改良的后巩膜加固术治疗病理性近视的疗效观察

Clinical observation of modified posterior scleral reinforcement surgery to treat pathologic myopia

目的探讨改良的后巩膜加固术对病理性近视治疗的安全性和有效性。方法应用异体巩膜材料,采用改良的单条带后巩膜加固法,对58例(103眼)病理性近视患者进行手术治疗,随访1年。结果患者术前眼轴为(29.92±2.68)mm,术后第1个月、第3个月、第1年眼轴分别为(29.69±2.87)mm、(29.71±2.97)mm、(29.84±2.56)mm,与术前比较,差异均无显著性(P>0.05);近视屈光度术前为(-18.33±7.64)D,术后第1个月、第3个月、第1年分别为(-18.26±7.50)D、(-18.19±7.22)D、(-18.47±7.80)D,与术前比较,差异均无显著性(P>0.05);矫正视力术后第1个月、第3个月、第1年时稳定和提高的分别为99眼(占96.12%)、101眼(占98.05%)和100眼(占97.09%);2例术后出现短暂复视,2眼术后出现少量眼底出血,3个月后吸收,无视网膜脱离、玻璃体出血等严重并发症发生。结论改良的后巩膜加固术并发症少,可稳定眼轴,稳定和改善视力,远期效果尚待进一步观察。

Objective To assess the safety and effectiveness of modified scleral reinforcement surgery. Methods Fifty-eight patients （103 eyes） with pathological myopia were treated with modified posterior scleral reinforcement surgery and were followed up for 1 year after the operation. Results The following main indicators of myopia advancement were investigated on a long-term basis and evaluated： axial length, refraction and visual acuity, The preoperative mean axial length was （29.92±2.68） mm. The postoperative axial length was （29.69±2.87） mm at 1 month, （29.71±2.97） mm at 6 months, and （29.84±2.56） mm at 1 year. There were no statistically significant differences between preoperative and postoperative axial length, The preoperative mean refraction （spherical equivalent, SE） was （-18.33±7.64） diopters （D）, The postoperative mean refraction （SE） was （-18.26±7.50）D at 1 month, （-18.19±7.22）D at 6 months, and （-18.47±7.80）D at 1 year. Differences between best corrected visual acuity （BCVA） before and after surgery were not statistically significant. The postoperative BCVA remained stable or improved in 96.12% of the eyes （99/103） at 1 month, 98.05% of the eyes （101/103） at 6 months, and 97.09% of the eyes （100/103） at 1 year. Postoperative complications included diplopia in 2 patients and retinal hemorrhage in 2 eyes. No other serious complications were observed after surgery. Conclusion This study indicates that modified scleral reinforcement is an effective and safe surgery that can stabilize the progression of pathological myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.