医生为什么不做近视眼手术,这个手术安全吗?

来源:健康报    关键词:激光近视手术, 准分子激光, 飞秒激光手术,    发布时间:2019-06-14

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近视手术以其精确、便捷、恢复快等优点,让很多近视患者畅享清晰视界。然而,戴眼镜的眼科医生却受到近视手术患者的质疑,近视手术那么多好处,眼科医生“近水楼台先得月”,为啥他们却不做呢?我们请到相关专家来回答大家对于近视眼手术的疑虑。


眼科医生为何不做近视眼手术呢?

陆军军医大学陆军特色医学中心

眼科副教授 陈开建:

近视手术有着严格的条件限制,有的人因为自身原因就不适合手术矫正。如果眼部检查以及医生专业的评估不符合要求,就不能接受手术。再就是近视患者个人意愿。近视手术并不是非做不可,而是属于选择性治疗。虽然近视属于疾病,但即使不做手术,戴框架眼镜或是隐形眼镜也可以达到矫正效果。所以,是否选择手术,完全取决于个人意愿。

其实,我们大部分人看到的只是戴眼镜的眼科医生,而不知道有一部分没戴眼镜眼科医生是接受近视手术后丢掉眼镜的。因此,眼科戴眼镜医生不做近视手术,其实是一种归因偏差,主观忽略了已经接受了手术的医生。


什么人适合做近视眼手术呢?

北京大学人民医院

眼视光医学中心 何燕玲:

并不是所有得近视的人都适合做近视眼手术,主要取决于眼睛的状态。一般来说,做准分子激光矫正手术需要达到下面的条件:

  • 首先患者本人有摘镜需求。
  • 其次年龄应在18岁~55岁,近两年屈光状态相对稳定,其加深发展每年不大于0.50D;
  • 佩戴角膜接触镜者,软镜需停戴1周以上,硬镜需停戴3周以上;
  • 角膜中央厚度应大于450微米;

陆军军医大学陆军特色医学中心

眼科副教授 陈开建:

在近视群体中,有些眼疾就不能做近视手术治疗。如白内障、青光眼、角膜炎、急性结膜炎、圆锥角膜、严重干眼症以及一些全身疾病等,都不适合做近视手术治疗。

近视眼手术都有哪几种?

陆军军医大学陆军特色医学中心

眼科副教授 陈开建:

就矫正近视的手术而言,可分为眼内手术和角膜屈光手术两大类型。眼内手术主要包括有晶体眼后房型人工晶体植入术、透明晶状体人工晶状体置换手术。而角膜屈光手术主要包括准分子激光手术、飞秒激光LASIK手术,以及全飞秒激光手术。至于哪种手术最好,每种手术方式都有自身的优势和局限性,这要根据每个人的眼睛情况来选择,适合才是最好的。

激光矫正手术的原理是什么?

火箭军总医院眼科主任梁歌:

近视眼是由于眼球前后径太长,眼球角膜太凸,外界光线不能准确汇聚眼底所致,激光治疗近视眼,就是利用激光光束,改变角膜前表面的弯曲度,以矫正眼球的屈光不正,可以说在角膜上“磨”出一副合适的眼镜,从而使外界光线能够准确地在眼底会聚成像,达到矫正近视的目的。

激光手术安全吗?

火箭军总医院眼科主任梁歌:

拿准分子激光治疗近视为例,实验表明,当准分子激光激射动物角膜表面时,在眼内安放的危险激光能量探测器测不出任何能量,由此证明准分子激光做角膜屈光手术对眼球内组织没有任何作用。值得一提的是,目前不断更新换代的准分子激光仪的计算机控制系统能够准确地执行所输入的数据,并有自检保护程序,有些还带有远红外眼球自动跟踪系统,更为激光安全治疗近视眼提供了可靠的保证。

准分子激光和飞秒激光,它们有何不同?

北京大学人民医院眼视光医学中心 何燕玲:

  • 准分子激光是一种波长为193nm的激光。它是超紫外的冷激光,每一光子具有很高的能量。这种激光作用于生物组织所依靠的不是热效应而是光化学效应。也就是说,它可以直接作用于生物组织的化学键使其断裂,从而使组织细胞的分子气化,因此可以达到很高的切削准确度。同时由于它是一种冷激光,基本不产生热效应,所以只作用于被照射部位的组织,对被照射区之外的组织不会产生不良影响,因此准分子激光是用于角膜屈光手术最理想的一种激光。
  • 飞秒激光是一种以超短脉冲形式运转的近红外激光,其应用原理是利用极短的脉冲宽度产生光爆破效应,获得极高的峰值功率和极强的聚焦能力,在生物组织内完成精确的切割。

手术前要做哪些准备?

火箭军总医院眼科主任梁歌:

  • 1.术前一般应停戴软性角膜接触镜(隐形眼镜)2周,硬性角膜接触镜3周,OK镜4周以上。
  • 2.术前3天局部滴抗生素眼药水,并且做注视训练,以便在术中能与医生很好地配合;术前一晚洗浴,保证充足的睡眠。
  • 3.手术当日洗脸,眼部不要化妆,以免术前眼部清洁、消毒困难,如果清洁不彻底,可能使一些小颗粒进入手术区域;不要使用香水或任何有刺激性气味的化妆品,以免影响激光机的工作状态,进而影响手术效果。
  • 4.术前眼周围区消毒后不要再用手接触。等待手术时放松心情,不要在等待期间交谈或大声喧哗,以免术中过度兴奋,无法控制情绪而影响手术效果。
  • 5.手术前注意预防感冒。如手术当天有身体不适,应推迟手术。

做完手术后,生活中要注意什么?

火箭军总医院眼科主任梁歌:

虽然利用激光术进行了矫正后摘掉了眼镜,可正常地看书、看电视、用电脑等,但仍需要注意正确用眼,保护视力,如连续近距离用眼1小时左右后,要休息或远眺片刻,避免长时间使用眼睛的精细工作,养成良好的用眼卫生习惯,做到“三要三不要”:姿势要端正、距离要一尺、用眼要间隔休息。不要光线太强或太弱,不要躺卧看书,不要晃动看书。以免引起视力疲劳,影响手术效果。

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