Bower Kraig S, Burka Jenna M, Hope R John, Franks James K, Lyon Terry L, Nelson Brett A, Sliney David H
Center for Refractive Surgery, Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
J Cataract Refract Surg. 2005 Aug;31(8):1506-11. doi: 10.1016/j.jcrs.2005.01.023.
To evaluate the potential occupational health hazards associated with scattered actinic ultraviolet (UV) laser radiation and broadband actinic UV plasma emissions during refractive surgery.
Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.
Intraoperative radiometric measurements were made with the Ophir Power/Energy Meter (LaserStar Model with silicon detector, Model PD-10) and the International Light Radiometer/Photometer (Model IL 1400 with actinic ultraviolet detector, Model SEL240) with and without UV blocking filters (BLK 270 and Schott types WG-280 and WG-230). Measurements made during laser calibration as well as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) procedures were evaluated using a worst-case scenario and then compared with the American Conference of Governmental Industrial Hygeinists (ACGIH) Threshold Value Limits (TLV) to perform a risk/hazard analysis.
Most optical emissions were between 193 nm and 280 nm, and approximately 25% of the measurement result was due to broadband emissions greater than 270 nm for calibration targets. About 25% of optical emissions during LASIK were beyond 230 nm. No emissions beyond 230 nm were observed during PRK. Ultraviolet scattered radiation level was similar between PRK and LASIK. Maximum measured values of 80 nJ/pulse at 14 cm for PRK and 45 nJ/pulse at 38 cm for LASIK were used as the absolute worst-case analysis for exposure. Assuming the worst-case exposure conditions are equal to the maximum measured value during these studies at a workload of 20 patients per day, the cumulative occupational exposure at close range of actinic UV radiation did not exceed the 8-hour occupational exposure limit of 3 mJ/cm(2) for any 24-hour period.
Scattered UV laser radiation did not exceed occupational exposure limits at distances greater than 30 cm from either laser calibration targets or patient treatments over a workday. Laser eye protection is not necessary to protect operating room personnel since exposure levels are very low even under a worst-case scenario.
评估屈光手术期间与散射光化性紫外线（UV）激光辐射及宽带光化性UV等离子体发射相关的潜在职业健康危害。
美国华盛顿特区沃尔特·里德陆军医疗中心屈光手术中心。
使用Ophir功率/能量计（带硅探测器的LaserStar型号，PD - 10型）和国际光辐射计/光度计（带光化性紫外线探测器的IL 1400型号，SEL240型），在有和没有紫外线阻挡滤光片（BLK 270以及肖特类型的WG - 280和WG - 230）的情况下进行术中辐射测量。对激光校准以及激光原位角膜磨镶术（LASIK）和准分子激光角膜切削术（PRK）手术期间的测量结果，采用最坏情况进行评估，然后与美国政府工业卫生学家会议（ACGIH）阈值限值（TLV）进行比较，以进行风险/危害分析。
大多数光发射在193纳米至280纳米之间，校准目标的测量结果中约25%归因于大于270纳米的宽带发射。LASIK期间约25%的光发射超过230纳米。PRK期间未观察到超过230纳米的发射。PRK和LASIK期间的紫外线散射辐射水平相似。PRK在14厘米处的最大测量值为80纳焦/脉冲，LASIK在38厘米处的最大测量值为45纳焦/脉冲，用作暴露的绝对最坏情况分析。假设最坏情况暴露条件等于这些研究期间在每天20例患者的工作量下的最大测量值，在任何24小时期间，光化性UV辐射近距离的累积职业暴露均未超过8小时职业暴露限值3毫焦/平方厘米。
在工作日，距激光校准目标或患者治疗部位大于30厘米处，散射UV激光辐射未超过职业暴露限值。由于即使在最坏情况下暴露水平也非常低，因此无需激光眼部防护来保护手术室人员。
