thicker in superior and inferior areas and thinner in nasal and temporal areas. The superior, nasal, inferior and temporal RNFL thicknesses before LASIK were （136 ± 7）μm, （77 ± 15） μm, （123 ± 11） μm, and （84 ± 16） μm, and those 4 weeks after LASIK were （135 ± 9）μm, （80 ± 12） μm, （123 ± 12） μm, and （83 ± 8） μm, which showed no statistical significance （P = 0.098 - 0.907）. Clockwise RNFL thicknesses before and after LASIK showed no difference （P = 0.114 - 0.974） except which on 3 o＇clock （P = 0.040）. [Conclusion] Routine LASIK operation on patients with low and medium myopia has no effect on RNFL and macular thickness.