空军飞行人员角膜屈光矫治现状分析

Primary screening of corneal diopter correction in air crews

摘要：目的掌握现役飞行人员实施角膜屈光矫治术的现状，为后续其全面视觉质量及飞行适应性评估做准备。方法以空军所属航空医学鉴定训练中心人住的现役飞行人员为筛查对象，行裂隙灯检查，部分结合角膜曲率及直接检眼镜彻照检查。对于裂隙灯检查具备角膜屈光矫治后特征、角膜K值低于40或角膜存在异常影动者，选择性实施角膜地形图和角膜厚度检查，结合相关病史采集，确定并记录筛查阳性或可疑阳性者资料。结果筛查现役飞行人员2386例，发现行各类角膜屈光矫治术者59例116眼（2人为单眼），筛查阳性率为2．47％；阳性者年龄23～43岁，平均28．53岁；其中飞行员5例占8．47％，机械师27例占45．76％，领航员1例占1．69％，通射员12例占20．34％，战勤人员14例占24．07％。矫治术式：准分子激光原位角膜磨镶术（1aserinsitukeratomileusis，LASIK）24例47眼占40．52％，准分子激光角膜切削术fphotorefractivekeratectomy，PRK）9例18眼占15．52％，可疑PRK（检查结果支持，本人否认）23例46眼占39．66％，准分子激光上皮瓣下角膜磨镶术（1asersubepithelialkeratomileusis，LASEK）I例2眼占1．72％，放射状角膜切开术（radialkeratotomy，RK）2例3眼占2．59％，以PRK术式居多（占55．18％）。矫治时间3个月～16年，平均7．59年。目前远视力（C字表）0．5～1．5，其中≥1．0有97眼（占83．62％），〈1．0有19眼（占16．38％）；接受检查者平均眼压13．50mmHgf1mmHg=0．133kPa）；平均K值右眼39．69、左眼39．83，平均角膜厚度右眼498．16μm、左眼506．20μm。术后并发症：13．56％存在不同程度干眼及间断视疲劳现象。结论自行角膜屈光矫治术者中83．62％远视力良好，13．56％存在不同程度干眼、视疲劳现象；其视觉质量及飞行适应性评估有待进一步全面检查后确定。

Objective To investigate the corneal diopter correction in air crews on active service for the assessment of their vision and adaptability to flight. Methods Air crews on active service from an aerospace medical identification and training center of air force underwent slit-lamp examination, corneal curvature and direct ophthalmoscopy, respectively. Those with indications for corneal diopter correction or with their corneal K value 〈40 or with abnormal corneal image underwent topography, during which their positive or suspected positive parameters were recorded. Results Of the 2 386 air crews on active service, 59 with 116 eyes （2.47%） aged 23-43 years （mean 28.53 years） received corneal diopter correction. Of these 59 air crews, 5 （8.47%） were pilots, 27 （45.76%） were engineers, 1 （1.96%） was a nevigater,/2 （20.34%） were correspondents and aimers, 12 （24.07%） were combat service supporters. Of these 59 air crews, 24 with 47 eyes （39.66%） underwent LASIK, 9 with 18 eyes （15.52%） underwent PRK, 23 with 46 eyes （55.18%） underwent PRK, 1 with 2 eyes （1.72%） underwent LASEK, and 2 with 3 eyes （2.59%） underwent RK. The operation time was 3 months -16 years （mean 7.59 years）. The distant vision was 0.5 -1.5 after operation with 97 eyes 〉t 1.0 （83.62%）, 19 eyes〈 1.0（16.38%）. The average intraocular pressure （lOP） was 13.50 mmHg, the average corneal K-value was 39.39 in right eyes and 39.83 in the left eyes, the average corneal thickness was 498.16 μm in the right eyes and 506.20 μm in the left eyes. Postoperative complications such as dry eye syndrome and asthenopia occurred in 13.56% of the air crews. Conclusion The distant vision is rather good in 83.62% of the air crews, dry eye syndrome and asthenopia are found in 13.56% of air crews after corneal diopter correction. Their vision and adaptability to flight should be further assessed.