Akar Y, Apaydin K C, Ozel A
Akdeniz University, School of Medicine, Department of Ophthalmology, Antalya-07070, Turkey.
Br J Ophthalmol. 2004 Dec;88(12):1573-6. doi: 10.1136/bjo.2004.044677.
To assess the effects of acute orbital volume changes after retrobulbar injection on optic nerve head topography.
The study population consisted of 95 patients with type 2 diabetes mellitus with clinically significant macular oedema who required focal pattern laser photocoagulation therapy in one eye. Before each laser treatment, 49 patients required a retrobulbar injection (approximately 7 ml of a mix of lidocaine 2% with epinephrine and bupivacaine 0.75% in equal volumes) to provide ocular akinesia. Both eyes of all patients underwent optic nerve head topographic analysis once before laser treatment (within 30 minutes), and repeated within 1 hour, 1 day, 1 week, 2 weeks, and 4 weeks after treatment, respectively. Topographic analyses were performed using a confocal scanning laser ophthalmoscope, HRT-II. The disc area, topography standard deviation, and a total of 12 topographic parameters were calculated by HRT-II.
The mean age of the patients was 37.9 (SD 3.2) years. The mean disc area of the subjects was 2.12 (0.44) mm(2). Fellow eyes which were not treated with laser, and those treated eyes which did not receive retrobulbar injection before therapy were found not to reveal significant changes in disc topography in any of the examinations (all p values >0.05). In the topographic examinations in the first hour, first day, and first week, laser treated eyes which underwent retrobulbar injection demonstrated significant increase in the disc area, rim area, rim volume, rim area/disc area, and cup shape measure parameters while optic cup parameters significantly decreased (all p values <0.05). In the second week examinations, they did not show significant difference in disc area measurements (p>0.05). By the fourth week, all of the optic nerve head topographic variables were not significantly different from the pre-injection values (all p values >0.05). Colour stereoscopic photographs did not reveal any differences in optic disc appearance.
Acute orbital volume change following retrobulbar injection may cause significant topographic evidence of optic disc oedema lasting approximately 1 week. Significant changes in optic rim and cup area may last for 2 weeks after injection, with all topographic changes returning to baseline by 1 month after injection. The present findings could be a model to reflect the pathological processes that occur in cases of acute orbital volume changes such as retrobulbar haemorrhage.
评估球后注射后急性眼眶容积变化对视乳头地形图的影响。
研究对象为95例患有具有临床意义的黄斑水肿的2型糖尿病患者，其一只眼睛需要进行局灶性模式激光光凝治疗。在每次激光治疗前，49例患者需要进行球后注射（约7毫升等量混合的2%利多卡因与肾上腺素和0.75%布比卡因）以实现眼球运动不能。所有患者的双眼在激光治疗前（30分钟内）均接受一次视乳头地形图分析，并分别在治疗后1小时、1天、1周、2周和4周内重复进行分析。使用共焦扫描激光检眼镜HRT-II进行地形图分析。HRT-II计算视盘面积、地形图标准差以及总共12个地形参数。
患者的平均年龄为37.9（标准差3.2）岁。受试者的平均视盘面积为2.12（0.44）平方毫米。未接受激光治疗的对侧眼以及治疗前未接受球后注射的患眼在任何检查中均未发现视盘地形图有显著变化（所有p值>0.05）。在第1小时、第1天和第1周的地形图检查中，接受球后注射的激光治疗眼的视盘面积、边缘面积、边缘体积、边缘面积/视盘面积和杯状形态测量参数显著增加，而视杯参数显著降低（所有p值<0.05）。在第2周检查中，它们在视盘面积测量上没有显示出显著差异（p>0.05）。到第4周时，所有视乳头地形图变量与注射前的值均无显著差异（所有p值>0.05）。彩色立体照片未显示视盘外观有任何差异。
球后注射后急性眼眶容积变化可能导致视盘水肿的显著地形图证据，持续约1周。视盘边缘和视杯面积的显著变化可能在注射后持续2周，所有地形图变化在注射后1个月恢复到基线水平。本研究结果可能是反映急性眼眶容积变化（如球后出血）病例中发生的病理过程的一个模型。
