未行准分子激光角膜屈光手术的原因分析
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摘要
目的:分析有意愿接受准分子激光角膜屈光手术治疗近视的患者在术前检查后未行手术的原因。方法:选取2015年1月至2017年6月在安徽医科大学附属第一医院眼科激光中心检查的近视患者,分析其中未行激光手术的原因。结果:共2 875例患者准备接受准分子激光角膜屈光手术,其中821例(28.6%)检查后未进行手术,男462例(56.3%),女359例(43.7%),年龄18~51(23.69±5.85)岁。8 2 1例中社会心理因素影响4 8 4例(5 9.0%),角膜薄或角膜厚度不足1 8 2例(2 2.2%),超高度近视(>10.00 D)100例(12.2%),高眼压19例(2.3%),弱视13例(1.6%),角膜曲率异常11例(1.3%),眼底病变7例(0.9%),角膜变性3例(0.4%),其他2例(0.2%)。结论:近视治疗术前检查后未进行准分子激光角膜屈光手术的原因多种多样,其中社会心理因素及角膜厚度不足是最主要的原因。术前详细检查,严格掌握手术适应证和禁忌证以及充分医患沟通是手术安全的保障。
Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054(71.4%) of them received refractive surgery. Among 821(28.6%) patients who did not get laser refractive keratomileusis, 462(56.3%) were male and 359(43.7%) were female, aged 18–51 years(range, 23.69± 5.85 years). The most common reason for not offering refractive surgery were social psychological factors(59.0%), low central corneal thickness(22.2%), high myopia(12.2%), high intraocular pressure(2.3%), poor corrected visual acuity(1.6%), corneal topography anomaly(1.3%), retinal disease(0.9%), corneal(0.4%) and other diseases(0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.
Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054(71.4%) of them received refractive surgery. Among 821(28.6%) patients who did not get laser refractive keratomileusis, 462(56.3%) were male and 359(43.7%) were female, aged 18–51 years(range, 23.69± 5.85 years). The most common reason for not offering refractive surgery were social psychological factors(59.0%), low central corneal thickness(22.2%), high myopia(12.2%), high intraocular pressure(2.3%), poor corrected visual acuity(1.6%), corneal topography anomaly(1.3%), retinal disease(0.9%), corneal(0.4%) and other diseases(0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.
引文
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8.荆翠红.屈光不正患者310例未行准分子激光矫治原因分析[J].临床医学,2010,30(2):93-94.JING Cuihong.Analysis of the reasons for the treatment of 310patients with incomplete excimer laser[J].Clinical Medicine,2010,30(2):93-94.
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11.宋耀文,贺瑞.准分子激光原位角膜磨镶术术后继发性圆锥角膜致病因素的研究现状[J].山西医科大学学报,2016,47(8):773-778.SONG Yaowen,HE Rui.The research status of secondary conical corneal pathogenicity after excimer laser in situ keratoplasty[J].Journal of Shanxi Medical University,2016,47(8):773-778.
12.Dupps W J Jr,Seven I.A large-scale computational analysis of corneal structural response and ectasia risk in myopic laser refractive surgery[J].Trans Am Ophthalmol Soc,2016,114:T1.
13.门洁,张晓辉,黄丹,等.早期圆锥角膜与近视的Orbscan II角膜地形图对比分析[J].航空航天医学杂志,2015,26(6):667-669.MEN Jie,ZHANG Xiaohui,HUANG Dan,et al.Comparison and analysis of Orbscan II corneal topography between early keratoconus and myopic[J].Journal of Aerospace Medicine,2015,26(6):667-669.
14.刘祖国,张梅,陈家祺,等.圆锥角膜的角膜前后表面形态及厚度检测[J].中华眼科杂志,2002,38(12):740-743.LIU Zuguo,ZHANG Mei,CHEN Jiaqi,et al.Corneal topography and thickness in keratoconus[J].Chinese Journal of Ophthalmology,2002,38(12):740-743.
15.王幼生,廖瑞瑞,刘泉.现代眼视光学[M].广州:广东科技出版社,2004:349.WANG Yousheng,LIAO Ruirui,LIU Quan.Modern optometry[M].Guangzhou:Guangdong Science and Technology Press,2004:349.
16.Arevalo JF,Lasave AF,Torres F,et al.Rhegmatogenous retinal detachment after LASIK for myopia of up to-10 diopters:10 years of follow-up[J].Graefes Arch Clin Exp Ophthalmol,2012,250(7):963-970.
17.姜耀和.角膜屈光手术术前眼底检查及治疗选择[J].吉林医学,2008,29(23):2259-2260.JIANG Yaohe.Preoperative ocular fundus examination and treatment options for corneal refractive surgery[J].Jilin Medical Journal,2008,29(23):2259-2260.
18.仇晨,钱韶红.近视与开角型青光眼临床相关研究进展[J].复旦学报(医学版),2014,41(3):419-424.QIU Chen,QIAN Shaohong.Progress in myopia and open-angle glaucoma(OAG)related clinical investigations[J].Fudan University Journal of Medical Sciences,2014,41(3):419-424.
19.李凤鸣.眼科全书(下册)[M].北京:人民卫生出版社,1996:2576-2577.LI Fengming.Encyclopedia of ophthalmology(the third volume)[M].Beijing:People’s Medical Publishing House,1996:2576-2577.
20.Sung KR,Lee JY,Kim MJ,et al.Clinical characteristics of glaucomatous subjects treated with refractive corneal ablation surgery[J].Korean JOphthalmol,2013,27(2):103-108.
2.李莹.准分子激光角膜屈光手术的利于弊[J].眼科,2011,20(3):148-150.LI Ying.The pros and cons of excimer laser keratorefractive surgery[J].Ophthalmology in China,2011,20(3):148-150.
3.周育锋,武金云,李晓霞,等.未行准分子激光屈光性角膜手术的原因探讨[J].甘肃科技,2014,30(1):127-128.ZHOU Yufeng,WU Jinyun,LI Xiaoxia,et al.Analysis on reasons that patients did not performing keratorefractive surgery[J].Gansu Science and Technology,2014,30(1):127-128.
4.候英芳,张新,苗永凤,等.LASIK术前检查后未做手术279眼临床分析[J].临床合理用药,2010,3(20):48-49.HOU Yingfang,ZHANG Xin,MIAO Yongfeng,et al.Clinical analysis about 279 eyes that gave up L ASIK after preoperative check[J].Chinese Journal of Clinical Rational Drug Use,2010,3(20):48-49.
5.孙平,陈燕,马晓蓉,等.未能进行准分子激光角膜屈光手术的原因分析[J].中华眼外伤职业眼病杂志,2011,33(2):115-118.SUN Ping,CHEN Yan,MA Xiaorong,et al.The clinical causes of patients unaccommodated for laser refractive keratomileusis[J].Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries,2011,33(2):115-118.
6.霍银平,周利晓,齐若.准分子激光角膜屈光手术术前检查临床分析[J].中国老年学杂志,2013,33(18):4552-4553.HUO Yinping,ZHOU Lixiao,QI Ruo.Preoperative clinical analysis of excimer laser corneal refractive surgery[J].Chinese Journal of Gerontology,2013,33(18):4552-4553.
7.戚晓圆.检查后未行准分子激光角膜屈光手术的原因分析[J].中国中医药资讯,2010,2(33):205-206.QI Xiaoyuan.Analysis of the causes of corneal refractive surgery after examination[J].Journal of China Traditional Chinese Medicine Information,2010,2(33):205-206.
8.荆翠红.屈光不正患者310例未行准分子激光矫治原因分析[J].临床医学,2010,30(2):93-94.JING Cuihong.Analysis of the reasons for the treatment of 310patients with incomplete excimer laser[J].Clinical Medicine,2010,30(2):93-94.
9.陆文秀.准分子激光屈光性角膜手术学[M].北京:科学技术文献出版社,2000:78.LU Wenxiu.Excimer laser refractive corneal surgery[M].Beijing:Science and Technology Literature Press,2000:78.
10.Rasik B.Vajpayee,Namrata Sharma,Samir A.Melki,et al.LASIK手术阶梯教程[M].赵家良,罗岩,译.北京:科学技术出版社,2007:9.Rasik B.Vajpayee,Namrata Sharma,Samir A.Melki,et al.Step by step LASIK surgery[M].Translated by ZHAO Jialiang,LUO Yan.Beijing:Science and Technology Literature Press,2007:9.
11.宋耀文,贺瑞.准分子激光原位角膜磨镶术术后继发性圆锥角膜致病因素的研究现状[J].山西医科大学学报,2016,47(8):773-778.SONG Yaowen,HE Rui.The research status of secondary conical corneal pathogenicity after excimer laser in situ keratoplasty[J].Journal of Shanxi Medical University,2016,47(8):773-778.
12.Dupps W J Jr,Seven I.A large-scale computational analysis of corneal structural response and ectasia risk in myopic laser refractive surgery[J].Trans Am Ophthalmol Soc,2016,114:T1.
13.门洁,张晓辉,黄丹,等.早期圆锥角膜与近视的Orbscan II角膜地形图对比分析[J].航空航天医学杂志,2015,26(6):667-669.MEN Jie,ZHANG Xiaohui,HUANG Dan,et al.Comparison and analysis of Orbscan II corneal topography between early keratoconus and myopic[J].Journal of Aerospace Medicine,2015,26(6):667-669.
14.刘祖国,张梅,陈家祺,等.圆锥角膜的角膜前后表面形态及厚度检测[J].中华眼科杂志,2002,38(12):740-743.LIU Zuguo,ZHANG Mei,CHEN Jiaqi,et al.Corneal topography and thickness in keratoconus[J].Chinese Journal of Ophthalmology,2002,38(12):740-743.
15.王幼生,廖瑞瑞,刘泉.现代眼视光学[M].广州:广东科技出版社,2004:349.WANG Yousheng,LIAO Ruirui,LIU Quan.Modern optometry[M].Guangzhou:Guangdong Science and Technology Press,2004:349.
16.Arevalo JF,Lasave AF,Torres F,et al.Rhegmatogenous retinal detachment after LASIK for myopia of up to-10 diopters:10 years of follow-up[J].Graefes Arch Clin Exp Ophthalmol,2012,250(7):963-970.
17.姜耀和.角膜屈光手术术前眼底检查及治疗选择[J].吉林医学,2008,29(23):2259-2260.JIANG Yaohe.Preoperative ocular fundus examination and treatment options for corneal refractive surgery[J].Jilin Medical Journal,2008,29(23):2259-2260.
18.仇晨,钱韶红.近视与开角型青光眼临床相关研究进展[J].复旦学报(医学版),2014,41(3):419-424.QIU Chen,QIAN Shaohong.Progress in myopia and open-angle glaucoma(OAG)related clinical investigations[J].Fudan University Journal of Medical Sciences,2014,41(3):419-424.
19.李凤鸣.眼科全书(下册)[M].北京:人民卫生出版社,1996:2576-2577.LI Fengming.Encyclopedia of ophthalmology(the third volume)[M].Beijing:People’s Medical Publishing House,1996:2576-2577.
20.Sung KR,Lee JY,Kim MJ,et al.Clinical characteristics of glaucomatous subjects treated with refractive corneal ablation surgery[J].Korean JOphthalmol,2013,27(2):103-108.