成人眼外肌术后角膜曲率及屈光状态的变化

目的:探讨成人显微眼外肌术后角膜曲率及屈光的变化。方法:选择2016-12/2017-05在云南省第二人民医院眼科行显微眼外肌术患者62例85眼,年龄18~43岁,按手术方式分为水平直肌组:Ⅰ组(单纯后徙组)32眼、Ⅱ组(单眼一条直肌后徙联合其拮抗肌截除组)34眼;斜肌组:Ⅲ组(单眼下斜肌断腱组)10眼、Ⅳ组(下斜肌转位组)9眼。分别于术前与术后1d,1wk,1、3、6mo行主观验光获得屈光度及角膜地形图采集角膜前表面(0~3、5、7mm)曲率值,比较各组内不同时间点患者屈光状态及角膜形态动态变化。结果:水平直肌术后短期可导致水平角膜曲率改变,此仅限于角膜中央5mm区内,基本在术后1mo恢复至术前水平。斜肌术后对角膜曲率无明显影响。水平直肌术后早期散光值增加,并出现近视移位,在术后1mo恢复至术前水平。斜肌术后球镜度、散光值无明显变化。结论:成人眼外肌手术后短期会出现角膜曲率及屈光变化。

Corneal curvature and refractive state changes after microscopically extraocular muscle surgery in adults

·AIM:To investigate the corneal curvature and refractive changes after microscopically extraocular muscle surgery in adults.·METHODS:To observe 62 cases of 85 eyes underwent microscopic extraocular muscle surgery in the Second People’ s Hospital of Yunnan Province from December2016 to May 2017,age 18 to 43,according to the surgical method,patients were divided into horizontal rectus surgery:Ⅰ group(simple migration group) 32 eyes,Ⅱgroup(rectus monocular migration combined with its antagonist muscle excision group) 34 eyes,the oblique muscle group:Ⅲ group(single oblique muscle tendon broken group) 10 eyes,IV group(oblique muscle transposition group) 9 eyes;Subjective optometry was performed preoperatively and postoperatively at 1 d,1 wk,1 mo,3 mo and 6 mo,respectively,to obtain the refractive state changes and the curvature value of the anterior surface of the cornea(0-3 mm,5 mm,7 mm) collected by corneal topography.The dynamic changes of the refractive state and corneal morphology of the patients in each group at different time points were compared.Anova and LSD-t test were used for comparison among time points and within each group.·RESULTS:Changes of corneal curvature in horizontal rectus muscle can be induced in a short period after the operation,which is limited to the central 5 mm area of the cornea,and basically restored to the preoperative level1 mo after the operation.There was no significant effect on corneal curvature after inferior oblique operation.Astigmatism value increased in the early postoperative period of horizontal rectus muscle;Myopic drift occurred and recovered to preoperative level 1 mo after surgery.After the operation of the inferior oblique muscle,there was no significant change in the spheroscopy and astigmatism.·CONCLUSION:Corneal curvature and refractive changes may occur after extraocular muscle in adults.