玻璃体切割手术前后眼内结构的变化

Alteration of intraocular structure before and after vitrectomy

目的:分析单纯玻璃体切割手术和玻璃体切割联合白内障摘除人工晶状体植入手术2种术式以及不同眼内填充物对术眼眼内结构的影响,以探讨可能发生的屈光改变,评估对视觉质量的潜在影响。方法:用超声生物显微镜(UBM)及光学相干生物测量仪(IOL Master)分别测量行单纯玻璃体切割手术患者(单纯组,37眼)和玻璃体切割联合白内障摘除人工晶状体植入手术患者(联合组,11眼)的中央前房深度(ACD)、房角开放距离(AOD)、小梁虹膜夹角(TIA)、眼轴长度(AL)等参数。单纯组中又根据术中使用玻璃体腔填充物的不同,分为硅油组、气体组及平衡液组。所有患者均于手术前及术后2wk测量其ACD,AOD250,AOD500,TIA500,AL及角膜曲率(K1,K2)等参数。结果:单纯组术后AOD250,AOD500,TIA500及AL与术前相比分别减少0.13±0.21mm,0.16±0.22mm,8.68°±9.72°,0.18±0.24mm(均P<0.05),而联合组术后ACD,AOD250,AOD500,TIA500及AL较术前增加0.95±0.54mm,0.13±0.12mm,0.22±0.20mm,11.49°±11.06°,0.45±0.30mm(均P<0.05)。根据填充物的不同进行分析,气体组的ACD,AOD250,AOD500及TIA500分别减小0.19±0.17mm,0.14±0.09mm,0.20±0.12mm及12.02°±6.64°(均P<0.05),硅油组的AOD250,AOD500,TIA500及AL分别减小0.19±0.25mm,0.21±0.26mm,10.44°±9.67°及0.23±0.19mm(均P<0.05),而平衡盐组的眼内结构均未发生明显的改变(P>0.05)。所有组别中,手术前后角膜厚度及曲率均未发生明显的变化(P>0.05)。结论:玻璃体切割联合白内障摘除人工晶状体植入术后的眼前节、眼轴改变均异于单纯玻璃体切割手术眼,但角膜厚度及角膜曲率均未发生明显的改变,而不同的眼内填充物对眼内结构和屈光状态也会造成不同程度的影响。玻璃体切割术后眼内结构的变化,将会改变眼的屈光状态,并可能对患者视觉质量产生潜在影响。

AIM：To explore the possible alteration of refraction and estimate the potential impact of visual quality,investigate the impact of intraocular structure between the simple operation and the combination of phacoemulsification and intraocular lens implantation,and observe the influence among various tamponade materials application.METHODS：Ultrasound biomicroscopy（UBM） and intraocular len（IOL） Master were measured for simple vitrectomy patients（the simple group,37 eyes） and vitrectomy combined with cataract surgery patients（the combined group,11 eyes）.Several parameters were measured such as the anterior chamber depth（ACD）,angle opening distance（AOD）,trabecular iris angle（TIA）,axial length（AL）,et al.The simple group was further divided into three sub- groups by various tamponade materials in vitreous：silicone oil group,gas group and equilibrium liquid group.All patients were measured including ACD,AOD250,AOD500,TIA500,AL and corneal curvature（K1,K2） parameters preoperatively and 2wk postoperatively.RESULTS：AOD250,AOD500,TIA500 and AL were decreased 0.13 ±0.21 mm,0.16 ±0.22 mm,8.68° ±9.72°and 0.18 ± 0.24mm（all P〈0.05） respectively in the simple group postoperatively.ACD,AOD250,AOD500,TIA500 and AL in combined group increased 0.95 ± 0.54 mm,0.13 ±0.12 mm,0.22 ± 0.20 mm,11.49° ± 11.06°,and 0.45 ± 0.30mm（all P〈0.05） respectively after operation.Alteration of ACD,AOD250,AOD500,TIA500 and AL were different between simple group and combined group（P 〈0.05）.Of data from various tamponade materials sub- groups,ACD,AOD250,AOD500 and TIA500 of the gas group reduced 0.19 ±0.17 mm,0.14±0.09 mm,0.20±0.12 mm,and 12.02° ±6.64°respectively after operation（P〈0.05）,the AOD250,AOD500,TIA500 and axial length of silicone oil group decreased 0.19 ±0.25 mm,0.21 ±0.26 mm,10.44° ± 9.67°and 0.23±0.19 mm respectively after operation（P〈0.05）,while equilibrium liquid group had no significant changed in all intraocular structure（P〉0.05）.However,neither the corneal thickness nor curvature（K1,K2） were changed postoperatively（P〉0.05）.CONCLUSION：Alteration of anterior segment and axial length in combined group are different from that of the simple group,while the corneal thickness and corneal curvature（K1,K2） are not obviously changed in all groups.Meanwhile,various tamponade materials can also cause different impact on intraocular structure and refraction.In brief,alterations of intraocular structure might cause discrepant refractive changes and potential influence of visual quality.