脉络膜脱离型视网膜脱离手术治疗前后眼压及眼轴改变的对比研究

Comparative Study on Change of Intraocular Pressure and Axial Length on Choroidal Detachment Associated with Retinal Detachment Eyes before and after Operation

目的:检测脉络膜脱离合并视网膜脱离患者采用不同治疗术式的术前、术后眼压及眼轴的变化,探讨眼压、眼轴与手术的相关性及两者与发病时间之间的关系。方法:收集2006年1月～2006年12月间诊断为脉络膜脱离合并视网膜脱离,并行手术治疗的患者共30例(30眼),均为首次手术使视网膜成功复位。按照需要分组后分别在确诊后使用糖皮质激素,然后在手术前1天、术后1周、术后1个月、术后3个月及术后6个月时应用A超以及Goldmann眼压计对患者进行眼轴以及眼压的测量,并使用统计学方法进行比较。结果:1.确诊时,患者对测眼压较患侧眼压高,两者差异极显著(P<0.01)。术前用糖皮质激素治疗7～10天后,患眼眼压值较激素治疗前明显升高(P<0.01)。两手术组术后(玻璃体视网膜手术复位组为取硅油术后)1周、术后1月、术后3月及术后6月的眼压比术前1天眼压均显著升高(P<0.01);术后1月比术后1周的眼压有所降低(P<0.05);术后1月、3月及6月眼压之间无统计学差异(P>0.05)。2.确诊时,患者对侧眼轴较患侧眼轴长,有统计学差异。术前用糖皮质激素治疗7～10天后,患眼眼轴较激素治疗前无统计学差异(P>0.05)。常规视网膜手术组术后1周、术后1月、术后3月和术后6月均比术前1天延长,差异有极显著统计学意义(P<0.01);术后1周(29.46±2.12mm)至术后6月(28.29±2.63mm)的眼轴逐渐回缩(P<0.01)。玻璃体视网膜手术复位组患者在硅油取出术后1周、1月、3月和6月比复位术前1天眼轴均显著延长(P<0.01);硅油取出术后1周(27.74±2.07mm)至术后6月(27.72±2.17mm)时眼轴无明显改变(P>0.05)。3.脉脱型视网膜脱离患者在确诊时双眼眼压差值与接受治疗前病程呈直线相关(r=0.833),病程越长眼压差值越大。结论:1.脉络膜脱离型视网膜脱离患者的患眼确诊时眼压降低、眼轴缩短。2.发病时间越长,患眼眼压越低。3.患者术前应用糖皮质激素,可改善病情,提升患眼眼压。4.常规视网膜手术复位后患者眼压回升、眼轴延长,但在术后1周至术后6月内眼轴长度会有所缩短,眼压值在术后1月内也会有所回落,1个月后趋于稳定;玻璃体视网膜手术复位患者在硅油取出术后,眼压较视网膜复位术前回升、眼轴也较视网膜复位术前延长,硅油取出术后1周至6月间眼轴值无明显改变,眼压值在硅油取出术后最初1个月内有所降低,随着时间的推移趋于平稳。

Objective： To investigate the change of intraocular pressure and axial length on choriodal detachment associated with retinal detachment by different operations before and after operation and analyses clinical significance. Methods： 30 patients （30 eyes） with choriodal detachment associated with retinal detachment and whose retina were successful replaced in the first operation were col- lected from January, 2006 to December, 2006 in our hospital./OP and axial length were measured with Goldmann tonometer and A scan at the moment of diagnosis, 1 day preoperatively with the treatment of glucocorticoid and 1 week, 1,3,6 months postoperatively. To summarize the change rule of IOP and axial length on choriodal detachment associated with retinal detachment eyes whose retinas were successfully replaced, and to analyze the relation between the IOP, axial length and the course of disease. Results： 1. At the moment of diagnosis, the mean IOP of all patient＇s health eyes was 13.80± 2.63 mmHg, and the eyes with disease was 5.00±3.47mmHg,there was statistically significant （P〈0.01） between them. After glucocorticoid treatment for 7-10days, means IOP of the disease eyes rose to 7.83± 2.93 mmHg, higher than before with statistically significant （P〈0.01）. At 1 week and 1,3,6 months postoperatively, the mean IOP of all patients＇ disease eyes was much higher than the IOP at 1 day preoperatively （P〈0.01）; the IOP at 1 month postoperatively was lower than the IOP at 1 week postoperatively（P〈0.05 ）; among 1,3 and 6 months, there were not statistically significant（P〉0.05 ）.2. At the moment of diagnosis, the mean axial length of all patient＇s health eyes was 27.36± 2.41ram mmHg, and the eyes with disease was 25.26±2.29 mm. After 7-10 days＇ glucocorticoid treatment, the mean axial length of disease eyes was 25.26± 2.02 mm, there was not statistically significant （P〈0.01） relative to before. In the operation of scleral encircling and buckling group, the mean axial length of disease eyes at 1 week,1 month,3 months and 6 months postoperatively were much longer than 1 day preoperatively （P〈0.01）, but it got shorter from 1 week postoperatively（29.46±2.12 mm） to 6 months postoperatively （28.29± 2.63 ram）, there was statistically significant（P〈0.01 ）. In the operation ofvitrectomy and scleral encircling and buckling group, the mean axial length of disease eyes at 1 week, 1 month,3 months and 6 months after the operation of silicone oil removal were much longer than 1 day before operation of retinal replacement （P〈0.01）. there was not statistically significant （P〉0.05） from 1 week （27.74± 2.07 ram） after silicone oil removal to 6 months （27.72± 2.17 ram） after silicone oil removal. 3. There was linear correlativity between the IOP difference between two eyes in patients with chododal detachment associated with retinal detachment and the disease course before treatment. Conclusions： 1. To choroidal detachment associated with retinal detachment, the lOP of disease eyes get low, axial length becomes shorter .2. lOP would decrease along with the course of diseases before treatment. 3. Using glucocorticoid before surgery could improve state of illness increased lOP 4. After successful operation ofscleral encircling and buckling, the lOP and axial length increase, and axial length shorten during the following 6 months, lOP decrease during the following 1 month, lOP gets steady after 1 month of the operation. After operation of silicone oil removal, lOP and axial length are increased than operation of vitrectomy and scleral encircling and buckling. Axial length has little change from 1 week to 6 months after the operation of silicone oil removal, lOP decrease a little during the first 1 month after the operation of silicone oil removal, and gets steady along with the time.