合并视网膜病变的近视患者优先行经上皮准分子激光屈光性角膜切削术的安全性

Security discussion on transepithelial photorefractive keratectomy preferentially performed on the patients with retinopathy

目的:探讨对术前发现合并视网膜病变(除视网膜脱离)的近视患者优先进行经上皮准分子激光屈光性角膜切削术(transepithelial photorefractive keratectomy,Trans-PRK)屈光手术治疗的安全性和疗效。方法:采用准分子激光系统对46例65眼术前检查发现有视网膜病变(除视网膜脱离外)的患者进行Trans-PRK治疗,其中先行眼底激光治疗后行Trans-PRK的21例33眼患者设为对照组,另外先行Trans-PRK后行眼底激光治疗的25例32眼患者设为研究组,两组均对患者术后视网膜情况、裸眼远视力、矫正视力、屈光度、眼压进行随访,观察并分析。结果:研究组Trans-PRK术后2wk及视网膜光凝后1mo检查,均未发现视网膜裂孔增大,未发现视网膜脱离,视网膜变性区范围无扩大,程度未加深。对照组于视网膜光凝后1mo及Trans-PRK后1mo检查见视网膜变性区及裂孔均稳定,未见扩大及加深。结论:合并视网膜病变的近视患者先行Trans-PRK或者先行视网膜光凝均未对视网膜病变造成影响;对术前检查发现合并视网膜病变(除视网膜脱离)的患者优先进行Trans-PRK术是安全、有效的,并且为患者争取了尽快恢复裸眼视力、参加体检的时间。

AIM： To study the safety and effectiveness of transepithelial photorefractive keratectomy （ Trans-PRK ） preferentially performed on the patients with retinopathy （ except retinal detachment ） in the preoperative examination. METHODS： Forty - six patients （ 65 eyes ） with retinopathy （ except retinal detachment ） in the preoperative examination underwent Trans- PRK using VISX STAR S4 IR laser platform, Of which 25 cases （ 32 eyes） in the study group were treated by Trans-PRK before retinal photocoagulation, whereas 21 cases （ 33 eyes ） in the control group underwent retinal photocoagulation prior to Trans-PRK. Clinical outcomes of retinopathy, uncorrected visual acuity, corrected visual acuity, refraction and intraocular pressure were observed and analyzed. RESULTS：After two weeks of Trans- PRK and one month of retinal photocoagulation, the examination results in the study group showed that the retinal holes were not found enlarged, and no retinal detachment occurred, the retinal pathological changes were stable and retinal degeneration area did not expanded. After one month ofretinal photocoagulation and one month of Trans-PRK, retinal degeneration areas and holes were stable,did not expand and deepen in control group. CONCLUSION：Preferentially performed Trans-PRK or retinal photocoagulation on the patients with retinopathy has no impact on retinopathy. The results show that it is safe and effective to preferentially perform Trans-PRK on patients with retinopathy, and gains time for the patients to recover uncorrected visual acuity as soon as possible and participate in physical examination.