摘要
目的观察高度近视孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)患者行玻璃体切割联合晶状体手术后屈光状态的变化。方法回顾性分析2016年1月至2017年3月于青岛大学附属医院确诊为RRD的患者30例30眼的临床病例资料。高度近视组15例15眼,非高度近视组15例15眼。两组患者均先行玻璃体切割联合白内障超声乳化吸出术并填充硅油,3个月后均行硅油取出联合人工晶状体(intraocular lens,IOL)植入术。IOL植入术后随访6个月。两组玻璃体切割术前均测量眼轴长度、角膜曲率,根据这两项指标计算IOL植入后的预测屈光度。硅油取出结合IOL植入术后1个月、3个月、6个月复测眼轴长度、角膜曲率、验光计算实际屈光度数(实际屈光度)。两组手术前后均测量最佳矫正视力并计算Log MAR视力。观察两组手术前后Log MAR视力、屈光度、眼轴长度、角膜曲率的变化,分析高度近视组术后屈光预测误差与术前眼轴长度之间的关系。结果术后两组视力均较术前提高,差异均有统计学意义(均为P<0.05)。高度近视组术后1个月、3个月、6个月屈光较术前均向近视方向漂移,随时间变化近视漂移逐渐增大,术后各时间点相比差异均有统计学意义(均为P<0.05);非高度近视组术后各时间点屈光较术前及术后各时间点屈光相比差异均无统计学意义(均为P>0.05)。高度近视组术后1个月、3个月、6个月眼轴长度、角膜曲率较术前均明显提高(均为P<0.05);非高度近视组术后1个月、3个月、6个月眼轴长度、角膜曲率较术前均无明显变化,差异均无统计学意义(均为P>0.05)。高度近视组术后6个月屈光预测误差与术前眼轴长度之间呈负相关(R^2=0.580,P=0.001)。结论RRD患者行玻璃切割联合晶状体术后最佳矫正视力提高,高度近视患者术后屈光向近视方向漂移,且随着术后时间的延长屈光向近视方向漂移更明显;高度近视患者术后眼轴增长,角膜曲率增大,高度近视患者术前眼轴越长,术后屈光越向近视方向漂移。
Objective To evaluate the changes in refractive state in high-myopic patients with rhegmatogenous retinal detachment after vitrectomy combined with cataract surgery. Methods C linical data of 30 patients of rhegmatogenous retinal detachment in the Affiliated Hospital of Q ingdao U niversity from January 2016 to M arch 2017 was retrospectively analyzed,and these patients w ere randomly dividedly into tw o groups: high myopia( 15 patients of 15 eyes) and non high myopia group( 15 patients of 15 eyes), in which patients firstly underw ent vitrectomy combined with phacoemulsification and silicone oil tamponade,follow ed by intraocular lens( IO L) implantation after the removal of silicone oil 3 months later. T he tw o groups w ere continuously follow ed-up for 6 months after IO L implantation. Before vitrectomy,the axial length,corneal curvature w ere measured for calculating the predictive spherical equivalent( SE). T hen axial length and corneal curvature at 1 month,3,6 months after IO L implantation were measured for calculating the actual SE. The best corrected visual acuity( BC VA) w as recorded before and after operation and the LogM AR w as calculated in each groups. The SE,axial length,corneal curvature before vitrectomy and 1 month,3,6 months after IO L implantation were respectively compared in each group. The relationship betw een the refractive prediction errors and the preoperative axial length in the high myopia group w as evaluated. Results The LogM AR visual acuity was improved in both groups,and the difference betw een before and after treatment w as statistically significant( both P < 0. 05). T he SE at 1 month,3,6 months after surgery show ed significantly myopic shift in the high myopic eyes,and the myopic shift gradually increased with time,with statistically significant at each time point( all P < 0. 05),but there was no significant difference in myopic shift between before and after surgery as well as among each time point after surgery in the non-high myopic eyes( P > 0. 05). Axial length and corneal curvature at 1 month,3,6 month after surgery inthe high myopia group were significantly increased( all P < 0. 05),whereas those in the non high myopia group did not change( all P > 0. 05). By simple linear regression analysis,the refractive prediction errors had a negative correlation with the preoperative axial length in the high myopia group( R2 = 0. 580,P = 0. 001). Conclusion The LogMAR visual acuity after vitrectomy combined with cataract surgery is improved in patients with rhegmatogenous retinal detachment. Postoperative axial length growth and corneal curvature increase are presented in patients with high myopia,and the longer the preoperative axial length is,t he more myopic shift the eye shows.
出处
《眼科新进展》
CAS
北大核心
2018年第1期73-76,共4页
Recent Advances in Ophthalmology
