饼式后巩膜加固术治疗未成年人病理性近视临床研究  

Clinical observation of cake-type sclera reinforcement for pathological myopia in minor

作　　者：陈珊娜 郑丽梅 洪荣照 白晶晶 刘侠 朱贞贞 李淑琴 杨茂民 吴正秀 吴美聪 孙飞 潘玲彩 

机构地区：[1]厦门科宏眼科医院,福建省厦门市361006

出　　处：《眼科新进展》2015年第4期351-355,共5页Recent Advances in Ophthalmology

基　　金：厦门市卫生局科技指导项目(编号:ZD2011S0491);厦门市湖里区科技计划社会发展项目(13社02)~~

摘　　要：目的探讨采用饼式同种异体巩膜行后巩膜加固术治疗病理性近视的安全性和有效性。方法采用饼式同种异体巩膜行后巩膜加固术,对21例42眼高度近视未成年患者进行治疗,随访1 a,观察术后眼压、裸眼视力、矫正视力、屈光状态、眼轴长度、角膜曲率,并行散瞳后裂隙灯眼底检查,观察患者裸眼及矫正视力变化、近视等效屈光度的增长速度、眼轴增长速度,观察术后有无视网膜脱离、玻璃体出血、巩膜缝穿等并发症的发生。结果术前非接触眼压为(14.63±2.01)mmHg(1 kPa=7.5mmHg),术后1 a为(14.53±1.64)mmHg,差异无统计学意义(均为P>0.05);术前裸眼及矫正视力分别为1.04±0.26和0.33±0.28(LogMAR视力表),术后1 a为0.88±0.23和0.25±0.21,与术前比较均有不同程度提高(P<0.001和P=0.004);术后近视等效球镜屈光度增长速度较术前显著减缓:术前近视等效球镜屈光度为(-9.44±2.66)D,增长速度为(-1.61±0.38)D·a-1;术后1 a分别为(-9.94±2.58)D和(-0.36±0.47)D·a-1,两组数据差异均有统计学意义(均为P<0.001);患者术后1 a眼轴与术前比较进行性延长显著减缓,术前眼轴长度为(26.60±1.30)mm,增长速度为(0.48±0.15)mm·a-1,术后1 a为(26.90±1.31)mm和(0.29±0.30)mm·a-1,两组数据差异均有统计学意义(P<0.001和P=0.012);术前角膜曲率为(43.65±1.40)D,术后1 a为(43.87±1.43)D,差异无统计学意义(P>0.05)。术后1 a无视网膜脱离、玻璃体积血、巩膜缝穿等并发症。结论饼式后巩膜加固术是一种延缓未成年人病理性近视等效球镜屈光度及眼轴发展的方法 ,手术方法相对简单,并发症发生相对少。Objective To investigate the safety and efficacy of the cake-type posterior scleral reinforcement surgery with the allogeneic sclera for high myopia. Methods Cake-type posterior sclera reinforcement surgery with the allogeneic sclera was performed in 21 cases（ 42 eyes） with high myopia,and the follow-up time lasted for one year. The postoperative intraocular pressure,uncorrected visual acuity,corrected vision acuity,refractive status,axial length,corneal curvature were observed,the slit lamp ophthalmoscopy examination with mydriatic was performed.The complications of our experiments was also observed,such as retinal detachment,vitreous hemorrhage,sclera seam wearing. Results Non-contact intraocular pressure before surgery was（ 14. 63 ± 2. 01） mmHg（ 1 kPa = 7. 5 mmHg）,one year after our surgery was（ 14. 53 ± 1. 64）mmHg,there was no statistical difference（ P〉0. 05）. According to LogMAR visual chart,the uncorrected and corrected visual acuity before surgery were 1. 04 ± 0. 26 and 0. 33 ± 0. 28,one year after surgery were 0. 88 ± 0. 23 and 0. 25 ± 0. 21,there were statistical difference（ P 0.001,P = 0. 004）. The growth rate of the equivalent diopter myopia after surgery was significantly slower than pre-operation,the preoperative equivalent diopter myopia was（- 9. 44 ± 2. 66）D,with an average growth rate of（- 1. 61 ± 0. 38） D yearly,one year after surgery was（- 9.94 ± 2. 58） D,with an average growth rate of（- 0. 36 ± 0. 47） D yearly,there two were significant difference（ all P 0. 001）. One year after surgery,the growth rate of eye axis was much slower than pre-operation,the preoperative axial length was（ 26. 60 ± 1. 30） mm with an average growth rate of（ 0. 48 ± 0. 15） D yearly,one year after surgery was（ 26. 90 ± 1. 31） mm with an average growth rate of（ 0. 29 ± 0. 30） mm yearly,there was statistical difference（ P 0. 001,P= 0. 012）. The preoperative corneal curvature was（ 43. 65 ± 1. 40） D,one year after surgery was（ 43. 87 ± 1.

关 键 词：病理性近视 同种异体巩膜 饼式后巩膜加固术 未成年人 

分 类 号：R778.110.5[医药卫生—眼科]