I. High myopia treatment process
Two, myopia classification
1.Classification according to the degree of myopia
1.Mild myopia: less than 300 degrees
2.Moderate myopia: 325 degrees to 600 degrees
3.High myopia: 625 degrees to 1000 degrees
4.Super high myopia: 1025 degrees or more
2.Classification by disease progression and pathological changes
1.Simple myopia: myopia is stable, generally within 600 degrees
2.Pathological myopia: the eye axis is too long, myopia deepens year by year, accompanied by progressive fundus lesions, which can lead to serious visual impairment; myopia generally occurs earlier and has a genetic tendency.
Third, the clinical manifestations of pathological myopia
1. Unstable myopia: myopia increases with age
2. Protrusion of the eyeball: due to the lengthening of the eye axis, the eye bulges forward
3.Drifting black shadows in front of the eyes: due to vitreous turbidity, mosquito flying
4.Fundus lesions: common myopic arcuate spots, leopard-like fundus, macular degeneration cleavage, fissure, hemorrhage, subretinal neovascularization, retinal detachment, etc.
5, vision loss: correction less than normal
IV. Surgical treatment of pathological myopia
1. Posterior scleral reinforcement: The purpose is to stabilize the eye axis, control the progression of myopia, prevent the aggravation of fundus lesions, and protect vision. Patients’ corrected visual acuity can generally be stabilized or improved after surgery, but it cannot shorten the eye axis, does not reduce myopic refraction, and cannot reverse the myopic arcuate spots, leopard-like changes, macular cleavage and other lesions that have occurred in the fundus. Refractive correction is needed after refractive surgery, either with lenses (frames, soft lenses, RGP) or refractive correction surgery
2, refractive correction surgery: currently there are intraocular refractive surgery and corneal refractive surgery. The purpose is to reduce myopic refraction and remove highly myopic glasses. Patients after posterior scleral reinforcement usually receive refractive correction surgery again after 1 month. The procedures are: IOL implantation in eyes with lens, refractive lens replacement, excimer laser surgery, etc.
V. Which patients with high myopia need to undergo posterior scleral reinforcement surgery
Diagnosed with pathological myopia, one of the following conditions
1. Myopia deepens year by year due to the lengthening of the eye axis (1.0D/year or more)
2, visual impairment due to fundus lesions (below 0.6 with lenses)
Six, the choice of high myopia correction surgery
1.IOL implantation for lens-bearing eyes
A special “lens” (lens eye IOL) is implanted into the eye to correct myopic refraction, suitable for patients with relatively thin corneas who cannot undergo “excimer laser myopia surgery”, according to the location of the lens implantation is divided into anterior chamber type and posterior chamber type The lens is divided into anterior chamber and posterior chamber according to the location of the lens implant.
2.Refractive lens replacement
A special “lens” (IOL) is implanted in the eye to replace the patient’s own lens in order to correct the refraction of myopia, and if there is a concurrent cataract, it can be treated at the same time, but it cannot retain its own adjustment function.
3. Excimer laser myopia surgery
The higher the degree of myopia, the more the thickness of the cornea cut by laser, for the safety of the surgery, generally 1000 degrees ~ 1200 degrees below the height of myopia is suitable for excimer laser correction.
VII. Contraindications to pathological myopia control and correction surgery
1, serious eye or systemic diseases, such as glaucoma, heart disease, etc.
2, lack of knowledge and confidence in the surgery, too worried, or unrealistic expectations of the curative effect
3.Inability to follow up as scheduled after surgery
4.Able to accept the prescription lens, generally not recommended corrective surgery
VIII. Pre-operative precautions
1.After completing the outpatient examination, make an appointment for surgery and inpatient surgery in advance, and go through the admission procedure before 9:00 a.m.
2.Fast in the morning of the day of hospitalization, blood tests and other tests need to be done, women avoid menstrual period for surgery
3. Detailed fundus examination and fundus laser treatment if necessary
4.General anesthesia surgery requires 6-8 hours of fasting before surgery, and a small amount of soft food can be eaten before local anesthesia surgery.
IX. Postoperative precautions
1.Posterior scleral reinforcement should be practiced as soon as possible after surgery.
2. Do not do eye massage or eye rubbing after anterior chamber IOL implantation to avoid pressure on the eye.
3. Pay attention to eye hygiene and avoid eye injuries
4.Be sure to review regularly (telephone follow-up)
X. Post-operative review and treatment.
High myopia is a lifelong eye disease, the lesions that have occurred in the fundus often have to continue to aggravate, or will produce new lesions, in order to prevent and timely treatment of complications, to protect the safety of surgery and surgical results, must be regularly re-examined, for the necessary treatment
1.Review items: visual acuity, optometry, intraocular pressure, eye axis, fundus photography, anterior segment photography, corneal endothelium, etc.
2.Post-operative treatment: lens prescription, medication, laser in the anterior segment, fundus laser, re-operation, etc.
3, review time: generally 1 week, 1 month, 3 months, half a year after surgery, and then every six months or so, and timely consultation in case of vision loss, eye pain, etc.