准分子激光原位角膜磨镶术后患者玻璃体视网膜病变观察

Incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis

目的 观察近视性屈光不正患者行准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)后的玻璃体视网膜病变情况。方法 对 995例 (1981只眼 )近视性屈光不正患者 ,于LASIK术前 1d ,术后 1、3及 12个月进行扩瞳 ,以间接检眼镜、三面镜及Volk视网膜镜等详细检查玻璃体和视网膜改变 ,术后 1年进行不定期复查。结果 发生玻璃体视网膜病变者 13例 (16只眼 ) ,占 0 81% ;术前屈光度数为 (- 9 4 5± 2 6 1)D。其中表现为视网膜格子样变性或原病变区扩大者 6只眼 ,占 0 30 % ;单纯玻璃体后脱离 2只眼 ,占 0 10 % ;黄斑出血 2只眼 ,占 0 10 % ;视网膜干孔2只眼 ,占 0 10 % ;孔源性视网膜脱离 4只眼 ,占 0 2 0 %。患者出现病变距LASIK术后 1～ 2 4个月不等 ,平均 (10 38± 6 2 0 )个月。患者术前屈光度数≥ - 6 0 0D者与 <- 6 0 0D者比较 ,两组术后玻璃体视网膜病变的发生率差异有显著意义 (χ2 =6 0 78,P <0 0 1) ;术前有或无视网膜格子样变性及干孔病灶患者间 ,术后视网膜格子样变性及干孔病灶的发生率差异有显著意义 (χ2 =138 6 4 ,P <0 0 1)。结论 与近视性屈光不正眼部病理改变的发展规律比较 ,尚无证据说明LASIK与术后患者玻璃体视网膜病变有直接关系 ,术前详细检查眼底。

Objective To determine the incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis. Methods Vitreoretinal pathologic conditions of 1981 consecutive eyes (995 patients) having undergone laser assisted in situ keratomileusis for the correction of myopia were studied. Preoperative and postoperative basic examinations included visual acuity, manifest and cycloplegic refraction, slit lamp microscope examination,applanation tonometry and a fundus examination after pupil dilatation by indirect ophthalmoscopy and biomicroscopy with spherical lens of +90 diopters. Before laser in situ keratomileusis, preventive treatment was carried out for predisposing lesion of retinal detachment in 8 eyes: 6 eyes for lattice degeneration and 2 eyes for atrophic holes. Postoperative examinations were conducted at 1, 3 and 12 months and once a year thereafter. All eyes were followed up for ≥12 months. Results Eyes were followed for a mean of (18 40±4 50) months (range 12-28) after the surgery. Sixteen eyes of 13 patients (0 81%) developed vitreoretinopathy after LASIK, including 6 eyes with lattice degeneration (0 30%) in which one of them had previous laser treatment, 2 with posterior vitreous detachment (0 10%), 2 with macular hemorrhage (0 10%), 4 with rhegmatogenous retinal detachment (0 20%), and 2 with retinal tear without retinal detachment (0 10%) in which one of them had previous laser treatment for lattice degeneration. Five patients were males (5 eyes involved). Others were females. Mean age of the group with vitreoretinal pathologic conditions was 31 80±5 85 years (range 22 to 43). The interval between refractive surgery and development of vitreoretinal complication was (10 38±6 20) months (range 1 to 24). The eyes that developed vitreoretinopathy had myopia -4 75 to -15 00 diopters (mean -9 45±2 61 D) before LASIK. The comparison of incidences of vitreoretinopathy after LASIK between the group of ≥-6 00 D and <-6 00 D before surgery showed significant difference ( P <0 01, χ 2=60 78). The comparison of incidences of vitreoretinopathy after LASIK had also significant difference ( P <0 01, χ 2= 138 64) between the eyes with pre LASIK lattice degeneration and dry hole and eyes without such lesions. The cases of lattice degeneration and retinal tear were treated with laser retinopexy. All cases of rhegmatogenous retinal detachment were managed with cryoretinopexy and scleral buckling. Retinal reattachment was attained in all eyes and good visual acuities were recovered. Conclusion No direct cause effect relationship between LASIK and vitreoretinopathy can be proven from this study. Although the incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis is low, it is necessary to strictly filter candidates. Preoperatively and postoperatively, pay attention to the lattice degeneration and other retina lesions, and long term follow up is important.