视网膜脱离巩膜环扎术后眼球生物测量及屈光状态观察

目的 研究视网膜脱离巩膜环扎术后眼部屈光状态的改变及其影响因素。 方法 用眼科超声仪、角膜曲率仪、验光仪等对巩膜环扎加压眼内嵴高为4～6　D的86例原发性视网膜脱离患者的86只患眼手术前1天及术后第1，4，12周时前房深度、眼轴长度、晶状体厚度、眼屈光度、角膜曲率等进行测量并将结果进行比较。 结果 前房深度在术后第1，4，12周时较术前显著变浅(P＜0.05)；眼轴长度无明显变化；晶状体厚度和眼屈光度在术后第1，4周时较术前分别有增厚和向负值偏移(P＜0.05)，术后第12周时两者与术前比较无显著差异；巩膜环扎联合≤1象限加压块组术后第1，4周加压径线的角膜曲率与术前比较差异显著(P＜0.05)。 结论 在较高眼内环扎嵴时，术眼术后早期晶状体增厚和前房变浅是眼屈光度负值增加的主要因素，其原因与术后虹膜晶状体隔移位等有关。 (中华眼底病杂志, 1999, 15: 227-229)     

巩膜环扎加压术后屈光度的改变

目的:探讨视网膜脱离巩膜环扎加压术后眼部屈光状态的改变。方法:用眼科A超、检影验光等对23例23眼原发性视网膜脱离患者手术前1d及术后1,4,12wk时的眼轴长度、眼屈光度等进行测量并将结果进行比较。结果:眼轴长度、晶状体厚度增加在术后1,4,12wk时均较术前增长(P<0.01)。眼屈光度增加、前房深度变浅,及角膜曲率增加在术后1,4,12wk时均较术前增加,且向负值偏移(P<0.05)。结论:巩膜环扎加压术后眼轴长度和屈光状态的变化与眼内嵴有关,术后眼轴增长是眼屈光度负值增加的主要因素。     

巩膜环扎术后眼球的屈光改变及生物测量

目的 :观察环扎术后眼球屈光状态的改变。方法 :前瞻性研究了 35例孔源性视网膜脱离巩膜环扎术患者。分别在术前 1天、术后 1 0天测量屈光度、前房深度、晶状体厚度、眼轴长度、角膜水平及垂直曲率。结果 :巩膜环扎术后屈光度向负值偏移 (- 0 75± - 0 2 5)D。角膜水平曲率变大、前房变浅 (P <0 0 5)。而角膜垂直曲率和晶状体厚度变化不明显 (P >0 0 5)。控制环扎带平均 65mm长时 ,眼内嵴高 3～ 6D ,眼轴长度平均增加 1 36mm。结论 :巩膜环扎术后眼屈光度向负值偏移。眼轴长度的增加是偏移的主要原因     

巩膜环扎加压术对眼屈光状态影响的临床观察

目的 通过测定巩膜环扎加压术前后眼屈光状态，探讨手术对屈光状态改变的影响。方法 观察行巩膜环扎加压术者19例（19只眼），测定术前1天、术后1月的模拟角膜镜读数、散光度及其轴向、角膜中央区3mm平均屈光力、角膜后表面高度、前房深度、晶状体厚度、眼轴长度、屈光度及术后双眼波前像差。结果 术后术眼各项高阶像差Z3、Z4、Z5及总高阶像差Zg与健眼比较均值增加，其中Z3、Z5及总高阶像差Zg的比较有统计学显著性差异（P〈0．05），K1值、散光值、屈光度、眼轴、前房深度、晶状体厚度及角膜后面表高度比较有显著性差异（P〈0．05），而K2值、散光轴向和角膜中央3mm平均屈光力无显著性差异（P〉0．05）；眼屈光度与眼轴、K1值密切相关，统计学有显著意义；结论 巩膜环扎加压术后，高阶像差增加，低阶像差向负值偏移，柱镜部分增加明显。     

巩膜环扎术后角膜地形图,眼轴及屈光度变化

采用ＴＭＳ２型角膜地形图仪对孔源性视网膜脱离患者１５例１５只眼。于巩膜环扎术前、术后１周及术后１个月进行角膜屈光力测量分析。同时测量手术前后眼轴及屈光度的改变。结果：①环扎术后１周角膜屈光力、散光值较术前稍增加，无统计学意义。而术后１个月角膜屈光力、散光值与术前检查基本相同。②环扎术后眼轴明显延长，近视度亦增大。随着时间推移，眼轴逐渐缩短，近视度减小。术后１月眼轴长度及近视度较术前明显增加。巩膜环扎术后眼轴长度的变化是导致眼屈光度变化的主要因素。     

巩膜扣带术后眼球屈光系统的变化

目的研究巩膜扣带术后眼球屈光系统的变化及其影响因素。方法应用A型超声仪、i-Trace像差仪等检测37例（37只眼）原发性孔源性视网膜脱离，其中巩膜外单纯硅橡胶外垫压（硅压）术9只眼，巩膜外环扎联合硅压术28只眼，术前及术后1、4、12周对角膜厚度、前房深度、晶状体厚度、玻璃体腔长度、眼轴长度及眼球角膜曲率、屈光度等低阶像差和高阶像差进行测量并将结果比较。结果巩膜扣带术后，1周和4周眼球物理指标变化显著（P〈0．05），环扎联合硅压组12周后仍有统计学意义。两种术式患者术后1、4周眼球屈光度和散光均向负值显著增加（P〈0．05），散光变化最大的方向多发生在巩膜外硅压条中央的垂直经线上。巩膜扣带术后总像差、低阶像差、高阶像差在术后1、4及12周同术前相比（P〈0．05）均具有统计学意义，单纯硅压组12周时总像差同术前相比具有统计学意义。结论巩膜扣带术后眼球低阶像差发生暂时性变化，总像差、高阶像差较术前增加，视觉质量下降。     

巩膜环扎术对玻璃体腔径及屈光度影响的研究

目的探讨视网膜脱离环扎术后玻璃体腔径改变及屈光度变化,揭示它们之间的变化规律及相互关系.方法采用自动角膜曲率计,眼A超及电脑验光仪对我院46例患者于巩膜环扎术前、术后1周、1个月及3个月进行角膜屈光力,眼轴及屈光度的测量.结果(1)术后1周角膜屈光力,散光值较术前稍增加,无统计学意义.而术后1个月,3个月角膜屈光力,散光值与术前检查基本相同.(2)术后眼轴明显延长,主要表现在玻璃体腔径的改变,近视度亦增加.随时间推移,眼轴(玻璃体腔径)逐渐缩短,近视度减少.但术后1个月,3个月眼轴长度(表现在玻璃体腔径),近视度较术前明显增加.结论巩膜环扎术后玻璃体腔径的改变是导致服轴延长的主要原因,进而引起眼屈光度的改变.     

视网膜脱离复位术后屈光改变的临床研究

目的　了解视网膜脱离复位术后屈光状态的改变及恢复情况。方法　收集 39例 (39只眼 )手术复位成功的孔源性视网膜脱离患者 ,于术前及术后 1周、1、3、6月分别进行检影验光 ,A超测量眼轴长度 ,角膜曲率计检查 ,观察动态变化情况。结果　术前本组孔源性视网膜脱离中 ,近视眼占 82 .0 5 %。 >4 .0 D者占 6 9.2 3% ,眼轴长度>2 6 mm者占 6 9.2 3%。 3例环扎术后 ,全部眼轴加长 ,近视度加深。术后 1周及 1月时 ,散光值 >2 .0者为 12 .82 % ,术后 3个月逐渐减少。放射状加压术后散光值更大 ,差异有显著性 (P <0 .0 5 ) ,但 6个月内能恢复原状。结论　术前眼轴越长 ,近视度越高 ,发生孔源性视网膜脱离机会越多。环扎术后 ,眼轴变长 ,近视度加深 ,且半年内无明显改善。环形加压术或放射状加压术后早期 ,近视度数降低 ,向远视方向改变 ,从 +0 .5 D～ +5 .0 D不等 ,1月时最为明显。放射状加压术更易引起角膜曲率改变 ,散光值更大。但这种屈光改变是暂时性的 ,术后 6个月逐渐恢复原状 ,并趋于稳定。临床上适宜于视网膜脱离复位术后 6个月重新验光配镜。     

充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离

目的 观察充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离的疗效.方法 回顾分析我科经充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离13例(13眼)孔源性视网膜脱离或合并增生性玻璃体视网膜病变(PVR),其中PVR A级3眼,B级6眼,C1级3眼,C2级1眼;黄斑部脱离4眼.眼轴长度21.45-28.47 mm.前次手术采用单纯巩膜外加压8眼,环扎联合加压3眼,环扎联合加压、注气2眼.患眼于本次术中玻璃体腔内注入纯全氟丙烷(C3F8)气体0.5-1.0ml,术后严密观察,保持适当体位,确保气泡封闭裂孔.结果 手术后随访2-13月,12眼视网膜完全复位.1眼因PVR进展视网膜下液增多,视网膜未复位,后行玻璃体手术.手术后9眼视力提高,3眼视力不变,1眼视力下降.结论 巩膜扣带术后残留视网膜脱离可以通过充气性视网膜固定术获得视网膜解剖复位,视力改善.     

最小量巩膜外垫压术治疗孔源性视网膜脱离的疗效分析

目的比较分析最小量巩膜外垫压术与巩膜环扎垫压术治疗孔源性视网膜脱离的疗效。方法回顾性分析2008年3月至2009年3月收治的20例（20只眼）孔源性视网膜脱离患者行最小量巩膜外垫压术（A组）的临床资料,并在同期住院行巩膜环扎垫压术的孔源性视网膜脱离患者中随机选择40例（40只眼）作为对照组（B组）,术后随访比较两组的视网膜复位率、最佳矫正视力及并发症情况。结果术后视网膜首次复位率A组为90％,B组为95％;最佳矫正视力A组为0．48±0．33,B组为0．48±0．28;增生性玻璃体视网膜病变（PVR）进展者A组占5％,B组占10％,两组间均没有显著差异（P=0．4642、0．9662、0．5089）。术后A组出现复视1只眼,B组出现短期高眼压3只眼,黄斑水肿1只眼,复视1只眼;两组术后屈光度的变化有显著差异（P=0．0019）,前房深度、眼轴长度及散光度的变化均没有显著差异（P=0．5444、0．8732、0．0582）。结论外加压手术是一种有效复位脱离视网膜的手术方式,最小量巩膜外垫压术对孔源性视网膜脱离能获得很好的疗效,而对眼球创伤小、仅改变眼局部形态结构,能避免传统巩膜环扎垫压术的一些并发症,但远期疗效还有待进一步观察。     

巩膜扣带拆除手术前后眼球变化的计算机断层扫描三维重建观察

目的 观察巩膜环形扣带拆除手术前后眼球球壁和眼轴长度的变化.方法 前瞻性、对照性研究.临床确诊为孔源性视网膜脱离的20例患者20只眼纳入研究.所有患者均行巩膜环形扣带手术,并于手术后2.0～3.5年行环形扣带拆除手术.环形扣带拆除手术前及手术后1、3、6个月,采用计算机断层扫描三维重建技术(3D-CT)对手术眼及健眼扫描,记录手术眼球球壁和眼轴长度变化情况.同时,采用光学相干生物测量仪(IOL-Master)测量手术眼的眼轴长度.对比分析两种测量方式测得眼轴长度的差异.结果 3D-CT扫描发现,环形扣带拆除手术前,所有手术眼扣带部位眼球球壁凹陷,呈"葫芦状"外形.环形扣带拆除手术后1个月,眼球球壁凹陷消失.3D-CT测量发现,环形扣带拆除手术前手术眼眼轴长度为(27.65±1.22)mm手术后1、3、6个月,手术眼眼轴长度分别为(27.30±1.56)、(27.29±1.46)、(27.12±1.49)mm;环形扣带拆除手术前后眼轴长度比较,差异无统计学意义(t=2.89,P=0.723).IOL-Master 测量发现,环形扣带拆除手术前手术眼眼轴长度为(28.32±1.94)mm;手术后1、3、6个月,手术眼眼轴长度分别为(28.17±1.87)、(28.21±1.94)、(28.25±1.93)mm;环形扣带拆除手术前后眼轴长度比较,差异无统计学意义(t=3.304,P=0.930).两种测量方式测得眼轴长度比较,差异无统计学意义(t=3.705,P=0.847).结论 巩膜环形扣带拆除手术前眼球球壁凹陷,手术后眼球球壁凹陷消失;环形扣带拆除手术前后眼轴长度无变化.     

Analysis of changes in corneal shape and refraction following scleral buckling surgery

PURPOSE: A prospective study was performed to investigate changes in corneal shape and axial length following scleral buckling surgery. METHODS: We investigated the changes in corneal shape, refraction, and axial length following scleral buckling surgery in 24 patients who underwent local buckling and 14 patients who underwent encircling with additional segmental buckling. The corneal shape was determined by corneal topography and autokeratometry, refraction was measured by autorefractometry, and axial length was measured by A-mode ultrasonography before surgery, and 1, 2, and 7 days, and 1, 3, and 6 months after surgery. RESULTS: After local buckling, the axial length shortened and a hyperopic change was observed. After encircling with additional segmental buckling, the axial length elongated and a myopic shift was detected. The direction of the surgically induced corneal astigmatic vectors was almost identical to the direction of the buckle. There was a tendency for shorter distances between the limbus and the buckle to be associated with greater absolute values. Astigmatism gradually decreased following surgery and stabilized in about 3 months. CONCLUSIONS: Surgeons should select a surgical procedure to ensure favorable postoperative visual acuity while minimizing changes in the shape of the cornea.     

Effects of scleral encircling surgery on vitreous cavity length and diopter

AIM: To observe the changes of vitreous cavity length and diopter after scleral encircling (SE) produce. METHODS: This prospective study included 68 eyes of 68 non-consecutive patients with macula-off retinal detachment who were operated by SE surgery. The corneal refractive power, ocular axial length and diopter were measured by keratometer, A-mode ultrasonic meter and computed dioptometer. RESULTS: There was no significant difference in corneal refractive power among preoperative and postoperative 1, 3 and 6 mo (0.57±0.54 D at pre-surgery;0.72±0.26 D at 1mo; 0.71±0.34 D at 3mo; 0.69±0.31 D at 6mo; all P>0.05 ). Axial lengths were obviously lengthened, especially in vitreous cavity length (17.87±3.09 mm, 19.69±3.12 mm, 18.97±3.56 mm, 18.76±3.47 mm, 18.68±3.42 mm at pre-surgery, 1wk, 1, 3 and 6mo postoperatively, P <0.05) and diopter also increased at beginning and then recovered gradually. After 1 and 3 mo, axial length (vitreous cavity length) and myopia were more and in higher degree than before surgery. CONCLUSION: The change of postoperative vitreous cavity length is the main factor that results in the changes of axial length and then makes the change of diopter.     

Effects of scleral buckling on refraction and ocular growth in young rabbits

Background: There have been a series of reports indicating that scleral buckling (SB) surgery may induce high myopia in advanced retinopathy of prematurity. The mechanism of SB on refractive change in children, however, is not clearly known. We designed this study to investigate the effects of SB on refractive error and ocular growth in young rabbits and demonstrate their mechanisms. Methods: For the study, SB surgery was performed on the right eyes of nine 5-week-old rabbits and 11 8-week old rabbits, with encircling buckle. The left eyes were monitored for control. Spherical equivalent, corneal power, and axial length were measured before SB and postoperatively at 2, 4, and 8 weeks. We compared the experimental group with the control group and analyzed the influence of age at the time of operation. Results: In the control group of eyes, corneal power decreased, axial length increased, and spherical equivalent developed emmetropization with aging. In all eyes that underwent SB surgery, high myopia developed, with the increase in axial length as a major factor in inducing myopia. These changes were greater in the 5-week-old group than in the 8-week-old group. In the eyes that underwent SB surgery, axial length increased more than the eyes in the control group up to 2 weeks after surgery, but ocular growth was arrested after that time. Conclusions: SB in young rabbits effects ocular growth and results in high myopia, and an increase of axial length plays a major role in this mechanism. Also, the difference in the effects of SB according to age at the time of surgery may suggest that SB in premature infants could induce a significant axial myopia and secondary amblyopia. Received: 8 November 1999 Revised: 17 January 2000 Accepted: 27 March 2000     

Ciliochoroidal detachment following scleral buckling surgery for rhegmatogenous retinal detachment

PURPOSE AND METHODS: We observed the peripheral choroid; ciliary body, and depth of the anterior chamber by ultrasound biomicroscopy (UBM) in 31 eyes with rhegmatogenous retinal detachment before and after scleral buckling surgery. Scleral encircling was performed in 11 eyes and segmental scleral buckling in 20 eyes. RESULTS: With UBM, ciliochoroidal detachment was detected in all eyes (100%) following scleral encircling and in 8 eyes (40.0%) following segmental scleral buckling. After scleral encircling procedure, the eyes with preoperatively bullous and wide retinal detachment showed a severe ciliochoroidal detachment and edema of the ciliary body. Shallowing of the anterior camber occurred in all 11 eyes (100%) after scleral encircling and in 12 of 20 eyes (60.0%) after segmental scleral buckling. Marked shallowing with closure of the angle and elevated intraocular pressure occurred in 2 eyes. CONCLUSION: The results showed that careful postoperative examinations for the anterior segments, chamber angle, and intraocular pressure are necessary with slit-lamp examination and applanation tonometry after scleral buckling surgery.     

Ciliochoroidal Detachment Following Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose and Methods: We observed the peripheral choroid, ciliary body, and depth of the anterior chamber by ultrasound biomicroscopy (UBM) in 31 eyes with rhegmatogenous retinal detachment before and after scleral buckling surgery. Scleral encircling was performed in 11 eyes and segmental scleral buckling in 20 eyes.Results: With UBM, ciliochoroidal detachment was detected in all eyes (100%) following scleral encircling and in 8 eyes (40.0%) following segmental scleral buckling. After scleral encircling procedure, the eyes with preoperatively bullous and wide retinal detachment showed a severe ciliochoroidal detachment and edema of the ciliary body. Shallowing of the anterior camber occurred in all 11 eyes (100%) after scleral encircling and in 12 of 20 eyes (60.0%) after segmental scleral buckling. Marked shallowing with closure of the angle and elevated intraocular pressure occurred in 2 eyes.Conclusion: The results showed that careful postoperative examinations for the anterior segments, chamber angle, and intraocular pressure are necessary with slit-lamp examination and applanation tonometry after scleral buckling surgery.