巩膜外加压术后角膜生物力学性能及中央厚度变化

Changes of corneal biomechanical properties and central thickness after segment sclearal buckling surgery

目的研究孔源性视网膜脱离患者行巩膜外加压术后角膜生物力学性能及中央厚度的变化。方法前瞻性临床研究。对2012年6月至2013年4月在温州医学院眼视光医院就诊的孔源性视网膜脱离患者31例（31只眼）作为手术组，分别于术前及术后1周、1个月、3个月采用眼反应分析仪（ORA）测量双眼角膜滞后量cornea hysteresis，CH），角膜阻力因子（cornea resistance factor，CRF），角膜补偿眼压（cornea—compensated intraocular pressure，IOPcc），模拟Goldmann眼压值（goldman—corrected IOP value，IOPg），Goldmann压平式眼压计测量眼内压GAT，A超测量角膜中央厚度（corneacentralthickness，CCT）。收集与术眼年龄、性别匹配的正常人群为正常对照组26人（26只眼），测量参数同手术组。应用统计学方法分析各组手术前后是否有统计学意义。结果手术组、正常组术前角膜生物力学性能及中央厚度之间，差异无统计学意义（P〉0．05）。手术眼CH术前为（10．48±1．17）mmHg，术后1周降至（8．41±1．64）mmHg，差异有统计学意义（P〈0．05），术后1个月为（9．28±0．97）mmHg，差异有统计学意义（P〈0．05），术后3个月时恢复正常（10．12±0．77）mmHg，差异无统计学意义（P=0．372，P〉0．05）。CCT术前为（544．74±29．02）μm，术后1周升至（561．52±34．叭）斗m，术后1个月降为（532．23±30．33）μm，差异有统计学意义（P〈0．05），术后3个月时为（536．55±29．03）μm，较术前低差异有统计学意义（P〈0．05）；CRF术前为（9．40±1．47）mmHg，术后1周降为（8．77±1．51）mmHg，差异有统计学意义（P=0．012，P〈0．05），术后1个月时恢复正常。对侧眼无显著变化。结论巩膜外加压术后角膜滞后量先降低后升高，术后3个月时恢复正常；角膜中央厚度先升高后降低，至术后3个月时仍低于术前水平。

Objective To investigate the characteristics of corneal biomechanical properties and central thickness changes after segment sclearal buckling surgery. Methods Prospectively selected 31 eyes of 31 patients diagnosed as rhegmatogenous retinal detachment undergoing segment sclearal buckling surgery, 26 normal eyes of 26 volunteers as control group. Corneal biomechanical proper- ties, including cornea hysteresis （CH） and cornea resistance factor （CRF）, were measured by the Ocu- lar Response Analyser （ORA） before and lweek, 1 month, and 3 months postoperatively. Intraocular pressure （IOPg） and corneal compensated IOP （IOPcc） were also measured by the OR-A, and the cor- nea central thickness was obtained via ultrasound pachymetry and GAT using Goldman topometry. Results There was no significant difference between the control and study group in biomechanical properties and cornea central thickness before surgery （P 〉0.05）. CH of study group decreased from 10.48±1.17mmHg to 8.34±1.58mmHg, （P 〈0.005）, increased to 9.28±0.97mmHg （P 〈0.05） 1 month and recovered to 10.12±0.77mmHg, （P =0.372） 3 months postoperatively. CCT increased from 544.74± 29.02txm to 561.52±34.01txm, （P 〈0.05） 1 week, decreased to 532.23±30.33μm, （P 〈0.05） 1 month, 536.55±29.03 μm 3 months postoperatively, （P 〈0.05）, still less than preoperatively. CRF decreased from 9.40±1.47 mmHg to 8.77±1.51 mmHg （P =0.012）, but recovered to normal 1 month postoperative- ly. Conclusions CH appears to decrease first and increase to normal after surgery, cornea central thickness increase after surgery but decrease later, still less than preoperative until 3 months.