眼内硅油对屈光状态影响的理论推导与临床观察

Theoretic and clinical study on refraction alteration induced by intraocular silicone oil

目的 研究眼内硅油对屈光状态的影响。方法 ( 1)理论推导 :在 5种模型眼上推导硅油填充后屈光变化。在无晶状体模型眼上设计 4种硅油状态 ,计算其对屈光的影响。 ( 2 )临床观察 :3 4只硅油填充眼 ,测定硅油取出前后的镜片屈光度。结果 ( 1)理论推导 :不同折射率的硅油可导致不同有晶状体模型眼镜片屈光度增加 6 0 7～ 8 3 9D。对于无晶状体眼 ,房水 /硅油界面为平面时 ,眼屈光无变化 ;硅油形成与玻璃体腔相同的球体、屈光指数为 1 40 5时 ,镜片屈光度改变 -5 47;硅油量过大或不足时 ,眼屈光度随硅油量不同而改变。 ( 2 )临床观察 :硅油导致有晶状体眼屈光改变6 90 5D± 1 40 3D ;无晶状体眼无巩膜环扎者屈光改变 -6 5 8D± -3 3 8D ,巩膜环扎眼屈光改变 -9 10D± -4 42D。结论 ( 1)硅油导致无晶状体眼近视化 ,有晶状体眼远视化。 ( 2 )Helmholtz模型眼是研究硅油对有晶状体眼屈光影响的最佳理论模型。 ( 3 )眼内硅油对无晶状体眼屈光状态的影响与硅油填充量密切相关。

ObjectiveTo study the refractive changes induced by intraocular silicone oil. Methods ① The theoretical study based on five schematic eyes and four shapes of silicone oil bubble models in aphakic eyes was taken to evaluate the relation between ocular refraction and the volume of silicone oil. ② Refraction was performed on 34 eyes before and after silicone oil extraction.Results① Theoretically, 5 types of phakic schematic eyes showed 6 07～8 39 D increase in spectacle refraction induced by intraocular silicone oil. There was no refractive changes in aphakic schematic eye with flat aqueous fluid/silicone oil interface, but a -5 47 D alteration in spectacle refraction when silicone oil formed a same radius of globe as vitreous cavity and refraction changed with the volume of silicone oil in excessive or relatively inadequate amount of silicone oil injection eyes. ②Clinically, spectacle refraction induced by intraocular silicone oil increased by 6 905±1 403 D in phakic eyes, decreased by -6 58 ±-3 38 D in aphakic eyes and -9 10±-4 42 D in aphakic buckled eyes. Conclusions① Intraocular silicone oil could induce hyperopia in phakic eyes and myopia in aphakic eyes. ② Helmholtz Schematic Eye proves to be the most suitable model to study the refractive effect of intraocular silicone oil in phakic eyes. ③ Refractive effect of intraocular silicone oil in aphakic eyes is closely related with the volume of silicone oil.