外路与内路睫状体离断复位术对术后早期角膜地形图影响的差异

Effect of direct or internal cyclopexy on early postoperative corneal topography

目的比较外路与内路睫状体离断复位手术对角膜地形图影响的差异。设计回顾性病例系列。研究对象2018年1月至2020年12月睫状体离断患者27例(27眼),其中有晶状体者17例行外路直视下复位术(外路组);人工晶状体眼或需在术中联合晶状体切除术者10例行内路睫状体离断复位术(内路组)。方法手术由同一术者完成。外路为直视下行睫状体复位。内路睫状体复位术为10-0双直针自角膜缘进针直接缝合离断睫状体,为非直视下缝合。术前及术后UBM检查确认睫状体离断及术后复位情况。术前,术后1周、1个月行Pentacam检查。配对t检验比较术前术后角膜地形图相关参数的变化,独立样本t检验比较两种手术方式角膜地形图相关参数的变化。主要指标角膜前表面散光度数、角膜7 mm和9 mm环域间的平均曲率(Rper)、角膜表面变异指数(ISV)及垂直非对称性指数(IVA)。结果术后1周内路组散光度数、Rper、ISV、IVA分别为(1.19±0.96)D、(8.10±0.30)mm、(18.50±6.13)、(0.15±0.05),外路组散光度数、Rper、ISV、IVA分别为(2.02±1.03)D、(8.05±0.29)mm、(27.00±4.69)、(0.18±0.05),散光度数及ISV外路组较内路组高(t=2.122,P=0.046;t=3.764,P=0.002),Rper、IVA均无统计学差异。术后1个月,内路组10例和外路组9例角膜地形图各数值相比均无统计学差异(P均>0.05)。结论外路直视下睫状体离断复位术术后早期散光更明显,而内路睫状体复位术对术后散光影响不大。

Objective To compare the difference of the changes of corneal topography after direct cyclopexy from after internal cyclopexy.Design Retrospective case series.Participants 27 patients(27 eyes)with cyclodialysis were included in Beijing Tongren Eye Center from January 2018 to December 2020.17 eyes with lens underwent direct cyclopexy and 10 eyes with intraocular lens or intraoperative combined lens resection underwent internal cyclopexy.Methods All patients were operated by the same surgeon.In the internal cyclopexy group,cyclodialysis was sutured without direct visualization which one of the two long straight needles of a double armed 10/0 polypropylene thread was pierced into the eye through corneal limbus.All patients were examined by ultrasound biomicroscopy(UBM)before and after operation to evaluate the cyclodialysis.Pentacam examination was performed before,1 week and 1 month after operation to analyze the changes of corneal topography parameters.Main Outcome Measures Pentacam parameters including astigmatism of anterior corneal surface,Rper(mean radius of curvature in the 7-9 mm area of the cornea),index of surface variance(ISV)and index of vertical asymmetry(IVA).Results In the internal cyclopexy group,astigmatism of anterior corneal surface,Rper,ISV and IVA at 1 week after operation was(1.19±0.96)D,(8.10±0.30)mm,(18.50±6.13),(0.15±0.05)respectively;however,in direct cyclopexy group,astigmatism of anterior corneal surface,Rper,ISV and IVA at 1 week after operation was(2.02±1.03)D,(8.05±0.29)mm,(27.00±4.69),(0.18±0.05)respectively.There was significant statistical difference in astigmatism and ISV between the two groups at 1 week after operation(t=2.122,P=0.046;t=3.764,P=0.002).In 10 eyes of internal cyclopexy and 9 eyes of direct cyclopexy group,the differences of all the parameters between two groups in 1 month after operation were no statistically significant(all P>0.05).Conclusion Direct cyclopexy can cause early postoperative astigmatism changes while internal cyclopexy has little effect on postoperative astigmatism.