后巩膜加固术对病理性近视球后血管血流动力学及脉络膜厚度的影响

目的评价后巩膜加固术对病理性近视脉络膜厚度及球后血管血流动力学的影响。方法前瞻性研究。选择2012年1月至2013年6月就诊于中国医科大学附属第四医院眼科行后巩膜加固术的的病理性近视患者34例（55眼），对其随访2年，比较术后视力、屈光度、眼轴及眼压（IOP）改变，并采用深层成像谱域光学相干断层扫描（EDI-OCT）检测患者黄斑中心凹下脉络膜厚度（SFCT），彩色超声多普勒成像仪检测球后血管血流动力学。采用重复测量单因素方差分析对各时间点的数据进行比较。结果术前与术后1、3、6、12、24个月的logMAR最佳矫正视力（BCVA）总体比较差异有统计学意义（F=3.960，P＜0.01），而等效球镜度（SE）、眼轴及IOP差异无统计学意义（F=1.374、1.382、1.193，P＞0.05）。术前与术后各时间点比较，睫状后短动脉（SPCA）及视网膜中央动脉（CRA）的收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）增加，血流阻力指数（RI）减低，且总体比较差异有统计学意义（SPCA：F=2.376，P＜0.05；F=4.476，P＜0.01；F=4.238，P＜0.01。CRA：F=2.316，P＜0.05；F=3.335，P＜0.01；F=9.770，P＜0.01）。术前SFCT为（122.4±31.9）µm，术后1、3、6、12、24个月的SFCT增厚，分别为（134.4±32.9）、（139.0±35.7）、（136.5±33.8）、（134.9±31.5）、（135.9±35.4）µm，术前与术后各时间点的SFCT总体差异有统计学意义（F=2.875，P＜0.05），各时间点的SFCT与术前两两比较差异均有统计学意义（P＜0.05）。结论后巩膜加固术可改善视力，稳定屈光度，防止眼轴变长，改善球后血管血流动力学，使脉络膜厚度增厚，从而控制和延缓病理性近视的发展。

Effects of postocular vascular hemodynamics and choroidal thickness after posterior scleral reinforcement surgery for pathological myopia

Objective To evaluate the effects of postocular vascular hemodynamics and choroidal thickness after posterior scleral reinforcement for pathological myopia.Methods From January 2012 to June 2013,34 patients (55 eyes) were enrolled in this prospective study and underwent posterior scleral reinforcement surgery.Two years after the procedure,visual acuity,refraction and axial length were measured,as well as choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) and postocular vascular hemodynamics using Doppler imagining (CDI).A paired repeated measures ANOVA was used to analyze the differences.Results There was a statistically significant improvement in postoperative best-corrected visual acuity (BCVA) at 1,3,6,12 and 24 months compared with preoperative eyes (F=3.960,P＜0.01).Postoperative spherical equivalent (SE),axial length and intraocular pressure remained stable,and no statistically significant differences were found (F=1.374,1.382,1.193,P＞0.05).After the 1,3,6,12 and 24 months observations periods,there was a statistically significant enhancement of postoperative peak systolic velocity (PSV) and end diastolic velocity (EDV) as well as a statistically significant decrease in the resistance index (RI) of the short posterior ciliary artery (SPCA) and central retinal artery (CRA) (SPCA:F=2.376,P＜0.05;F=4.476,P＜0.01; F=4.238,P＜0.01.CRA:F=2.316,P＜0.05; F=3.335,P＜0.01; F=9.770,P＜0.01).Significant differences in subfoveal choroidal thickness (SFCT) were found before and after the operation (F==2.875,P＜0.05).The preoperative subfoveal choroidal thickness (SFCT) was 122.4±31.9 μm,which increased to 134.4±32.9 μm at 1 month,139.0±35.7 μm at 3 months,136.5±33.8 μm at 6 months,134.9±31.5 μm at 12 months,and 135.9±35.4 μm at 24 months.The differences were statistically significant (P＜0.05).Conclusion Scleral reinforcement surgery can improve visual acuity,prevent refractive progression and axial length elongation,increase postocular vascular hemodynamics and ehoroidal thickness so as to stabilize the progression of pathological myopia.