LASIK与LASEK术前后视网膜中动脉血流动力学对比观察

Effect on hemodynamics of central retinal artery in LASIK and LASEK

目的：观察准分子激光原位角膜磨镶术（LASIK）与准分子激光上皮下原位角膜磨镶术（LASEK）术前术后对视网膜中动脉血流动力学的影响。方法：应用美国GE公司新LG7彩色多普勒超声诊断仪,分别对LASIK患者86例172眼和LASEK患者17例34眼于术前、术后1,3,6mo检测视网膜中动脉血流,并用脉冲多普勒检测收缩期峰值流速（peak sysrolic velocit,PSV）,舒张期最小血流速度（end diastolic velocity,EDV）,并计算出阻力指数（resistance index,RI）和搏动指数（pulsatilityindex,PI）。并将两组术式的以上血流参数进行对比。结果：LASIK组与LASEK组术中,所有病例手术顺利,无并发症。术后6mo,屈光度基本稳定;术后6mo视力,LASIK组：86例172眼裸眼视力0.8~1.5（平均0.95±0.27）,均达到或超过术前最佳矫正视力。LASEK组：17例34眼裸眼视力0.6~1.2（平均0.83±0.30）,矫正视力均达到或超过术前最佳矫正视力。在两组手术病例18~40岁的近视眼人群中,视网膜中央动脉血流动力学参数值跟性别和眼别无相关性。LASIK组手术前、术后1,3,6mo视网膜中动脉PSV,EDV,RI和PI分别为：（1）PSV：9.62±0.40,9.59±0.51,9.65±0.44,9.61±0.49cm/s;（2）EDV：3.26±0.38,3.24±0.29,3.22±0.31,3.27±0.34cm/s;（3）RI：0.661±0.040,0.662±0.050,0.656±0.050,0.664±0.040cm/s;（4）PI：1.501±0.020,1.503±0.020,1.502±0.020,1.501±0.020cm/s。LASEK组手术前、术后1,3,6mo视网膜中动脉PSV,EDV,RI和PI分别为：（1）PSV：9.63±0.33,9.58±0.44,9.64±0.29,9.80±0.49cm/s;（2）EDV：3.28±0.40,3.27±0.39,3.26±0.38,3.30±0.41cm/s;（3）RI：0.659±0.040,0.658±0.040,0.661±0.030,0.663±0.030cm/s;（4）PI：1.502±0.020,1.501±0.020,1.503±0.020,1.501±0.020cm/s。两组手术前后各时间点血流动力学参数值经统计学分析均无显著差异（P〉0.05）。结论：LASIK与LASEK两组手术方式中激光切削时的冲击力及负压吸引对视网膜中动脉血流动力学无临床病理性影响。

·AIM：To evaluate the effect of laser in situ kerat-omileusis（LASIK）and laser epithelial keratomileusis（LASEK）on central retinal artery（CRA）blood flow.·METHODS：Clinical data of 86 patients 172 eyes underwent LASIK and 17 patients 34 eyes underwent LASEK were collected.CRA peak systolic velocity（PSV）and end diastolic velocity（EDV）in cm/s were recorded using color Doppler.Primary outcomes recorded were CRA-PSV and EDV at preoperative and postoperative 1 month,3 and 6 months;Resistance index（RI）=（PSV-EDV）/PSV;Pulsatility index（PI）=（PSV-EDV）/mV.SPSS 13.0 statistic software package was used for data analysis.·RESULTS：In LASIK group,CRA-PSV,EDV,RI and PI at various time were 9.62±0.40,9.59±0.51,9.65±0.44,9.61±0.49cm/s;3.26±0.38,3.24±0.29,3.22±0.31,3.27±0.34cm/s;0.661±0.040,0.662±0.050,0.656±0.050,0.664±0.040cm/s;1.501±0.020,1.503±0.020,1.502±0.020,1.501±0.020cm/s.In LASEK group,time-varing data were respectively 9.63±0.33,9.58±0.44,9.64±0.29,9.80±0.49cm/s;3.28±0.40,3.27±0.39,3.26±0.38,3.30±0.41cm/s;0.659±0.040,0.658±0.040,0.661±0.030,0.663±0.030cm/s;1.502±0.020,1.501±0.020,1.503±0.020,1.501±0.020cm/s.There were no significant differences between pre-and postoperation at various times.·CONCLUSION：During LASIK and LASEK,impact force and vacuum suction have no adverse effect on CRA blood flow.·