两种外路手术治疗孔源性视网膜脱离对眼球结构和眼压影响的观察

目的 观察巩膜外硅胶海绵垫压术和巩膜外环扎联合硅胶垫压术后眼球结构的改变及对眼压的影响。设计 回顾性病例系列。研究对象 孔源性视网膜脱离住院手术治疗患者64例64眼,其中接受巩膜外单纯硅胶海绵垫压术25眼（海绵组）,巩膜外环扎联合硅胶垫压术39眼（联合组）。方法 手术前,术后1周、1个月及3个月应用A型超声仪、超声生物显微镜（UBM）对眼球生物参数检测,非接触眼压计检测眼压。主要指标 眼压、角膜厚度、角膜曲率、前房深度、晶状体厚度、睫状体厚度、房角开放距离和小梁虹膜夹角。结果 术后3个月时64眼全部视网膜解剖复位。眼压、角膜厚度、角膜水平曲率、角膜垂直曲率、晶状体厚度、睫状体厚度,术后1周与术前相比显著增加（P均<0. 05）。海绵组术后1个月和3个月眼压与术前相比无显著性差异,而联合组术后3个月眼压（15.41±2.58）mmHg与术前（13.66±3.16）mmHg相比有显著性差异（P=0.009）。海绵组和联合组角膜垂直曲率术后1周分别为（45.03±1.08）D、（44.47±0.90）D（P=0.027）。结论 巩膜外硅胶海绵垫压术和巩膜外环扎联合硅胶垫压术对角膜、前房及房角等眼球结构的早期影响较明显;巩膜外环扎联合硅胶垫压术对眼压影响持续时间长,应给予关注和干预。（眼科,2017, 26： 30-34）     

准分子激光原位角膜磨镶术后角膜后表面改变的特点及其影响因素

目的探讨准分子激光原位角膜磨镶术(LASIK)后角膜后表面的改变的特点和影响因素。方法对61例行LASIK术的近视患者分别于术前、术后1周、1个月、3个月采用OrbscanⅡ观察角膜后表面的曲率半径、不规则系数、前房深度,并利用多元回归分析术后1周角膜后表面的前膨与影响因素的关系,以最佳适合球面(PBFS)曲率半径的差值和角膜后表面高度差(PED)作为角膜后表面的前膨的指标。结果LASIK术前、术后1周、1个月、3个月前房深度分别为(3.2448±0.2806)、(3.2770±0.2810)、(3.2579±0.2932)、(3.2651±0.2875)mm;PBFS曲率半径分别为(6.5095±0.2177)、(6.3731±0.2127)、(6.4257±0.2358)、(6.4354±0.2266)mm;角膜后表面5.0mm范围的不规则系数分别为0.622±0.142、0.978±0.244、0.884±0.207、0.881±0.174,术后各期较术前明显增大(P<0.01),术后1个月和3个月的差异无统计学意义(P>0.05)。多元回归分析显示术后1周角膜后表面的前膨与术前屈光度数呈正相关(r=0.0173,P=0.005),与术后1周角膜厚度呈负相关(r=-1.495,P=0.001)。结论LASIK矫正近视直接改变了角膜前表面,也相应引起了角膜后表面的变化,术后角膜后表面变陡且不规则性增加,但3个月内不会渐进性发展。其改变与术前屈光度数呈正相关,与术后1周角膜厚度呈负相关。     

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     

Posterior corneal ectasia following LASIK

PURPOSE: To evaluate the cases of posterior corneal ectasia following laser in situ keratomileusis. MATERIAL AND METHODS: Thirteen eyes of 7 patients, that were diagnosed to have posterior corneal ectasia (?0.060 mm) on Orbscan topographic system following LASIK, were identified. The parameters evaluated were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, contrast sensitivity, glare, corneal topography, keratometry and pachymetry. The preoperative and postoperative data at day 1, 1 week, 1 month, 3 months, 6 months and 1 year were retrospectively analyzed. RESULTS: The mean UCVA of the patients before LASIK surgery was 0.032 +/- 0.04. It was 0.320 +/- 0.159 in follow-up of LASIK surgery after 1 year. The mean Pre-LASIK BCVA was 0.59 +/- 0.11. There was no change in mean BCVA at 1 year. The mean preoperative spherical equivalent was -14.25 +/- 2.91 D except in 2 hyperopic eyes in which the mean spherical equivalent preoperatively was +5.75 +/- 0.35 D. The mean postoperative spherical equivalent after 1 year of LASIK surgery in last follow-up (+/- enhancement) was - 3.45 +/- 2.08 in the myopic eyes and + 1.0 +/- 0.70 in the two hyperopic eyes. The mean preoperative posterior corneal elevation was 0.022 +/- 0.011 mm, which at the end of 1 week following LASIK was 0.067 +/- 0.009 and at 1 year/ last follow-up following LASIK, it was 0.068 +/- 0.006 mm. CONCLUSIONS: Higher amplitudes of refractive correction may lead to the occurrence of posterior corneal ectasia.     

Oversized corneal grafts for corneal opacities with iridocorneal adhesions.

OBJECTIVE: To evaluate the efficacy of 1-mm oversized corneal grafts in patients with acquired corneal opacities and extensive peripheral iridocorneal adhesions. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Twenty patients (20 eyes) aged 15 years or older with unilateral or bilateral corneal opacification and a shallow anterior chamber. INTERVENTION: Penetrating keratoplasty was performed with donor corneal buttons oversized by 1 mm. MAIN OUTCOME MEASURES: The various parameters evaluated were visual acuity, graft clarity, keratometry, anterior chamber depth, intraocular pressure, and spherical equivalent refraction 12 months after surgery. RESULTS: The keratoplasties were performed in 15 eyes with a corneo-iridic scar after infectious keratitis (75%) and 5 eyes with failed graft (25%). At the final follow-up, a clear graft was achieved in 17 eyes (85%), and 14 eyes (70%) achieved a best-corrected visual acuity of 6/12 or better. Three of the grafts failed because of rejection. The average keratometry was 44.1 +/- 1.0 diopters (D), and the mean spherical equivalent was -3.23 +/- 2.86 D. The oversized grafts provided a mean anterior chamber depth of 2.36 +/- 0.42 mm, and the mean intraocular pressure at the 12 month follow-up was 16.38 +/- 2.09 mmHg. CONCLUSIONS: Corneal grafts oversized by 1 mm provide adequate anterior chamber depth and reduce the risk of peripheral anterior synechiae and secondary glaucoma in patients with corneal opacities and extensive peripheral iridocorneal adhesions.     

2.8 mm切口超声乳化白内障吸除术的临床观察

探讨２．８ｍｍ透明角膜切口超声乳化白内障吸附折叠式人工晶状植入手术效果。方法对１０５例（１２６只眼）行上述手术患者的术后视力、屈光状态、角膜状态,前房反应、角膜内皮细胞损失率进行回顾性总结。结果术后１ｄ、３ｄ、１周、２或３个月裸眼视力在０．５以上的眼数分别为１０２只眼（８１．０％）,１０８只眼（８５．７％）、１１２只眼（８８．９％）及１１２只眼（８８．９％）;术后３ｄ、１周、１个月、３个月平均散光     

白内障人工晶状体植入术前后角膜厚度和前房深度及前房角的改变

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术前后,术眼前房深度和角膜厚度及前房角结构的改变。方法:对20例20眼老年性白内障患者行超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1wk使用超声生物显微镜量化测量前房深度、角膜厚度和前房角宽度。结果:全部患者术后1wk角膜厚度明显增加,前房深度明显增大;500μm处前房角开放距离(AOD500)及ACA角度均与术前值比较明显增加,且均P<0.01。结论:超声乳化白内障吸除折叠式人工晶状体植入术可以使角膜厚度显著增加;可显著增加老年性白内障患者的前房深度及房角宽度。     

Residual bed thickness and corneal forward shift after laser in situ keratomileusis

PURPOSE: To prospectively assess the forward shift of the cornea after laser in situ keratomileusis (LASIK) in relation to the residual corneal bed thickness. SETTING: Miyata Eye Hospital, Miyazaki, Japan. METHODS: Laser in situ keratomileusis was performed in 164 eyes of 85 patients with a mean myopic refractive error of -5.6 diopters (D) +/- 2.8 (SD) (range -1.25 to -14.5 D). Corneal topography of the posterior corneal surface was obtained using a scanning-slit topography system before and 1 month after surgery. Similar measurements were performed in 20 eyes of 10 normal subjects at an interval of 1 month. The amount of anteroposterior movement of the posterior corneal surface was determined. Multiple regression analysis was used to assess the factors that affected the forward shift of the corneal back surface. RESULTS: The mean residual corneal bed thickness after laser ablation was 388.0 +/- 35.9 microm (range 308 to 489 microm). After surgery, the posterior corneal surface showed a mean forward shift of 46.4 +/- 27.9 microm, which was significantly larger than the absolute difference of 2 measurements obtained in normal subjects, 2.6 +/- 5.7 microm (P<.0001, Student t test). Variables relevant to the forward shift of the corneal posterior surface were, in order of magnitude of influence, the amount of laser ablation (partial regression coefficient B = 0.736, P<.0001) and the preoperative corneal thickness (B = -0.198, P<.0001). The residual corneal bed thickness was not relevant to the forward shift of the cornea. CONCLUSIONS: Even if a residual corneal bed of 300 microm or thicker is preserved, anterior bulging of the cornea after LASIK can occur. Eyes with thin corneas and high myopia requiring greater laser ablation are more predisposed to an anterior shift of the cornea.     

Sirius角膜地形图仪测量LASIK和LASEK术后角膜后表面的研究

目的通过Sirius角膜地形图仪测量LASIK和LASEK术后角膜后表面,分析其变化特点．评价各因素对角膜后表面变化的影响。方法前瞻性临床研究。人选2012年5月至2013年7月在宁波第一医院行准分子激光屈光手术患者,其中LASIK手术37例（74眼）,LASEK手术26例（52眼）,术前应用Sirius角膜地形图仪测量每眼．并完善术前常规检查,记录相关数值。记录患者术中的切削深度、切削比例、残留基质厚度,术后1周、1个月、3个月复查。各时间点之间数据比较应用重复测量资料方差分析．各变量与角膜后表面高度变化量之间的影响程度应用多元线性回归。结果LASIK与LASEK术后1周、1个月和3个月角膜后表面高度与术前比较稍增高,差异有统计学意义（F=43.58、7.51,P〈0.01）;残留基质对LASIK术后1周、1个月和3个月后表面高度变化量有影响（f=-3.421、-3.376、-3.116,P〈0.01）,对LASEK术后1个月和3个月后表面高度变化量有影响（t=-3.077、-2.872,P〈0.01）。结论Sirius角膜地形图仪测定显示LASIK、LASEK术后均表现为角膜后表面微量前移。残留基质厚度对角膜后表面变化影响较大。     

前房容积与白内障超声乳化术后角膜内皮变化的相关性分析

目的探讨白内障超声乳化术前前房容积、前房深度状态与术后角膜内皮细胞变异之间的相关性。方法对46例（60只眼）老年性白内障行白内障超声乳化吸出及人工晶状体植入术。术前以Pentacam三维前房分析仪测定前房容积、前房深度,并分别于术前和术后1周使用非接触型角膜内皮显微镜观察中部角膜内皮细胞的密度变化。结果术前的平均前房容积为（153.43±21.37）mm3,前房深度为（2.72±0.33）mm。术后1周平均中部角膜内皮细胞损失率为（9.27±5.17）%,术前的前房容积与术后1周角膜内皮细胞损失率呈显著负相关（r=-0.703,P〈0.001）,前房深度与术后1周角膜内皮细胞损失率亦呈显著负相关（r=-0.711,P〈0.001）。结论白内障超声乳化吸出人工晶状体植入术后角膜内皮细胞损失率与术前前房空间状态密切相关,Pentacam三维前房分析仪对于前房空间的量化测量为临床评估手术预后提供重要参考。     

近视眼角膜厚度及相关因素分析

目的:探讨青年近视患者角膜厚度分布特点及其相关因素。方法:选取青年近视患者200例(400眼),按屈光度不同分为4组,应用OrbscanⅡ眼前节分析系统对患者的角膜中央点、最薄点、后表面平均屈光度最大点,以及距中心1.5,2.5mm上方、下方、颞上、颞下、鼻上、鼻下、颞侧、鼻侧部位的角膜厚度及相应的前房深度、后表面高度、后表面曲率、前表面曲率进行测量。结果:角膜厚度呈中心薄周边厚分布,最薄点位于距中心2.5mm范围内(86%),角膜颞下部位(50%)。后表面平均屈光度最大点、最薄点、中央点三个点的角膜厚度在不同近视组中差异无统计学意义(P>0.05)。不同部位的角膜厚度与其他因素相关分析。结果:中央点:角膜厚度与前房深度、前表面曲率负相关(r=-0.181,-0.103,P=0.000,0.039)。最薄点:角膜厚度与相应的前房深度、后表面高度、后表面曲率绝对值、前表面曲率呈负相关(r=-0.167,-0.113,-0.104,-0.109;P=0.001,0.024,0.038,0.03)。后表面屈光度最大点:角膜厚度与相应的前房深度、后表面高度、后表面曲率绝对值、前表面曲率呈负相关(r=-0.342,-0.138,-0.189,-0.159;P=0.000,0.000,0.000,0.001)。结论:角膜厚度最薄点多位于旁中心2.5mm颞下部位;角膜厚度与近视程度无关;角膜厚度与相应的前房深度、后表面高度、后表面曲率绝对值、前表面曲率为负相关关系。     

Corneal topographic changes after retinal detachment surgery

PURPOSE: To evaluate the changes in corneal topography after scleral buckling surgery for retinal detachment. METHODS: Twenty-one eyes of 21 patients with the diagnosis of retinal detachment were included in this prospective study. Scleral buckling surgery was performed on all patients. The corneal topography of each was measured before surgery and at 1 week and 1 and 6 months after surgery by computer-assisted videokeratoscopy using the EyeSys 2000 Corneal Analysis System. Changes in corneal videokeratographies were analyzed using the Holladay Diagnostic Summary (HDS) software package. RESULTS: A statistically significant central corneal steepening (average, 1.8 diopter) was noted 1 week after surgery. The total and irregular astigmatic components both revealed a significant but transient increase in the first postoperative month. All these topographic changes persisted for as long as 6 months but returned to preoperative values afterward. CONCLUSION: Scleral buckling was found to induce transient changes in corneal topography producing both myopia and corneal astigmatism. Videokeratography is helpful for documenting such corneal changes after scleral buckling surgery for retinal detachment.     

2 mm微切口与3~5 mm切口SMILE术后角膜高阶像差的比较

目的探讨2 mm微切口与3~5 mm切口飞秒激光小切口角膜基质透镜取出术（SMILE）后角膜前后表面及整体角膜高阶像差的变化。方法对照研究。选取行SMILE手术的患者61例（61眼）,取右眼作为研究对象,其中行2 mm微切口SMILE术的26例（26眼）作为MILE组,行3~5 mm切口SMILE术的35例（35眼）作为对照组,采用Pentacam测量患者术前、术后1个月和6个月的角膜前、后表面及整体角膜的波前像差值。术后6个月时,MILE组和对照组完成随访的病例数分别为20例和35例。采用重复测量方差分析进行同一组内手术前后像差值的比较,采用独立样本t检验比较2组间的像差值。结果在对照组,术后不同时间角膜前、后表面及整体角膜的总高阶像差（tHOA）、垂直彗差（Z3-1）、水平彗差（Z31）和球差（Z40）与术前相比差异均有统计学意义（P<0.05）。在MILE组,术后1个月和6个月角膜前表面和整体角膜的tHOA、Z3-1、Z31和Z40与术前相比差异有统计学意义（均P<0.01）,角膜后表面的Z3-1和Z40与术前相比差异有统计学意义（P<0.01）。2组间的角膜前表面tHOA、Z3-1和Z31在术后1个月和6个月差异均有统计学意义（t1个月=3.509、-4.103、2.418,P<0.05;t6个月=2.248、-2.628、2.617,P<0.05）,2组间角膜后表面的Z31在术后1个月和6个月差异均有统计学意义（t=-2.416、-2.852,P<0.05）,2组间整体角膜tHOA、Z3-1和Z31在术后1个月差异均有统计学意义（t=2.376、-3.323、2.623,P<0.05）。结论不同切口大小对角膜前、后表面及整体角膜不同项高阶像差的影响不同,术后6个月时切口大小对整体角膜的tHOA,Z3-1、Z31和Z40无影响,2 mm的微切口对角膜后表面像差的影响相对较小。     

Corneal topographic changes after retinal and vitreous surgery.

PURPOSE: To investigate the topographic changes in the cornea after retinal and vitreous operations. DESIGN: Observational prospective case series. PARTICIPANTS: The study population included 46 patients after vitreoretinal surgery: 11 underwent pneumatic retinopexy, 10 underwent vitrectomy, and 25 underwent scleral buckling procedure. METHODS: The corneal topography was measured by videokeratography with the absolute program and evaluated statistically by a quantitative comparative method, which was developed for this study, for the whole and the central cornea. MAIN OUTCOME MEASURES: The corneal topographic changes were measured in diopters (D), evaluating and comparing the preoperative and postoperative measurements. RESULTS: None of the operative procedures changed the shape of the whole cornea. Vitrectomy induced radial steepening of the central cornea 1.2 to 1.6 D, corresponding to the scleral sutures. Central steepening (average, 2.2 D) was also noted in the first week after circular buckling, but it flattened (average, 1.4 D) after 1 to 3 months. When an additional radial or circumferential buckling element was added to the circular buckle, steepening of the entire cornea and radial steepening of the central cornea (average, 0.6-0.8 D) occurred in the first week and flattened or returned to baseline after 1 to 3 months. There was no correlation between the location of the additional buckling element and the corneal topographic change. CONCLUSIONS: Corneal videokeratography is a useful tool for evaluating the postoperative corneal curvature. It showed that vitreoretinal surgery alters the shape of the cornea when buckling or scleral sutures are used, but pneumatic retinopexy does not.     

巩膜切口深度对白内障术后散光的影响

目的 ：观察巩膜切口深度对硬性人工晶状体在白内障超声乳化术后散光的影响。

方法：依据术前角膜地形图测角膜散光度数46例46眼,均行巩膜缘后3mm水平切口,术后visante oct分两组：A组切口深度为1/2巩膜深度(23眼); B组切口深度为1/3巩膜深度(23眼); 分别于术后1wk; 1,3mo观察两组角膜散光情况,并进行统计分析。

结果：A,B组术后裸眼视力均有明显改善,同时根据角膜地形图的检测结果,术后散光1,3mo与术后1wk相比,角膜散光度数有所回退,A组具有统计学差异。

结论：1/2巩膜切口对硬性人工晶状体在白内障超声乳化术后散光影响较小。     

Influence of excimer laser photorefractive keratectomy on the posterior corneal surface

PURPOSE: To investigate the influence of excimer laser photorefractive keratectomy on the refraction and geometry of the posterior corneal surface. SETTING: Miyata Eye Hospital, Miyazaki, Japan. METHODS: Thirty-seven eyes of 21 patients with refractive errors of -2.00 to -9.75 diopters (D) were treated with the VISX Twenty-Twenty excimer laser system. The refractive and anteroposterior changes in the posterior corneal surface were measured using scanning-slit corneal topography (Orbscan, Orbtek, Inc.) preoperatively and 1 week and 1 and 3 months postoperatively. RESULTS: Mean posterior corneal refraction was -6.51 D +/- 0. 29 (SD) preoperatively; it decreased to -7.00 +/- 0.49 D, -7.00 +/- 0.55 D, and -6.92 +/- 0.42 D at 1 week, 1 month, and 3 months, respectively (P <.001, Tukey multiple comparison). Mean forward shift of the posterior corneal surface was 29.5 +/- 1.9 microm, 34.4 +/- 3.4 microm, and 54.3 +/- 4.0 microm at 1 week, 1 month, and 3 months, respectively. The amount of posterior corneal refractive change correlated with the degree of forward shift (r= -0.691, P <. 001). The residual corneal thickness correlated with the refractive change (r = 0.524, P <.001) and the forward shift (r = -0.851, P <. 001) of the posterior corneal surface. CONCLUSION: Photorefractive keratectomy induced significant refractive changes in the posterior corneal surface and forward shift of the cornea, both of which correlated with the thinness of the residual cornea.     

羊膜卷填塞治疗角膜穿孔羊膜的演变及对角膜内皮细胞的影响

目的 观察羊膜卷填塞联合C3F8气体填充治疗角膜穿孔术后羊膜的演变及其对角膜内皮细胞的影响.方法 因各种原因所致角膜穿孔而施行羊膜卷填塞联合前房C3F8气体填充术共56例（56眼）.术中以20％C3F8气体填充前房.术后观察前房深度、房水渗漏情况、气泡维持时间、角膜内皮细胞密度及形态,以及羊膜卷与角膜融合情况.结果 56例角膜穿孔均得到修复,羊膜卷无脱落,术后2个月时羊膜卷与角膜逐渐融合,其间无明显缝隙,C3F8气体在前房存留时间5～16 d,平均（8.2±4.8）d.术前与术后1个月、2个月时角膜内皮细胞密度差异均无统计学意义（t=1.02,1.71,P ＞0.05）,六角形细胞比例术后1个月时低于术前（t=2.13,P＜0.05）,术后1个月与术后2个月时差异无统计学意义（t=1.65,P＞0.05）.结论 羊膜卷填塞联合前房C3F8气体填充可有效修复角膜穿孔,术后羊膜卷与角膜融合好,C3F8气体能较长时间维持前房深度,防止房水渗漏,对角膜内皮细胞影响甚小.     

翼状胬肉手术后角膜曲率变化及对人工晶状体度数测算的影响

目的　探讨翼状胬肉手术后角膜曲率变化及对人工晶状体度数测算的影响。方法　收集2016年7月至2017年4月于广州医科大学附属第二医院行手术治疗的原发性鼻侧翼状胬肉患者,共32例42眼,设为胬肉组;对照组为胬肉组中单眼翼状胬肉患者的对侧眼,共22例22眼。术前测量胬肉组患者翼状胬肉长度、宽度和面积,同时计算对照组理论人工晶状体度数。在术前及术后1个月、3个月使用IOL Master测量胬肉组患者眼轴长度、前房深度、角膜曲率、理论人工晶状体度数等。结果　胬肉组术前角膜水平曲率为（43.32±1.69）D,术后1个月为（44.30±1.40）D,术后3个月为（44.32±1.43）D。术前角膜平均曲率（44.32±1.32）D,术后1个月为（44.78±1.40）D,术后3个月为（44.73±1.38）D,术后角膜水平曲率和角膜平均曲率均较术前升高（均为P<0.05）,但术后1个月与术后3个月差异均无统计学意义（均为P>0.05）。胬肉组患者术前术后眼轴长度、前房深度、角膜垂直曲率均无明显变化（均为P>0.05）。胬肉组患者术前理论人工晶状体度数为（21.46±1.57）D,术后1个月为（20.84±1.65）D,术后3个月为（20.86±1.64）D。术后理论人工晶状体度数较术前下降,差异均有统计学意义（均为 P<0.01）。根据ROC曲线计算得出,翼状胬肉长度2.15 mm、宽度4.20 mm、面积5.18 mm²为判断翼状胬肉及其手术对人工晶状体度数测算是否有较大影响的最佳诊断界值。结论　翼状胬肉术后角膜水平曲率和角膜平均曲率增加。角膜曲率的改变导致测算的人工晶状体度数下降。当翼状胬肉较大时会对人工晶状体度数测算产生有临床意义的影响。     

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)     

合并眼前节病变的玻璃体视网膜手术方式探讨

目的探讨合并眼前节病变的玻璃体视网膜手术治疗方式及疗效。方法回顾性分析我院2004年9月~2005年9月间6例(6只眼)合并眼前节病变的玻璃体视网膜手术患者资料。6例患者分别应用眼前节手术联合玻璃体切割或外路视网膜脱离手术的方法治疗,根据患者的具体情况制定不同的联合手术方式,术后1、2周,1、3、6月随访观察患者的视力、角膜、前房、人工晶状体、视网膜的情况,6例患者术后随访时间为2~6月。结果全部患者视网膜复位,视力不同程度提高,3例患者未见不良反应发生。1例后房型人工晶状体发生移位,1例患者术后出现前房渗出,经药物治疗短期内吸收,2例患者少量气体进入前房,角膜水肿,其中1例前房气体吸收后消退,另1例角膜上半水肿,经2个月药物治疗后好转。结论合并眼前节病变的玻璃体视网膜联合手术能够减轻患者的痛苦和降低治疗风险及费用,并使玻璃体视网膜手术的操作变的更容易和准确。术后经过有一定的特殊性,适当的手术方式及用药可以降低不良反应的发生。