玻璃体切割术后眼内硅油粘度对屈光度的影响

Changes of Refraction and Axial Length Due to Viscosity of Intracular

目的:证实硅油的不同粘度对眼屈光状态不同影响。方法:共收治视网膜脱离 49 例(49 只眼),为排除患者的屈光状态及眼轴长度对本研究的影响,作者按年龄、屈光状态及眼轴长度进行配对分组,使其具有可比性。一组眼内填塞硅油的粘度为3 700 cst,其为法国产,另一组硅油的粘度为5 000 cst,其为德国产。采用常规扁平部三通道玻璃体切割术,所有均联合巩膜环扎术或外加压术。对视网膜前膜用眼内钩、镊及剪分离后,用玻璃体切割头切除,经剥膜和视网膜松驰切开等处理后,视网膜弹性得到恢复,向眼内缓慢注入 3 700 cst硅油或 5 000 cst硅油置换重水或气体。术后进行随访。结果:①视力:两组患者术后视力均比手术前有不同的程度的提高,其中提高到手动者6例,指数者11例,0.02者10例,0.05者8例,0.1者9例,0.2者5例。②屈光度与眼轴长度,所有硅油注入眼,屈光度及眼轴长度有相应的增加,且增加的幅度随着硅油的粘度不同而有所差异。③眼底情况:所有硅油填塞眼,视网膜均平伏,裂孔封闭,部分病例术后行氩激光补充光凝,取油后,46 例视网膜脱离无复发,3 例视网膜脱离复发,再次行眼内注气或硅油填充术。结论:硅油的粘度越大,其矫正无晶体眼的远视效果越好。

Objective: To assess changes of refraction and axial length according to different viscosity of intraocular silicone oil. Methods: 49 cases (49 eyes) of retinal detachment were divided into two groups with the matched age, refraction and axial length of eyes between the two group. The viscosity of intraocular silicone oil in one group was 3 700 cst and was 5 000 cst in another group. All cases received pars plana vitrectomy and encircling procedure or scleral buckling. The operative procedures included membranes peeling, retinotomy, inner exchange of the fluid and silicone oil tamponade, and subretinal membranes were removed out in 7 eyes. Results: ① The visual acuity was improved in 49 eyes including HM in 6, FC in 11, 0.02 in 10, 0.05 in 8, 0.1 in 9 and 0.2 in 5. ② The changes in refraction and axial length were 6.44 diopters and 12.08 mm, respectively. Eyes injected with 5 000 cst tended to have higher increasing in the refraction and axial length than that eyes injected with 3 700 cst silicone oil. Statistically significant differences were shown for the changes in refraction, while no significant difference were found in axial length. Conclusion: Intraocular silicone oil induces increasing in refraction and axial length, and this increasing seems to vary with different viscosities.