玻璃体手术对糖尿病视网膜病变术后角膜厚度的影响  

Influence of vitrectomy for corneal thickness in diaebetic retlnopathy eyes with Pentacam

作　　者：邵彦[1] 胡博杰[1] 刘慧[1] 李筱荣[1] 

机构地区：[1]天津医科大学眼科中心,300384

出　　处：《中华实验眼科杂志》2012年第1期73-77,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景玻璃体切割手术对糖尿病患者角膜厚度影响的研究具有理论意义和现实意义。目的观察比较糖尿病视网膜病变（DR）眼玻璃体切割术术后角膜厚度的变化趋势。方法前瞻性队列研究。收集因DR行单纯玻璃体切割术的连续病例70例75眼，采用Pentacam三维眼前节分析仪，由同一检查医师检查。于术前和术后7d、1个月、3个月测量角膜顶点、角膜最薄处及距角膜顶点4mm垂直线与右眼240°、120°、60°交点或与左眼300°、120°、60°的交点共5个部位的角膜厚度进行动态分析，采用重复测量的方差分析进行手术前后角膜厚度的比较性研究。进一步研究不同角膜部位是否行23g玻璃体切割术、手术持续时间、不同玻璃体腔填充物对角膜厚度变化率的影响。结果玻璃体切割术前，术后7d、1个月、3个月角膜平均厚度分别为（639．9±103．1）、（689．5±119．3）、（666．5±113．7）、（650，8±108，6）μm。按糖尿病病程为13年、年龄为57．2岁水平修正角膜厚度变化率，术后各随访时间点角膜厚度变化率的差异有统计学意义（F=210．928，P=0．000）；不同部位角膜厚度变化率不同（F=24．843，P=0．000），角膜厚度变化率按大小顺序依次为P4〉P，〉P3〉P2〉P1。行23g经结膜无缝合玻璃体切割术（TSV）对角膜厚度的影响小于传统的20g手术（F=53．843，P=0．000）；玻璃体内填充惰性气体对角膜厚度的影响明显大于填充平衡盐溶液者（F=5．288，P=0．022）；但是不同的手术持续时间对角膜厚度变化的差异无统计学意义（F=1．233，P=0．293）。结论DR有晶状体眼行玻璃体切割手术对于角膜是安全的，23gTSV及平衡盐溶液填充对角膜的影响更小。Pentaeam眼前节分析仪不仅能获得中央角膜厚度值，同样可以获得周边角膜厚度信息。Background The research of corneal thickness after pars plana vitrectomy in DM patient plays an important role not only theoretically but clinically. Objective Present study was to evaluate the change in corneal thickness after pars plana vitrectomy. Methods A prospective coherent study was designed. Seventy-five eyes of 70 consecutive diabetic retinopathy（DR） patients were collected in Tianjin Medical University Eye Center. Pentaeam was used to assess the central and periphery corneal thickness by the same investigator preoperatively and 7 days,1 and 3 months postoperatively, respectively. The thickness values from five corneal zone were obtained, including cornea vertex,the thinnest point of the cornea, periphery cornea near the scleral incision of 4 mm away to vertex of cornea on vertical and 240°, 120° ,60° meridian（ right eye） or 300°, 120° ,60° meidian （left eye）. These results were compared and analyzed with ANOVA of repeated measurement data. Subgroup analysis was performed to evaluate the influence of different corneal positions, the use of conventional 20g or 23g transconjunetival sutureless vitrectomy（TSV） groups, surgery duration, gas or fluid endotamponde on corneal thickness. This study was approved by Ethic Committee of this hospital. Written informed consent was obtained from the subjects before any relative medical procedure. Results The mean corneal thickness was （ 639.9 ± 103. 1 ） , （ 689.5 ± 119.3 ） , （ 666.5 ±113.7） , （ 650.8±108.6 ） μm before operation, postperative 7 days, 1 and 3 months respectively. As covariates appearing in the model, the corneal thickness change rates were revised as the parameters as following： diabeitc duration = 13.0 and age = 57.2. The revised corneal thickness was significant different among various time points （F = 210. 928 ,P=0. 000） and different corneal zones（F=24. 843 ,P=0. 000） with the size order in turn P4〉P3〉P1〉P2〉Ps＇ The corneal thickness change rates were less in 23g TSV group compared with

关 键 词：角膜厚度/中央 周边 经结膜无缝合玻璃体切割术 糖尿病视网膜病变 

分 类 号：R779.6[医药卫生—眼科]