长眼轴患者白内障超声乳化术后角膜生物力学的变化

Changes of corneal biomechanics after phacoemulsification in patients with high myopia

目的观察长眼轴患者行白内障超声乳化术后角膜生物力学的变化。方法收集拟接受白内障手术的患者58例68眼,将其分为长眼轴组(28例34眼)和正常眼轴组(30例34眼),应用可视化角膜生物力学分析仪(corneal visualization scheimpflug technology,Corvis ST)对患者术前及术后1周、1个月的角膜生物力学参数进行测量。结果术前及术后1周、1个月两组峰距、中央角膜厚度、矫正眼压、眼压及长眼轴组第二压平时间和最大形变幅度的总体比较,差异均有统计学意义(均为P<0.05);术后1周与术前相比,两组峰距、中央角膜厚度、矫正眼压、眼压明显增大,长眼轴组最大形变幅度较术前减小,差异均有统计学意义(均为P<0.05),但术后1个月正常眼轴组峰距、中央角膜厚度、矫正眼压、眼压均恢复到术前水平(均为P>0.05),而长眼轴组最大形变幅度较术前减小,矫正眼压、眼压较术前均增高(均为P<0.05)。术后1个月与术后1周比较,两组峰距、中央角膜厚度、矫正眼压、眼压均有减小趋势(均为P<0.05)。长眼轴组术后1周中央角膜厚度、矫正眼压及最大形变幅度的变化量与眼轴长度均存在正相关性(r=0.493,P=0.003;r=0.575,P<0.001;r=0.587,P<0.001),而正常眼轴组的相关参数的变化量与眼轴长度均无相关性(均为P>0.05)。结论白内障超声乳化术能影响角膜生物力学,且长眼轴患者较正常眼轴者术后更易引起角膜生物力学改变,在白内障术后应注意其用药时间及激素类药物的使用,防止伤口愈合不良导致迁延感染及高眼压的发生。

Objective To observe the corneal biomechanical changes in patients with long-axis cataract after phacoemulsification.Methods Totally 68 eyes of 58 preoperative patients with cataract were involved in this study.The research objects were grouped by axial length:the long axial group(34 eyes of 28 patients) and the normal group(34 eyes of 30 patients).Corneal visualization scheimpflug technology(Corvis ST) was used to measure the biomechanical parameters of the cornea at 1 day before surgery,postoperative 1 week and 1 month.Results There is a significant difference between 1 day before surgery,postoperative 1 week and 1 month in the peak distance,central cornea thickness,intraocular pressure(IOP) and correction IOP in the two groups,as well as the second applanation time and deformation amplitude in the long axial group(all P<0.05).At postoperative 1 month,compared with preoperative measurement,the peak distance,central cornea thickness,IOP and correction were all recovered to preoperative levels in the normal group(all P>0.05),while the peak distance,central cornea thickness,IOP and correction IOP were significantly higher,and deformation amplitude was lower than before operation in the long axial group(all P<0.05).There is a decreasing trend in the peak distance,central cornea thickness,intraocular pressure and correction in the two groups at postoperative 1 month compared with postoperative 1 week(all P<0.05).In the long axial group,the changes in central corneal thickness,the correction IOP,deformation amplitude at were positively associated with the axial length at postoperative 1 week(r=0.493,P=0.003;r=0.575,P<0.001;r=0.587,P<0.001),but there was no correlation in the control group(all P>0.05).Conclusion The phacoemulsification can change the corneal biomechanical,especially in patients with long axial.After cataract surgery,more attention should be paid to the medication time,the use of hormone drugs in order to prevent wound infection and the occurrence of high IOP.