后巩膜加固术前周边眼底检查结果分析

高度近视不仅是屈光异常 ,而且是眼轴增长引起视网膜、脉络膜组织退行性改变的一种器质性眼病 ,其发生率约占近视眼的 2 % ,是主要的致盲眼病之一。目前认为 ,后巩膜加固术是控制高度近视眼轴增长的唯一可行方法〔1〕。我科自 1998年开展后巩膜加固术以来 ,对 186例 (372眼 )欲行后巩膜加固术的高度近视患者进行了详细的周边眼底检查 ,现将检查结果报告如下 :材料和方法对 1998年 10月至 2 0 0 1年 4月于我院眼科门诊就诊并要求行后巩膜加固术的 186例 372眼高度近视患者进行了详细的双眼周边眼底检查 ,患者年龄 6～5 3岁 ,平均年龄 2 7岁 ,…     

高度近视眼底病变与眼轴长度的关系

本文报告３２例（６２眼）高度近视患者眼底病变情况及眼轴测量结果，二者分组对照分析，发现随着眼轴长度增加，眼底病变范围扩大、程度加重，且后极部病变增多；分析了眼轴长度与眼底病变的内在联系和相互影响，认为高度近视的形成机制复杂，远远超过了屈光不正的范畴，而眼轴的延长是眼底病变形成和发展的危险因素和中间环节，确切病因和发病机制尚待探索。     

后巩膜加固术在高度近视性黄斑病变手术中的应用

近视性黄斑病变致盲率高,常用治疗手段为玻璃体切割术,然而单纯玻璃体切割术对于已出现严重后巩膜葡萄肿的超高度近视患者疗效欠佳。近年来临床应用玻璃体切割术联合后巩膜加固术治疗高度近视继发眼底病变,特别在黄斑劈裂及黄斑裂孔病例中,疗效肯定,前景可期。我们针对近年来后巩膜加固术的材料与术式变迁作一全面综述,并进一步讨论其应用于眼底手术中的发展远景。     

后巩膜加固术治疗高度近视

后巩膜加固术能机械性加强巩膜，尤其是后半部巩膜，阻止眼球扩张及眼轴延长，从而阻断高度近视的进展。我院行３６例（６６眼）后巩膜加固术，术后１年以上视力提高和稳定６３眼（９５．４％），眼轴长度稳定６５眼（９８．５％）。认为后巩膜加固术是现今治疗高度近视唯一行之有效的方法。     

儿童青少年高度近视眼轴长度屈光度、年龄及眼底损害的相关性

目的:探讨儿童青少年高度近视更合理的防治时机.方法:观察76例147眼之眼轴长度及其与屈光度、年龄及眼底严重损害发生率之间的相关性并分析病变过程中后巩膜葡萄肿、漆裂样纹损害、玻璃体变性及Fuchs斑等病变之发生与进展.结果:眼轴长度、屈光度、年龄与眼底严重损害成正相关;眼轴在26mm以下,屈光度8D以下或年龄10岁以下眼底严重损害发生率很低;在眼底损害中,后巩膜葡萄肿出现较早,发展亦快,在眼轴由26mm增长至30mm之全过程中后巩膜葡萄肿发生率均显著增高;20岁之前眼轴长度、屈光度进展较快,但眼底严重损害较少和较轻,20岁以上者眼轴长度、屈光度进展较缓,然眼底严重损害之发生率却显著增高.结论:及时控制儿童、青少年高度近视之病程进展是眼科临床一项重要措施.     

影响高度近视白内障患者疗效的相关因素分析

目的:分析白内障摘除手术治疗高度近视白内障患者疗效的影响因素.方法:回顾性研究.纳入高度近视合并白内障患者行白内障摘除术86例118眼,所有患者均完成术后6mo随访调查且临床资料完整,记录所有患者术后6mo最佳矫正视力(best correct visual acuity,BCVA),以0.3为分界将患者分为低视力组(视力<0.3)与视力正常组(视力≥0.3),回顾性分析两组患者临床资料,对年龄、性别、病程、BCVA、角膜屈光度、眼轴长度、角膜散光、巩膜、眼底病变程度、术后并发症、玻璃体脱离、黄斑病变等因素进行统计,采用单因素及多元Logistic回归分析法筛选影响白内障摘除手术治疗高度近视白内障患者疗效的相关因素.结果:所有患者中低视力34眼(29%),视力正常84眼(71%);低视力组眼轴长度、角膜散光度、合并黄斑病变所占比例、合并后巩膜葡萄肿所占比例、晶状体核硬度分级、眼底病变程度与视力正常组对比差异有统计学意义(P<0.05);眼轴长度(OR:1.567,95%CI:1.129~2.224)、黄斑病变(OR:8.054,95%CI:1.741~37.541)、晶状体核硬度分级(OR:3.642,95%CI:2.512~18.787)、眼底病变程度(OR:7.964,95%CI:1.254~28.415)均与高度近视白内障疗效相关(P<0.05);随访6mo,晶状体后囊膜混浊5眼,无继发性青光眼、人工晶状体移位、角膜失代偿及视网膜脱离并发症发生.结论:眼轴长度、黄斑病变、晶状体核硬度分级、眼底病变程度均为影响白内障摘除手术治疗高度近视白内障患者术后视力恢复的独立危险因素,为促进患者术后视力恢复,必须积极控制危险因素,重视术中精细操作.     

巩膜加固术治疗高度近视的研究进展

由眼轴不断加长引起的病理性近视（高度近视）及其并发症是导致视力损害及致盲的主要原因之一。因其病因尚不完全明了，目前仍无较理想的治疗方法。放射状角膜切开术（ＲＫ）、准分子激光角膜成形手术虽可解决部分屈光问题，但不能阻止本病进展。巩膜加固术，旨在加固后葡萄肿的变薄区巩膜，阻止后葡萄肿进展，达到稳定近视度数；阻止黄斑及后极部视网膜变性发生和发展的作用，从而挽救部分进展迅速的高度近视患者的视力。本文拟从实验和临床角度，重点讨论巩膜加固术所用的加固材料、手术适应证及禁忌证、手术方法、手术效果及并发症。     

饼式后巩膜加固术治疗高度近视的临床观察

目的:探讨采用饼式后巩膜加固术对高度近视治疗的安全性和有效性。方法:采用饼式后巩膜加固术,对20例39眼高度近视患者进行手术治疗,随访1～3a。结果:患者术后眼轴无进行性延长,与术前比较差异无显著性;近视屈光度术后与术前比较,差异也无显著性;矫正视力术后均有不同程度的提高。结论:采用饼式后巩膜加固术并发症少,可稳定眼轴,稳定和改善视力,是一种安全有效的预防和治疗高度近视的方法。     

病理性近视后巩膜葡萄肿的研究进展

我国近视眼患者超过3亿,其中高度近视患者已超过一千万,高度近视中很大一部分为病理性近视(pathological myopia,PM),其并发的眼底病变已成为眼底病中不可逆致盲的首位眼病.在病理性近视眼底一系列退行性病变中,后巩膜葡萄肿(posterior staphyloma,PS)是最基础的病变之一,其发病原因仍无定论,可能是眼轴不断延长、巩膜中胶原的合成及分解紊乱造成胶原蛋白减少共同造成巩膜变薄而不能抵抗眼压的结果.目前病理性近视后巩膜葡萄肿的唯一治疗手段为后巩膜加固术.对于无临床症状或者因PS而产生的并发症需要定期观察,手术时机仍需要大量的临床研究进行评估.     

后巩膜加固术治疗儿童进行性高度近视的疗效观察

目的探讨对进行性高度近视患儿施行改良型Snyder-Thompson式后巩膜加固术的疗效。方法对<14岁28例(52眼)进行性高度近视患儿手术前后采用IOLMaster测定眼轴长度,散瞳验光屈光度矫正视力和眼底检查,应用配对t检验进行比较分析。结果眼轴长度术前为(28.47±2.36)mm,术后为(28.77±2.44)mm,差异有统计学意义(t=6.28,P<0.05)。术后与术前相比,平均眼轴增长(0.31±0.35)mm。矫正视力术前为0.45±0.25,术后为0.61±0.26,差异有统计学意义(t=12.61,P<0.05)。术后眼底未见1例并发症。结论改良型后巩膜加固术有可能延缓儿童高度近视眼轴的增长。     

高度近视眼底改变的最新研究进展

近视是全球发生率最高的屈光不正,我国有近6亿近视患者,其中高度近视（high myopia,HM）患者超过8000万。HM随着眼轴的进行性增长,眼底出现一系列退行性病变,如视盘斜入、颞侧脉络膜萎缩弧、后巩膜葡萄肿、后极部视网膜和脉络膜病变及周边部视网膜改变等,病理性近视多伴随或者导致黄斑病变、白内障、玻璃体病变、视网膜脱离与劈裂等严重并发症。目前,近视的发生趋于年轻化、高度化,HM眼底病变尤其黄斑病变是东亚国家主要的致盲原因。本文回顾近年国内外文献,就HM眼底改变的最新研究进展进行综述。     

An examination of the relation between intraocular pressure,fundal stretching and myopic pathology

Pathological myopia is one of the leading causes of visual impairment worldwide. Myopic development and progression is biomechanical and dominated by axial elongation. This clinical perspective examines some of the stretch‐related fundal changes, which are associated with axial elongation and myopic pathology. The biomechanics of stretching of the fundus appears to depend on genetically and/or visual experience‐based scleral changes, which reduce its thickness and elastic modulus so that it becomes more susceptible to the distending forces of intraocular pressure. These changes include reduced collagen synthesis, altered collagen fibres, tissue loss, altered proteoglycans and increased matrix metalloproteinase activity. Such changes are associated with reduced scleral rigidity and related increased potential to stretch in response to intraocular pressure. As axial elongation progresses, the sclera appears likely to continue to reduce in thickness and in its capacity to resist intraocular pressure, especially when pressure becomes elevated. Tessellation, lacquer cracks, myopic crescents, staphylomata, chorioretinal atrophy and retinal detachment are examined within a model for stretching of the fundus. Age, refractive error and axial length, for example, are associated with increased pathological progression. Myopic pathological progression can become dominated by vascular changes and include a greater risk of loss of acuity and blindness. Measures to control myopic pathology, which successfully slow or prevent stretching of the fundus, appear to be key factors in reducing or even avoiding permanent visual loss associated with this condition. For example, limiting axial elongation and related myopic fundus pathology by inhibiting changes which reduce the elastic modulus of scleral tissue is a desirable outcome from interventions to control myopia. Similarly, reducing exposure to the distending stress of elevated intraocular pressure appears to be a desirable form of intervention to control myopia, especially if myopic pathology can be reduced or prevented.     

后巩膜加固术对病理性近视合并白内障超声乳化手术后疗效的观察

目的 探索后巩膜加固术对病理性近视合并白内障术后视功能改善的作用。方法 对60例(60眼)病理性近视合并老年性白内障患者,随机分为加固组30例(30眼)和对照组30例(30眼)。加固组先行后巩膜加固术,1个月后再行白内障手术;对照组直接实行超声乳化(Phaco)联合人工晶状体(IOL)植入术,分析2组术前和术后3 d、7 d、1个月、3个月、6个月、12个月、18个月、24个月的视力、眼轴、术后眼底并发症等情况。结果 ①2组视力在白内障术后均较术前有所提高,其中3~24个月加固组最佳矫正视力均优于对照组,差异有统计学意义(P<0.05)。②加固组的眼轴长度在白内障术后24个月后无明显加长(P>0.05),在白内障术后6~24个月时短于对照组,差异有统计学意义(P<0.05)。③随访至24个月时,对照组共出现6例黄斑囊样水肿、1例孔源性视网膜脱离,加固组出现1例黄斑囊样水肿,未出现视网膜脱离,差异无统计学意义(P>0.05)。结论 对于病理性近视合并老年性白内障患者,先行后巩膜加固术,术后1个月再作白内障超声乳化(CP)联合IOL植入术,能有效抑制眼轴延长,提高术后视功能,减少视网膜后极部病变。     

高度近视眼底形态学研究进展

高度近视是目前世界范围内造成视力障碍的主要原因,随着社会发展,近视率逐年上升。高度近视的发展与眼轴的进行性延长密切相关,而眼轴的延长不可避免的会出现一系列的眼底改变,如近视弧形斑、漆裂纹、脉络膜新生血管、黄斑脉络膜萎缩、视网膜脱离、后巩膜葡萄肿等。当前近视呈现出低龄化、高度化的特点,已经成为我国主要的致盲性原因。本文针对高度近视视盘、黄斑、视网膜、脉络膜及巩膜的形态学改变,对最新研究进行简要的归纳总结,以期为结合高度近视眼底形态开发智能预测模型以及临床诊断和进一步针对治疗措施的研究提供一定的参考。     

The efficacy and safety of modified Snyder–Thompson posterior scleral reinforcement in extensive high myopia of Chinese children

Background

To observe the efficacy and safety of modified Snyder–Thompson posterior scleral reinforcement in extensive high myopia of Chinese children. We had a retrospective design, and included a control group of children with natural progression of high myopia.

Methods

This study included 64 eyes in 41 Chinese children with extensive high myopia who underwent modified Snyder–Thompson posterior scleral reinforcement surgery (PSR group), and 17 eyes in 11 age- and myopia-matched children who wore spectacles (control group). The mean follow-up was 4.99?±?1.3 years in the PSR group and 4.48?±?1.3 years in the control group. Axial length, spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and fundus examinations were recorded before and after treatment, and complications were noted.

Results

The mean change in SE at the end of the follow-up period was 1.5?±?1.44 diopters (D) and 3.02?±?1.57D in the PSR and control groups respectively. These changes were equivalent to an increase in axial length of 1.27?±?0.54 mm and 2.05?±?0.91 mm respectively. The PSR group showed less myopic progression and less eye elongation (p?<?0.001). A notable increase in UCVA was only found in the PSR group (p?=?0.0001). The improvement in BCVA was significantly greater in the PSR group (p?=?0.0354). There were no serious complications of PSR surgery.

Conclusion

The modified Snyder–Thompson PSR surgery was effective and safe in controlling extensive high myopia of Chinese children.     

后巩膜加固术后的眼内屈光手术治疗病理性近视的临床观察

目的:观察后巩膜加固术(posterior scleral reinforcement surgery,PSR)后眼内屈光手术治疗病理性近视的临床疗效。方法:对178例(323眼)病理性近视患者先行后巩膜加固术,1mo后再行眼内屈光手术,随访18mo。结果:最佳矫正视力(BCVA)PSR手术前后为4.65±0.38和4.72±0.33,差异有统计学意义(P<0.05),眼内屈光手术后1,12,18mo为4.80±0.30,4.86±0.29,4.82±0.31,与屈光手术前比较差异均有统计学意义(P<0.05);屈光度眼内屈光手术前及手术后1,12,18mo分别为-16.36±5.03D和-0.98±1.23D,-0.99±1.24D,-0.96±0.99D,术后各时期分别比较差异无统计学意义(P>0.05);眼轴PSR手术前后为29.92±2.68mm和29.80±2.58mm,差异无统计学意义(P>0.05),眼内屈光手术术后18mo眼轴为29.84±2.56mm,与术前比较差异无统计学意义(P>0.05);手术无严重并发症发生。结论:对于病理性近视患者,行后巩膜加固术后的眼内屈光手术进行屈光矫正,有效稳定,远期效果尚待进一步观察。     

高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离治疗的临床研究

目的:研究高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的临床治疗效果及不同手术方式的有效性。方法:回顾性分析2003-05/2008-05诊断治疗的高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离91眼,分析视网膜复位情况及最佳矫正视力。结果:在这些视网膜脱离的治疗中,有6种手术方式:单纯黄斑区巩膜外垫压12眼,5眼(42%)首次术后视网膜回贴;单纯玻璃体腔气体充填15眼,6眼(40%)首次术后视网膜回贴;平坦部玻璃体切除联合球内气体充填20眼,14眼(70%)首次术后视网膜回贴;平坦部玻璃体切除、视网膜前膜剥离联合球内气体充填16眼,11眼(69%)首次术后视网膜回贴;巩膜环扎、玻璃体切除、视网膜前膜剥离联合球内气体充填25眼,18眼(72%)首次术后视网膜回贴;巩膜环扎、玻璃体切除联合硅油填充13眼,10眼(77%)首次术后视网膜回贴。64眼(70%)首次手术治疗后视网膜回贴,85眼(93%)视网膜回贴。结论:玻璃体切除联合球内惰性气体或硅油填充是治疗高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的最有效方法。     

Role of the sclera in the development and pathological complications of myopia

Myopia is one of the most prevalent ocular conditions and is the result of a mismatch between the power of the eye and axial length of the eye. As a result images of distant objects are brought to a focus in front of the retina resulting in blurred vision. In the vast majority of cases the structural cause of myopia is an excessive axial length of the eye, or more specifically the vitreous chamber depth. In about 2% of the general population, the degree of myopia is above 6 dioptres (D) and is termed high myopia. The prevalence of sight-threatening ocular pathology is markedly increased in eyes with high degrees of myopia ( > -6 D). This results from the excessive axial elongation of the eye which, by necessity, must involve the outer coat of the eye, the sclera. Consequently, high myopia is reported as a leading cause of registered blindness and partial sight. Current theories of refractive development acknowledge the pivotal role of the sclera in the control of eye size and the development of myopia. This review considers the major biochemical mechanisms that underlie the normal development of the mammalian sclera and how the scleral structure influences the rate of eye growth during development. The review will characterise the aberrant mechanisms of scleral remodelling which underlie the development of myopia. In describing these mechanisms we highlight how certain critical events in both the early and later stages of myopia development lead to scleral thinning, the loss of scleral tissue, the weakening of the scleral mechanical properties and, ultimately, to the development of posterior staphyloma. This review aims to build on existing models to illustrate that the prevention of aberrant scleral remodelling must be the goal of any long-term therapy for the amelioration of the permanent vision loss associated with high myopia.     

高度近视性黄斑出血的临床观察

目的：观察高度近视性黄斑出血的临床特点和探讨其治疗方法。方法：对确诊为高度近视黄斑出血的28列32眼分别作视力、矫正视力、眼前节、眼底、A／B超、眼底彩照和眼底荧光血管造影（fundus fluorecein angiography,FFA)等检查,给予中西药物治疗,随访观察2－26个月（平均16个月。）结果：经FFA检查32眼中28眼（87．5％）为单纯型黄斑出血,其中25眼（89．3％）伴有漆裂样纹。出血经治疗多在15天至2个月吸收。另外4眼FFA显示为脉络膜新生血管出血,最终均因反复出血,后巩膜葡萄肿和脉络膜萎缩而预后较差。结论：高度近视性黄斑出血分单纯型和脉络膜新生血管型,前者出现吸收快,后者反复出血严重损害中心视力而预后不良。