玻璃体切除术后屈光度及视功能分析

目的 观察各种类型玻璃体切除术后患者屈光度变化和视功能恢复情况,为后期进行光学矫正提供依据.方法 回顾性病例对照研究.2009年1月至2011年2月期间250例玻璃体切除患者,其中男147例,女103例,年龄3～78岁,平均(48.6±16.4)岁.按玻璃体切除是否联合硅油填充或联合晶状体切除不同分为单纯玻璃体切除87例,玻璃体切除联合硅油填充131例,玻璃体、晶状体切除联合硅油填充32例3组,分析术前、术后1周至1个月、术后半年到1年的屈光度和视力变化,调查主观感觉视物是否扭曲变形.采用单因素方差分析.结果 单纯玻璃体切除组术后1周至1个月眼的总屈光度小于术前,但差异无统计学意义,其余2组在术后l周至1个月眼的总屈光度明显小于术前,差异有统计学意义(F=22.406、18.714,P＜0.05);3组的散光程度在术后1周至1个月均大于术前,差异有统计学意义(F=4.395、4.81、6.354,P＜0.05).3组在术后半年至1年屈光度和散光变化不明显,差异无统计学意义.最佳矫正视力在1周至1个月比术前有明显提高,术后半年至1年趋于稳定.术后1个月33例最佳矫正视力大于0.3的患者出现视物扭曲变形的情况,在术后半年到1年有13例仍然存在视物不同程度扭曲变形.结论 玻璃体切除手术可以明显改善患者的视功能,降低眼的总屈光力,增加眼的散光度,术后半年至1年其屈光度基本趋于稳定.部分矫正视力较好的患者,可能出现初期术后不同程度的视物扭曲变形,但随着时间延长会逐渐改善.

Analysis of refraction and visual function changes postvitrectomy

Objective To observe the refractive changes and visual function recovery of patients after various types of vitrectomy, and provide the basis for late optical correction. Methods It was a retrospective case-control study. Two hundred and fifty postvitrectomy patients, including 147 males and 103 females, were followed up from January 2009 to February 2011. The patients ranged in age from 3 to 78 years （mean 48.6±16.4 years）. They were divided into 3 groups based on the type of surgical technique： including simple vitrectomy, 87 patients; vitrectomy combined with silicone oil filling, 131 patients; vitrectomy combined with crystal excision and silicone oil filling, 32 patients. Refraction and visual function changes were analyzed and subjective sensation was assessed preopertively and one week to one month after the operation, and again a half year to one year after the operation. Data were analyzed with ANOVA. Results The mean refractive error （RE） for the 3 groups was lower one week to one month after the operation compared to preoperative RE. There were no statistically significant preoperative or postoperative differences for the simple vitrectomy patients （P〉0.05）. However, there was a statistically significant difference for the patients in the other two groups （F=22.406, 18.714, P〈0.05）. The degree of astigmatism was higher 1 week to 1 month after the operation than preoperative levels for the 3 groups. These changes were statistically significant （F=4.395, 4.81, 6.354, P〈0.05）. There were no obvious changes in RE or degree of astigmatism a half year to one year after the operation for the 3 groups. And there was no statistically significant difference between the simple vitrectomy group and the other 2 groups （P〉0.05）. Best corrected visual acuity （BCVA） improved significantly 1 week to 1 month after the operation compared to preoperative VA and it remained stable a half year to one year after the operation. Visual distortion symptoms occurred in thirty-three patients with a best corrected visual acuity of more than 0.3 one month after the operation and was still present in 13 patients a half year to one year after the operation. Conclusion Vitrectomy can significantly improve visual function, reduce total refractive error and increase the degree of astigmatism in patients. Visual distortion occurred in the patients with better BCVA after the operation and gradually improved.