玻璃体视网膜手术后眼球屈光系统的改变及其影响因素分析

Refraction changes after vitrectomy and its influencing factor

目的探讨玻璃体视网膜手术后眼球屈光系统的改变及其影响因素。方法选取2009年1月至2011年1月在我院行玻璃体视网膜手术患者68例(68眼),根据采用的手术方式不同,分为A组(20G)和B组(23G),并根据术中玻璃体腔注射物不同,分为注气组和注硅油组,术前、术后1周、1个月、3个月分别应用眼科A型超声仪、电脑验光仪、Pentacam三维前房分析仪等对患者的中央角膜厚度(central corneal thickness,CCT)、前房容量(anterior chamber volume,ACV)、前房深度(anterior chamberdepth,ACD)、眼轴长度(ocular axis length,OAL)、角膜曲率(corneal curvature,CC)、屈光度等进行测量,并将结果进行比较。结果患者术前与术后CC、CCT、ACD差异均无统计学意义(均为P>0.05);术前与术后平均ACV、OAL相比差异均有统计学意义(均为P<0.05)。术后1周、1个月、3个月B组视力(0.11±0.05、0.19±0.03、0.23±0.10)优于A组(0.08±0.02、0.13±0.09、0.16±0.11),差异均有统计学意义(均为P<0.05)。A组术后1周、1个月时屈光度较术前明显增大,差异有统计学意义(均为P<0.05),术后3个月与术前相比,差异无统计学意义(P>0.05);B组屈光度术后1周、1个月、3个月与术前相比,差异均无统计学意义(均为P>0.05)。注气组术前与术后1周、1个月、3个月的CC、CCT、ACV、ACD以及OAL差异均无统计学意义(均为P>0.05);硅油组术前与术后1周、1个月、3个月CC、CCT差异均无统计学意义(均为P>0.05),ACV、OAL差异均有统计学意义(均为P<0.05)。结论玻璃体视网膜手术后对眼球屈光系统有所影响,主要影响因素为手术方式及眼内填充物。

Objective To discuss the influence factors of ocular refraction changes after vitrectomy.Methods Sixty-eight patients underwent vitrectomy in our hospital from January 2009 to January 2011 were divided into two groups（group A and B） based on the surgical type（20 G and 23 G）,then according to the different vitreous injection,the cases were divided into gas group and silicone oil group.The central corneal thickness（CCT）,anterior chamber volume（ACV）,anterior chamber depth（ACD）,ocular axial length（OAL）,corneal curvature（CC） and diopter at pre-operation and postoperative 1 week,1 month,3 months were measured by A-mode ultrasonic meter,optometer and Pentacam system.Statistical analysis was performed.Results There was no statistical difference in CC,CCT,ACD between pre-operation and post-operation（all P0.05）,but there were statistical differences in ACV and OAL（both P0.05）.The visual acuity at postoperative 1 week,1 month,3 months of group B（0.11±0.05,0.19±0.03 and 0.23±0.10） was better than that of group A（0.08±0.02,0.13±0.09 and 0.16±0.11）,there were statistical differences（all P0.05）.The diopter at postoperative 1 week and 1 month in group A was significantly better than pre-operation,there were statistical differences（both P0.05）,but there was no statistical difference between pre-operation and postoperative 3 months（P0.05）.There was no statistical difference in diopter at postoperative 1 week,1 month and 3 months compared with pre-operation in group B（all P0.05）.There was no statistical difference in CC,CCT,ACV,ACD and OAL at postoperative 1 week,1 month and 3 months compared with pre-operation in gas group（all P0.05）,and no statistical difference in CC and CCT at postoperative 1 week,1 month and 3 months compared with pre-operation in silicone oil group（all P0.05）,but statistical differences in ACV and OAL（both P0.05）.Conclusion Vitrectomy can cause the refraction changes and the main influence factors are surgical type and vitreous injection.