歼击机飞行员准分子激光角膜屈光手术后放飞一例并文献复习

A qualified case of fighter pilot treated by laser-assisted subepithelial keratomileusis and literature review

目的 探讨飞行员角膜屈光手术治疗的飞行适应性及航空医学的鉴定原则.方法 分析1例歼轰-7飞行员双眼近视的临床诊断、治疗过程及医学鉴定情况,复习相关文献.结果 本例飞行员诊断为近视性屈光不正2年,保守治疗无效.本人要求手术治疗.眼科检查未见手术禁忌证,经过准分子激光上皮下角膜磨削术治疗,术后常规局部抗炎、促进角膜伤口愈合等药物治疗约1个半月,3个月后复查视功能（包括视力、立体视觉、对比敏感度）恢复正常;双眼角膜伤口愈合良好,电脑验光屈光度稳定;角膜地形图示切削区居中.经低压舱模拟航空低压缺氧环境检查,视功能稳定,给予特许飞行合格.术后正常参加双座机飞行40 h. 结论 军事飞行员近视角膜屈光手术治疗后,角膜伤口愈合良好,视功能恢复正常者可以考虑放飞.飞行适应性评价除常规定期视功能、屈光度、角膜等检查外,应进行对比敏感度、眩光等与飞行环境相关的特殊视功能检测.准分子激光角膜屈光手术是解决军事飞行员近视的有效方法.

Objective To discuss the effects of laser refractive surgery adopted to flight and the principle of related aeromedical evaluation.Methods A case of JH-7 pilot with myopia was analyzed on clinical diagnosis,treatment,recovery,aeromedical evaluation and re-flight status,and the related literatures were reviewed.Results Myopic refractive error eyes of the pilot had been diagnosed for 2 years and the conservative treatment was inefficacy.Upon his request and no surgical contraindications were found the laser assisted subcpithelial keratomileusis （LASEK） was conducted to the pilot.He then received conventional local anti-inflammation treatment and enhanced recovery medication for one and balf month.According to 3 months follow-up,his visual functions （visual acuity,stereopsis,contrast sensitivity function） returned to normal.The corneal wound healed well.The diopter of eyes was stable.Corneal topography showed the ablation zone was located at center.His visual functions were normal in altitude chamber test.The pilot was waivered for the flight with other pilot and had safely flown for 40 h.Conclusion The military pilots may get waiver permission to fly as they are ensured the safety and efficacy of laser refractive surgery.The evaluation of flight adaptability should conventionally include not only the visual acuities,refraction,corneal examinations,but also such examinations as contrast sensitivity and glare adaptability for special flight environment.Laser refractive surgery is an efficacious option for refractive correction in military pilots.