角膜屈光手术后的复视和斜视。

Department of Ophthalmology, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.

Department of Ophthalmology, Naval Medical Center Portsmouth. 620 John Paul Jones Cr., Portsmouth, VA 23708, USA.

Mil Med. 2020 Jun 8;185(5-6):e755-e758. doi: 10.1093/milmed/usz395.

INTRODUCTION

Diplopia and strabismus are known complications after corneal refractive surgery (CRS). Within the U.S. Armed Forces, refractive surgery is used to improve the operational readiness of the service member, and these complications could cause significant degradation to their capability. This study was performed in order to identify the incidence of strabismus and diplopia following CRS within the U.S. Military Health System.

METHODS

A retrospective review of all patients who underwent photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in the Department of Defense from January 2006 through September 2013 was designed and approved by the Naval Medical Center Portsmouth Institutional Review Board. The military health system data mart was queried for all patients who underwent one of these procedures and subsequently had an International Classification of Disease-9 code for any strabismus or diplopia through 2014 allowing at least 1 year of follow-up. We then calculated the incidence of both diplopia and strabismus for these procedures as the primary measure and the overall prevalence as a secondary measure.

RESULTS

A total of 108,157 patients underwent PRK or LASIK during our study period with 41 of these patients subsequently having a diagnosis of diplopia or strabismus. After chart review, 16 of these patients were excluded resulting in 25 patients for inclusion in either the strabismus (23 patients, 0.02%) or diplopia (3 patients, 0.003%) cohorts with one patient having both. Of the 23 patients with postoperative strabismus, 4 were new cases giving an incidence of 0.004% and 2 new cases of diplopia for an incidence of 0.002%.

CONCLUSION

Diplopia and strabismus are rare complications after CRS in the U.S. military population. These procedures continue to increase the operational readiness of our service members with minimal risk of these potentially debilitating complications. Overall, this study provides support for the continued use of PRK and LASIK despite study limitations related to the use of large databases for retrospective review. Future prospective studies using delineated preoperative and postoperative examinations with sensorimotor testing included may be able to resolve the limitations of this study.

简介

复视和斜视是已知的角膜屈光手术（CRS）后的并发症。在美国武装部队中，屈光手术用于提高军人的作战准备状态，而这些并发症可能会显著降低他们的能力。本研究旨在确定美国军事医疗系统中 CRS 后斜视和复视的发生率。

方法

设计并经朴茨茅斯海军医疗中心机构审查委员会批准，对 2006 年 1 月至 2013 年 9 月期间在国防部接受光折射性角膜切除术（PRK）或激光辅助原位角膜磨镶术（LASIK）的所有患者进行回顾性分析。通过军事医疗系统数据集市，对接受上述任何一种手术且在 2014 年前至少有 1 年随访期间有国际疾病分类第 9 版斜视或复视诊断代码的所有患者进行查询。然后，我们计算了这两种手术的复视和斜视发生率作为主要指标，以及总患病率作为次要指标。

结果

在我们的研究期间，共有 108157 例患者接受了 PRK 或 LASIK 手术，其中 41 例患者随后被诊断为复视或斜视。经过病历回顾，排除了其中 16 例患者，最终纳入斜视（23 例患者，0.02%）或复视（3 例患者，0.003%）队列的患者各 25 例，其中 1 例患者同时患有斜视和复视。在 23 例术后斜视患者中，有 4 例为新发病例，发病率为 0.004%，有 2 例新发病例为复视，发病率为 0.002%。

结论

复视和斜视是美国军事人群中 CRS 后的罕见并发症。这些手术继续提高了我们军人的作战准备状态，同时最小化了这些潜在致残性并发症的风险。总体而言，尽管存在与使用大型数据库进行回顾性研究相关的研究局限性，但本研究为继续使用 PRK 和 LASIK 提供了支持。未来可能会开展前瞻性研究，包括明确的术前和术后检查以及感觉运动测试，以解决本研究的局限性。