Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Chin Med J (Engl). 2017 Sep 20;130(18):2234-2240. doi: 10.4103/0366-6999.213959.
: Localized macular edema and retinal nerve fiber layer (RNFL) thinning have been reported shortly after laser in situ keratomileusis (LASIK) in adults. However, it is still unclear how LASIK affects the retina of children. This study aimed to investigate the macular retina and RNFL thickness in children with refractive amblyopia who underwent femtosecond laser-assisted LASIK (FS-LASIK).
: In this study, we included 56 eyes of 32 patients with refractive amblyopia who underwent FS-LASIK in our hospital from January 2012 to December 2016. Foveal (foveal center retinal, parafoveal retinal, and perifoveal), macular inner retinal (superior and inferior), and peripapillary RNFL thicknesses (superior, inferior, temporal, and nasal) were measured using Fourier-domain optical coherence tomography before surgery and 1 day, 3 days, and 1 week after surgery. We divided these patients into three groups based on their refractive error: High myopic group with 22 eyes (equivalent sphere, >6.00 D), mild myopic group with 19 eyes (equivalent sphere, 0-6.00 D), and hyperopic group with 15 eyes (equivalent sphere, >+0.50 D). We compared the macular retina and RNFL thickness before and after LASIK. A paired simple t-test was used for data analysis.
: One week after surgery, the visual acuity for all 56 eyes of the 32 patients reached their preoperative best-corrected vision. Visual acuity improved two lines or better for 31% of the patients. The residual refractive errors in 89% of the patients were within ±0.5 D. In the high myopic group, the foveal center retinal and parafoveal retinal thicknesses were thicker 1 day and 3 days after surgery than before surgery (t = 2.689, P = 0.012; t = 2.383, P = 0.018, respectively); no significant difference was found 1 week after surgery (P > 0.05). The foveal center retinal and parafoveal retinal thicknesses were greater 1 day after surgery than they were before surgery (P = 0.000 and P = 0.005, respectively) in the mild myopic and hyperopic groups. No significant difference was found 3 days or 1 week after surgery (P > 0.05). In all three groups, no significant difference was found in the macular inner retinal or peripapillary RNFL thickness 1 day, 3 days, or 1 week after surgery (P > 0.05).
: The foveal center retinal edema after FS-LASIK is mild and reversible in children, that mostly occurred in the high myopic group with no effect on the visual acuity, and is always relieved within 1 week.
在成人接受激光原位角膜磨镶术（LASIK）后不久，已经报道了局部黄斑水肿和视网膜神经纤维层（RNFL）变薄。然而，LASIK 如何影响儿童的视网膜仍然不清楚。本研究旨在研究接受飞秒激光辅助 LASIK（FS-LASIK）的屈光性弱视儿童的黄斑视网膜和 RNFL 厚度。
在这项研究中，我们纳入了 2012 年 1 月至 2016 年 12 月期间在我院接受 FS-LASIK 的 32 名患者的 56 只眼。使用傅里叶域光学相干断层扫描（OCT）在手术前和手术后 1 天、3 天和 1 周测量黄斑中心视网膜（中心凹视网膜、旁中心视网膜和周边中心视网膜）、黄斑内层视网膜（上、下）和视盘周围 RNFL 厚度（上、下、颞、鼻）。我们根据屈光不正将这些患者分为三组：高度近视组 22 只眼（等效球镜>6.00D），轻度近视组 19 只眼（等效球镜 0-6.00D），远视组 15 只眼（等效球镜>0.50D）。我们比较了 LASIK 前后的黄斑视网膜和 RNFL 厚度。使用配对 t 检验进行数据分析。
术后 1 周，32 名患者的 56 只眼的视力均达到术前最佳矫正视力。31%的患者视力提高了两行或更多。89%的患者的残余屈光不正在±0.5D 以内。在高度近视组中，术后 1 天和 3 天的中心凹视网膜和旁中心视网膜厚度比术前厚（t=2.689，P=0.012；t=2.383，P=0.018）；术后 1 周无明显差异（P>0.05）。在轻度近视和远视组中，术后 1 天的中心凹视网膜和旁中心视网膜厚度均比术前厚（P=0.000 和 P=0.005）。术后 3 天或 1 周无明显差异（P>0.05）。在所有三组中，术后 1 天、3 天和 1 周，黄斑内层视网膜或视盘周围 RNFL 厚度均无明显差异（P>0.05）。
FS-LASIK 后黄斑中心视网膜水肿在儿童中是轻微和可逆的，主要发生在高度近视组，不影响视力，且在 1 周内总是缓解。
