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近视手术后视力下降 近视手术后注意事项

发布时间:2015-12-27   问大夫  责任编辑:詹敏怡

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近视眼在生活当中给我们造成了许多的不方便,近视眼大部分是由于不能够良好健康的用眼而导致的,或者恶阴暗灯光下看书,玩手机,坐姿不正确等等。近视眼怎么办?戴眼镜确实是一种负担,手术怎样?近视眼手术适合那些人?近视手术后视力会下降吗?看看吧。

近视眼手术

近视眼由于眼球的前后径太长、眼睛膜前表面太凸,外界光线不能准确会聚在眼底所致。准分子激光矫正近视(LASIK/PRK)是用电脑精确控制的准分子激光,根据近视度数和有无散光在瞳孔区的角膜基质层进行刻蚀,使眼角膜前表面稍稍变平。从而使外界光线能够准确地在眼底视网膜上会聚成像,达到矫正近视的目的。近视手术前患者需要在正规医院进行检查,需要了解是否适合进行近视手术,有些群体是不能进行近视眼手术的,如高血压、糖尿病及患有其他感染疾病的患者,需要先治疗后再检查能否进行近视手术。

适应症状

① 患者本人有摘镜的要求。

② 年龄在18周岁(最好是20周岁)以上。

③ 近两年屈光度稳定。

④ 矫正屈光度范围:近视最好不超过1500度,散光不超过600度,远视不超过600度。

⑤ 屈光参差。

⑥ 现戴角膜接触镜者:软镜应停戴2周以上,硬镜应停戴3周以上,OK镜应停戴1—3月以上。

⑦ 角膜厚度大于450 um(取决于屈光状态)。

⑧ 眼部无活动性疾病等。

不适应人群

1、未满十八岁

十八岁以下不宜做手术、手术要求患者的屈光状态是稳定的。屈光状态包括近视、远视、散光等屈光不正的现象。由于18周岁以下的青年正处于身体生长期,眼睛屈光度不稳定,若盲目接受手术,一两年后视力极有可能回退。最佳手术的年龄是25岁至30岁。

2、先天眼病者

激光近视手术要求角膜有一定厚度,这个厚度因人而异,有些人先天不足就不能做激光手术。

3、老花眼也不宜做手术

老花是因年龄增长调节力衰减所致,即使暂时治愈,也会因年龄进展而复发。

4、从事水上运动的人也不宜做手术

因此,准分子激光治疗近视手术必须具备以下几个方面的条件:一是年龄在18岁到50周岁之间;二是近视度数要稳定两年以上;三是无其他严重眼病及眼科手术史;四是无糖尿病、胶原性疾病以及疤痕性体质。

术前检查

初诊前咨询让患者对屈光手术方法和治疗过程有一定的了解,并同时为患者解答疑问和消除顾虑,使得患者能更好地配合医生进行检查和治疗。初诊检查是对患者眼睛和身体健康状况的检测和了解,以便决定是否适合屈光激光手术。

患者必须准确填写病史调查表,让医生充分了解您的身体条件。初诊检查完后,可以大致确定你是否适合接受激光手术治疗,对于手术的预期效果也有一个大体的概念。如果符合条件,我们的医生会根据您的检查结果和其他情况,推荐不同手术方法,并预约相应的复诊检查项目和时间。同时,您必须缴纳一定的检查费用以保证下次检查顺利进行。

初诊检查项目:视力、屈光、眼底(扩瞳)、眼压、了解病员病史、电脑验光、角膜地形图、角膜厚度及手术必须的其他相应检查等。

患者可按医嘱和初诊后的不同预约时间在相应的专家处复诊。复诊是术前对患者的眼睛作进一步的检查,精确测量眼睛的生理结构和屈光参数,了解患者的工作和生活情况,以便手术专家为患者确定最适合您的手术方法和制定最佳的手术方案,确保手术质量。

术中注意事项

近视手术主要是在眼角膜上进行的,而眼角膜上面没有血管,但是有神经,所以你在做手术是没有疼痛感。近视手术过程中,患者的良好配合是手术能否成功的重要前提,因此,近视手术中,患者应该注意以下几点:

1、放松心情,不要紧张。

2、不要用力挤眼、不要随意动眼球、要按医生的引导固定不动.

3、手术关键时刻,要遵医嘱、不要讲话、更不允许乱动。

4、术中一定要盯住一闪一闪的红色或绿色注视灯,即使看不到注视灯也不要乱动,要按医生的引导轻轻移动眼球而头不要移动。

5、在手术台上,不要用手再碰手术消毒区域。

术后注意事项

1、重视用药定期随访

一个成功的准分子激光手术不仅取决于医生高超的手术技术,还和术后规则的用药和随访分不开。准分子激光术后用药特别重要,应该遵照医生的指导使用,不可以因为自我感觉良好而随意停药或滥用,同时应定期到医院随访,否则可导致准分子手术后遗症的出现。曾经有一位大学生,手术非常成功,术后1周复查双眼视力均达1.5,但之后他再也没来检查,2个月后因视力急剧下降来复诊,检查发现视力为0.4,眼压达35mmHg。追问病史,原来他一直用激素眼药水,自认为视力已正常而不到医院检查眼压,到出现了视力下降才引起重视,虽经积极治疗眼压恢复正常,但他的视力只能恢复到0.8。准分子激光手术后通常要用激素眼药水1~2个月,目的是为了促进术后的恢复和防止近视回退。而激素眼药水具有升高眼压,导致激素性青光眼的可能,因此准分子激光手术后用药期间一定要定期到医院复查,尤其要随访眼压。另外,对于LASIK手术者,由于角膜瓣的存在,术后应避免外力碰撞术眼,以免导致角膜瓣移位严重的后果。

2、高度近视仍需当心

近视患者由于眼轴变长多伴有眼底的病变,尤其高度近视患者,表现为周边视网膜变薄,萎缩变性,一旦出现视网膜裂孔,就有可能导致视网膜脱离。视网膜脱离是近视眼导致失明较常见的眼病,应引起近视眼患者特别重视。准分子激光虽然使视力恢复了正常,但它并不能改变近视对眼睛已经造成的改变。因此对于术后视力正常的近视眼者,依然要像对待近视眼一样爱护自己的眼睛,高度近视患者在准分子术后的注意事项有:应注意避免打篮球等剧烈运动及强体力劳动。当头部受到震动或做重体力劳动、剧烈运动时,视网膜会受到牵拉而发生裂孔,造成视网膜脱离,视网膜脱离的初期一般表现为眼前有闪电样光带出现,飞蚊黑点大量增加,或视野产生暗影逐渐扩大,一旦出现以上症状,应引起高度重视,须立即到医院诊治,不可拖延。若等到视力明显下降再就诊,则治疗的效果较差。

3、依然注意用眼卫生

虽然进行准分子激光手术者基本是18岁以上的成年人,一般传统观点认为成年人的视力比较稳定,不容易进一步下降,但实际情况并非如此。中华民族是一个近视高发民族,全国约有近4亿近视患者,而且还在逐年增加,20岁以后近视还在增加的人并不在少数,这主要是和现代社会电脑的普及、工作压力的增大有关,超常时间近距离的工作仍然可导致近视进一步加深。因此对于以近距离工作为主的人来说,准分子激光术后仍然要注意保护好眼睛。准分子激光手术后1~2月内,多数人看近都较吃力,此时应减少近距离用眼时间,不仅可避免眼部疲劳酸痛等不适,而且有利于眼睛的恢复。对于视力已完全恢复正常者,仍然要注意用眼卫生,尤其长时间看电脑和伏案近距离工作者,用眼1小时后一定要休息片刻,可以做眼保健操放松眼球,或眺望远处,给眼睛以适当的休息,避免过度用眼导致准分子手术后遗症的出现。

近视手术后视力下降

近视眼手术后存在常见的并发症:屈光回退(就是大家俗称的又近视了);眼干(主要原因为眼角膜神经线的破坏,导致顺目动作减少;以及角膜曲率的改变,导致泪膜破裂时间短);眩光(主要出现在晚上,夜间瞳孔散大,手术切削边缘对光线散射造成)。这三大并发症是最常见,也是患者感觉最不舒服的。

术后选择合适的偏光镜

准分子激光近视手术后初期,患者的角膜敏感性会降低,这时灰尘,沙砾容易进入眼睛,如果处理不当,会造成角膜受伤。在这种情况下佩戴一副适合脸形的眼镜来阻挡灰沙是非常必要的。准分子激光术后,大部分患者还会出现畏光的现象,建议在室外活动时,佩戴一副偏光太阳镜。偏光太阳镜能消除光线照射在水面、玻璃、平滑路面等产生的强烈眩光,可有效保护眼睛。并且可以减少紫外线对眼睛的伤害。另外到具有专业资质,良好信誉的眼科专科医院选配优质的偏光镜是非常重要的。作为手术后眼睛的主要保护工具,偏光镜的选择一定要慎重,一副合格的太阳镜的主要作用是阻挡紫外线(99%至100%)及有害射线,减少可见光的透过率,有效地保护眼睛。而且正规的太阳眼镜属于平光镜系列,屈光度严格控制在0.008度以下。而一副劣质的太阳镜则可能给眼睛带来严重的损害,轻者会使眼睛干涩、疲劳、灼热及疼痛、流泪,或者引起头晕、恶心、呕吐等全身不适,重者还有可能对角膜、晶体及视网膜造成不可逆的永久损害。

术后注意饮食

1.黑豆核桃冲牛奶:黑豆粉1匙,核桃仁泥1匙,牛奶1包,蜂蜜1匙。将黑豆500克,炒熟后待冷,磨成粉。核桃仁500克,炒微焦去衣,待冷后捣如泥。取以上两种食品各1匙,冲入煮沸过的牛奶1杯后加入蜂蜜1匙,每天早晨或早餐后服用,或与早点共进。黑豆含有丰富的蛋白质与维生素B1等,营养价值高,又因黑色食物入肾,配合核桃仁,可增加补肾力量,再加上牛奶和蜂蜜,这些食物含有较多的维生素B1、钙、磷等,能增强眼内肌力,加强调节功能,改善眼疲劳的症状。

2.枸杞桑葚粥:枸杞子5克,桑葚子5克,山药5克,红枣5个,粳米100克。将上述原料熬成粥食用。此方中的枸杞子、桑葚子能补肝肾,山药、红枣健脾胃。视力疲劳者如能每日早晚两餐,较长时间服用,既能消除眼疲劳症状,又能增强体质。

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