后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性分析

Security and validity of posterior sclera reinforcement for high myopic retinopathy

目的探讨后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性。方法随访2 a观察41例76眼患有高度近视性视网膜病变行后巩膜加固术患者术前术后眼轴长度、最佳矫正视力、视网膜劈裂的贴附情况和并发症情况。结果术后3 d、1个月、3个月、6个月眼轴长度分别为(27.71±1.60)mm、(28.11±1.62)mm、(28.58±1.80)mm和(29.01±1.92)mm,均较术前的(30.29±2.01)mm缩短,且差异均有统计学意义(均为P=0.000)。术后1 a眼轴长度逐渐增长至术前水平,术后2 a眼轴长度与术前相比差异无统计学意义(P=0.300)。术后1个月最佳矫正视力即得到提高,但与术前相比差异无统计学意义(P=0.080)。术后3个月、6个月、1 a、2 a最佳矫正视力持续提高,且与术前相比差异均有统计学意义(均为P<0.05)。34眼术前伴视网膜劈裂者,术后27眼(79.41%)视网膜完全贴附;4眼(11.76%)基本贴附;3眼(8.82%)改善。术中未见并发症发生,术后有结膜刺激征、高眼压、眶内炎症反应、浅前房、复视及视物变形、黄斑出血复发等并发症发生,均在3个月内恢复。结论后巩膜加固术是高度近视性视网膜病变的一种安全有效的治疗方法,它可以有效地控制病理性近视的进展。

Objective T o investigate the efficacy of security and validity of posterior sclera reinforcement( PSR) for high myopic retinopathy( M R). Methods T his study included 76 eyes in 41 patients w ith M R w ho underw ent PSR and w ere follow ed up for tw o years. Preoperative and postoperative axial length,best-corrected visual acuity,t he reattachment of retinoschisis and the complications w ere evaluated. Results T he axial length w as shortened 3 days,1 month,3 months and 6 months after operation compared w ith preoperation[( 27. 71 ± 1. 60) mm,( 28. 11 ± 1. 62) mm,( 28. 58 ± 1. 80) mm and( 29. 01 ± 1. 92) mm vs.( 30. 29 ± 2. 01) mm],and the difference w as statistically significant( all P = 0. 000). T he axial length gradually increased to preoperative level at 1 year after surgery,and there w as no significant difference in the postoperative 2-year and preoperative axial length( P = 0. 300). T he best corrected visual acuity w as improved 1 month after surgery,but the improvement had no significantly difference compared w ith the preoperative one( P = 0. 080). T he best corrected visual acuity w as improved at 3 months,6 months,1 year and 2 years postoperatively continuously,and the improvement had significantly difference compared w ith the preoperative ones( all P < 0. 05). In addition,t here w ere 34 eyes w ith retinoschisis before surgery,and the retina w as completely attached postoperatively in 27 eyes( 79. 41%),almost attachment w as observed in 4 eyes( 11. 76%),and improvement was in 3 eyes( 8. 82%). No complications occurred during surgery. Conjunctival irritation,high intraocular pressure,orbital inflammation,diplopia and visual deformation and macular bleeding recurrence occurred postoperatively and all recovered in 3 months. Conclusion During 2-year follow-up, it is safe and effective for PSR to treat MR,which can control myopic progression effectively in patients with pathological myopia.