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目的观察行准分子激光屈光矫正术前近视患者直接检眼镜和间接检眼镜的检查结果。方法分别以直、间接检眼镜对2315例(4574眼)和1358例(2429眼)行激光屈光手术的近视患者在扩瞳状态下进行眼底检查,对可疑眼底病灶辅以三面镜确诊。对检查结果进行分类比较。结果1998~2000年准分子激光术前以直接检眼镜检查患者共2315例(4574眼),发现视网膜脱离2眼,未发现周边眼底异常。2001~2002年对1358例患者(2429只眼)术前进行间接检眼镜检查,检查发现各种周边部视网膜脉络膜变性和异常。其中包括视网膜非加压发白315眼占13.0%,色素沉着467眼占19.2%,条状变性160眼占6.59%,格子样变性40眼占1.65%,玻璃体视网膜牵引26眼占1.07%,视网膜裂孔49眼占2.02%,亚临床视网膜脱离8眼占0.33%。对严重的周边视网膜变性、裂孔及视网膜浅脱离80眼占3.29%进行眼底激光的治疗,4眼占0.16%进行手术治疗。分析发现近视屈光度越高,眼底发生格子样变性、干性裂孔、视网膜脱离的几率较大(P<0.01)。结论准分子激光术前间接检眼镜检查可以发现直接检眼镜不易发现的眼底周边视网膜异常,为及早发现和治疗眼底病变提供良好的方法和机会。非手术高度近视患者也应进行常规周边眼底检查。
Objective To observe the results of direct ophthalmoscopy and indirect ophthalmoscopy in preoperative myopic patients undergoing excimer laser refractive surgery. Methods 2315 cases (4574 eyes) and 1358 eyes (2429 eyes) underwent laser refractive surgery under direct dilation and indirect ophthalmoscopy respectively. Fundus examination was performed in dilated pupils, and suspicious fundus lesions were confirmed by three-mirror. Check the results for classification comparison. Results A total of 2315 patients (4574 eyes) were examined by direct ophthalmoscopy before excimer laser surgery from 1998 to 2000. Two cases of retinal detachment were found, and no peripheral ocular fundus abnormalities were found. Between 2001 and 2002, 1358 patients (2429 eyes) underwent preoperative ophthalmoscopy before surgery, and various peripheral retinal choroidal degeneration and abnormalities were found. Including retinal uncompressed whitening 315 eyes accounted for 13.0%, pigmentation 467 eyes 19.2%, strip degeneration 160 eyes 6.59%, lattice degeneration 40 eyes 1.65%, vitreoretinal traction 26 eyes 1.07%, the retina 49 eyes with cracked hole accounted for 2.02%, and 8 eyes with subclinical retinal detachment accounted for 0.33%. Severe peripheral retinal degeneration, retinal detachment and retinal detachment 80 eyes accounted for 3.29% fundus laser treatment, 4 eyes accounted for 0.16% for surgical treatment. Analysis found that the higher myopia refraction, fundus retinal degeneration, dry holes, retinal detachment probability (P <0.01). Conclusions Indirect ophthalmoscopy before excimer laser surgery can find the peripheral retinal abnormalities not easily detected by direct ophthalmoscopy and provide a good method and opportunity for the early detection and treatment of retinal lesions. Non-surgical patients with high myopia should also be routine peripheral fundus examination.