视网膜脱离复位术后屈光改变的临床研究

The clinical research of refractive pressure after retinal detachment surgery

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摘要目的　了解视网膜脱离复位术后屈光状态的改变及恢复情况。方法　收集 39例 (39只眼 )手术复位成功的孔源性视网膜脱离患者 ,于术前及术后 1周、1、3、6月分别进行检影验光 ,A超测量眼轴长度 ,角膜曲率计检查 ,观察动态变化情况。结果　术前本组孔源性视网膜脱离中 ,近视眼占 82 .0 5 %。 >4 .0 D者占 6 9.2 3% ,眼轴长度>2 6 mm者占 6 9.2 3%。 3例环扎术后 ,全部眼轴加长 ,近视度加深。术后 1周及 1月时 ,散光值 >2 .0者为 12 .82 % ,术后 3个月逐渐减少。放射状加压术后散光值更大 ,差异有显著性 (P <0 .0 5 ) ,但 6个月内能恢复原状。结论　术前眼轴越长 ,近视度越高 ,发生孔源性视网膜脱离机会越多。环扎术后 ,眼轴变长 ,近视度加深 ,且半年内无明显改善。环形加压术或放射状加压术后早期 ,近视度数降低 ,向远视方向改变 ,从 +0 .5 D～ +5 .0 D不等 ,1月时最为明显。放射状加压术更易引起角膜曲率改变 ,散光值更大。但这种屈光改变是暂时性的 ,术后 6个月逐渐恢复原状 ,并趋于稳定。临床上适宜于视网膜脱离复位术后 6个月重新验光配镜。 Objective To study the changes of optics and the function recovery after retinal detachment surgery. Methods This article collects 39 cases (39 eyes) which is the patinas who with the successful rhegmatogenous retinal detachment. They were underwent retinoscopy optometry, A-scan and keratometer examination before surgery as well as 1 month, 3 month, 6 month after surgery in order to been detected. Result The ratiloof myopia was 82.05% among 39 eyes before surgery the ration of the patinas who optical over 26mm is 69.23%,>4D is 69.23%. All the axial length and diopter were larger after buckling in 3 cases. The ratio of the case whose central corned power >2.0 is 12.82%. 1 week and 1 month post-operation, it was decrease gradually 3 month after operation. The central corneal power is much higher than after radical forces scleral. There is the statistical different (P<0.05), but it could recovery gradually 6 month after surgery. Conclusion The long central corneal power, the high myopia before surgery, it will have more chance to get rhegmatogenous retinal detachment. After the buckling, the axes were lengthed and diopter increased, it will last half one year. In the early stage after the scleral buckling and radical forces scleral. The degree of myopia is decline and it will transfer to hypermmetropia from +0.5D to +5.0D above. It is express after 1 month. The radical forces scleral surgery is easy cause the change of corneal curvature and the central corneal power much higher, but this was temporary, it will be recovery back 6 months after surgery and will be stable during the clinical, it is proper to reselecting the refractive correction 6 months after the surgery.