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[环扎式巩膜扣带术对角膜形态及生物力学特性的影响]

[Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea].

作者信息

Ruiz-De-Gopegui E, Ascaso F J, Del Buey M A, Cristóbal J A

机构信息

Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

出版信息

Arch Soc Esp Oftalmol. 2011 Nov;86(11):363-7. doi: 10.1016/j.oftal.2011.05.027. Epub 2011 Sep 9.

Abstract

OBJECTIVE

To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters.

METHODS

We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (μm), and anterior chamber depth (ACD).

RESULTS

CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg vs 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05).

CONCLUSIONS

SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB.

摘要

目的

探讨环扎巩膜扣带术(SB)对角膜生物力学特性及其形态学参数的影响。

方法

我们前瞻性地检查了12只诊断为玻璃体积血并接受玻璃体切割术(PPV)的眼睛,以及15只接受PPV联合巩膜扣带术(PPV/SB)修复孔源性视网膜脱离(RRD)的眼睛。在术前和术后1个月,使用眼反应分析仪(ORA)测量角膜生物力学特性,包括角膜滞后(CH)和角膜阻力因子(CRF)。ORA还测定了眼内压(IOPg)和角膜补偿眼压(IOPcc)的值。最后,使用Orbscan II地形仪(Orbtek公司)测量角膜的四个形态学参数:平均角膜曲率、最薄角膜点(μm)和前房深度(ACD)。

结果

PPV/SB术后CH从10.2±1.7mmHg显著降至7.6±1.1mmHg(p = 0.003),但单纯PPV术后未出现显著下降(9.8±3.2mmHg对11.6±2.7mmHg,P = 0.465)。两组术后CRF均无显著变化。PPV/SB组IOPg和IOPcc显著升高(分别为P = 0.019和P = 0.010),而PPV组未升高(分别为P = 0.715和P = 0.273)。与PPV组不同,PPV/SB组IOPcc值在术前(P = 0.001)和术后(P = 0.003)均显著高于IOPg值。PPV/SB组和PPV组术后角膜形态学参数均无显著变化(P>0.05)。

结论

SB手术导致角膜生物力学特性改变,但未改变角膜形态学参数。它可能导致眼压测量出现低估误差。对于修复非复杂性RRD,PPV可能是一种比PPV/SB侵入性更小的手术方法。

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