發(fā)布時(shí)間：2018-03-05 01:03

  本文選題：變性近視　切入點(diǎn)：后鞏膜加固術(shù)　出處：《鄭州大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】：近視在全球特別在我國發(fā)生率很高,在盲和低視力疾病中,變性近視及其并發(fā)癥所致的盲目占第4-7位。變性近視是眼的前后徑(矢狀徑)進(jìn)行性延長和鞏膜向后擴(kuò)張而導(dǎo)致后極部視網(wǎng)膜和脈絡(luò)膜發(fā)生病變的眼病,因而嚴(yán)重不可逆地?fù)p害視功能。變性近視的預(yù)防和治療逐漸受到眾多學(xué)者的關(guān)注,后鞏膜加固術(shù)作為去除變性近視的病因,預(yù)防變性近視的進(jìn)展,并防治其并發(fā)癥的治療方法,已得到廣泛的認(rèn)可。國內(nèi)外學(xué)者在不斷地研究和改進(jìn),臨床應(yīng)用取得了一定的成績,獲得了滿意的療效。此手術(shù)通過增加眼球壁的厚度,增強(qiáng)鞏膜的抵抗力,而阻止近視的發(fā)展；并且由加固物的機(jī)械和抗原刺激,增加局部的血供和營養(yǎng),而改善視功能。 后鞏膜加固術(shù)使變性近視視功能改善的機(jī)制,尚無確切的定論。本研究試圖通過分析變性近視后鞏膜加固手術(shù)前后的裸眼和矯正視力、屈光狀態(tài)、眼A/B超、眼球前后徑、光相干斷層掃描(OCT)、視野、視覺敏感度及眼電生理檢查等各項(xiàng)檢查結(jié)果,以探討術(shù)后視覺質(zhì)量改善的機(jī)制。 材料和方法 2008年8月至2010年7月間行后鞏膜加固術(shù)的變性近視45例51眼,右眼31眼,左眼20眼；男21例,女24例；年齡范圍為3～72歲。手術(shù)前裸眼視力手動(dòng)／20cm-0.1,平均為0.046±0.038；屈光度-7.00D--27.00D(按等效球鏡計(jì)算),平均為(-16.71±4.28)D；矯正視力0.01～().8,平均為().296±0.282；眼前后徑測量為25.7-36.05mm,平均為(30.03±3.11)mm。加固固材料為同種異體鞏膜,手術(shù)方法為局部麻醉或全身麻醉下行單條帶后鞏膜加固術(shù)。 統(tǒng)計(jì)學(xué)分析方法：對術(shù)前、術(shù)后出院時(shí)及2-24月復(fù)查3個(gè)不同時(shí)間點(diǎn)的視力、屈光度、眼前后徑、中心視野的光敏度、視覺電生理的波幅和時(shí)間等數(shù)據(jù),采用計(jì)量資料配對t檢驗(yàn)方法,眼后極部病變發(fā)生率采用卡方檢驗(yàn)方法。 結(jié)果 1.術(shù)后視力：術(shù)后裸眼視力：數(shù)指/30cm-0.15,平均為0.059±0.047,與術(shù)前(0.046±0.038)相比較視力增加,差異有統(tǒng)計(jì)學(xué)意義(t=2.56,P0.05)；術(shù)后2-24月復(fù)查時(shí)裸眼視力：數(shù)指/30cm-0.15,平均為0.064±0.043,與術(shù)前相比較視力明顯增加,差異有統(tǒng)計(jì)學(xué)意義(t=2.728,P0.01)；術(shù)后矯正視力：0.01-1.0,平均為0.318±0.264,與術(shù)前相比較視力增加,差異有統(tǒng)計(jì)學(xué)意義(t=2.192,P0.05)；術(shù)后2-24月復(fù)查時(shí)矯正視力：0.01-1.0,平均為0.387±0.258,與術(shù)前相比較視力增加,差異有統(tǒng)計(jì)學(xué)意義(t=2.967,P0.01)。 2.術(shù)后的屈光度：-7.75～-26.OOD,平均為(-16.25±4.16)D,與術(shù)前相比較似有減輕,但差異無統(tǒng)計(jì)學(xué)意義(t=0.994,P0.05)；術(shù)后2-24月復(fù)查時(shí)的屈光度：-7.75～-26.OOD,平均(-16.39±4.32)D,與術(shù)前相比較似有減輕,但差異也無統(tǒng)計(jì)學(xué)意義(t=0.902,P0.05)。 3.術(shù)后2-24月復(fù)查測量眼前后徑為26.03～35.8mm,平均為(29.96±3.02)mm,與術(shù)前25.7-36.05mm,平均為(30.03±3.11)mm對比,差異無統(tǒng)計(jì)學(xué)意義(t=0.276,P0.05)。 4.本組31眼對比術(shù)前術(shù)后中心視野的生理盲點(diǎn)擴(kuò)大、中心相對暗點(diǎn)、旁中心暗點(diǎn)和普遍性損害的形態(tài)改變,術(shù)后明顯改善；對比31眼術(shù)前和復(fù)查的平均光敏感度缺損值(MD)和總模式偏差值(PSD)。術(shù)前MD為-5.14--20.13dB,平均為(-11.61±3.98)dB,PSD為1.93-12.7dB,平均為(5.46±2.86)dB；術(shù)后2-24月復(fù)查MD為-3.98～-17.94 cB,平均為(-8.32±3.46)dB,PSD為1.56-9.49dB,平均(4.46±2.75)dB,對比差異均有統(tǒng)計(jì)學(xué)意義(t=2.324和2.103,P0.01)。 5.本組31眼術(shù)前行光相干性斷層掃描(OCT),發(fā)現(xiàn)24眼有并發(fā)癥,包括脈絡(luò)膜視網(wǎng)膜萎縮瘢痕11眼,脈絡(luò)膜新生血管4眼,黃斑前膜2眼,黃斑劈裂者6眼,黃斑孔(全層和板層)7眼,視網(wǎng)膜脫離7眼。術(shù)后復(fù)查萎縮瘢痕術(shù)后2眼有好轉(zhuǎn)；脈絡(luò)膜新生血管2眼消退；黃斑前膜2眼術(shù)后無好轉(zhuǎn),但對視網(wǎng)膜的牽拉減輕；黃斑劈裂4眼內(nèi)外層之間橋樣劈裂腔完全消失或基本消失；黃斑孔7眼中3眼為板層孔,1眼消失,4眼為全層孔,伴視網(wǎng)膜脫離的黃斑孔,其中3眼脫離消退后黃斑孔消失,1眼黃斑孔未消失；3眼無黃斑孔的黃斑部視網(wǎng)膜脫離,術(shù)后均復(fù)位,但其中1眼術(shù)后2月仍有少量網(wǎng)膜下積液；4眼有孔的黃斑部視網(wǎng)膜脫離,術(shù)后視網(wǎng)膜均復(fù)位,黃斑孔消失,1眼術(shù)后5個(gè)月再次脫離,但不伴黃斑孔。對手術(shù)前后眼后極部病變行卡方檢驗(yàn)x2=6.637,P0.01,差異明顯有統(tǒng)計(jì)學(xué)意義。 結(jié)論 1.后鞏膜加固術(shù)是針對病因的治療方法,是預(yù)防變性近視進(jìn)展,防治其并發(fā)癥的有效治療方法,手術(shù)安全可靠。 2.后鞏膜加固術(shù)后裸眼和矯正視力穩(wěn)定,部分較術(shù)前提高；中心視野缺損形態(tài)改善,平均光敏感度缺損值(MD)和總模式偏差值(PSD)均降低。 3.后鞏膜加固術(shù)后的屈光度和眼前后徑穩(wěn)定。 4.后鞏膜加固術(shù)改善視覺質(zhì)量的機(jī)制可能是：后鞏膜加固術(shù)加固了向后延伸的鞏膜葡萄腫,緩解了對后極部各層的牽拉,治愈或減輕了變性近視并發(fā)的黃斑區(qū)瘢痕萎縮、脈絡(luò)膜新生血管、黃斑劈裂、黃斑前膜、黃斑孔、黃斑部視網(wǎng)膜脫離等,從而提高了視功能,改善了視覺質(zhì)量。
[Abstract]:Especially in our country in the global myopia incidence rate is very high, in the disease of blindness and low vision, caused by degenerative myopia and its complications accounted for 4-7. The blind eye degenerative myopia is the anteroposterior diameter (sagittal diameter) was prolonged and the sclera expands backward caused retinal and choroidal lesions of the eye therefore, serious irreversible damage of visual function. The prevention and treatment of degenerative myopia has attracted the attention of many scholars, the removal of posterior scleral reinforcement surgery as a cause of degenerative myopia, prevent degenerative myopia progression, treatment and prevention of complications, has been widely recognized. Scholars at home and abroad to study and improve. The clinical application and achieved certain results, obtained satisfactory curative effect. The operation by increasing the eyeball wall thickness, scleral reinforcement resistance, and prevent the development of myopia; and the reinforcement mechanism and antigen thorn Stimulate, increase the local blood supply and nutrition, and improve the visual function.
The mechanism of posterior scleral reinforcement to degenerative myopia visual function improvement, there is no definite conclusion. This study attempts to analyze the degenerative myopia after posterior scleral reinforcement surgery before and after the uncorrected and corrected visual acuity, refraction, ocular A/ B, eyeball, optical coherence tomography (OCT), vision, visual sensitivity and EOG the physiological examination of the test results, to explore the mechanism of the improvement of visual quality after surgery.
Materials and methods
Of the 45 cases of degenerative myopia reinforcement surgery between July 2010 and August 2008 51 scleral line, right eye in 31 eyes, 20 eyes left; 21 cases were male, 24 were female; the age range was 3~72. Preoperative visual acuity manual / 20cm-0.1, with an average of 0.046 + 0.038; -7.00D--27.00D diopter (according to spherical equivalent calculation) on average, (-16.71 + 4.28) D; 0.01 (.8) - corrected visual acuity (.296), an average of + 0.282; anterior and posterior diameter measurement is 25.7-36.05mm, the average (30.03 + 3.11) for allogeneic scleral reinforcement surgery method for mm. solid material, or under local anesthesia for single band scleral reinforcement body anesthesia.
Statistical analysis methods: preoperative, postoperative discharge and 2-24 months after the 3 different time points of the visual acuity, diopter, anteroposterior diameter, light sensitivity of central visual field, visual electrophysiology amplitude and time data, measurement data using the paired t test method, posterior polar lesions were calculated by the method the chi square test.
Result
1. vision: postoperative uncorrected visual acuity: refers to the number of /30cm-0.15, an average of 0.059 + 0.047, and the preoperative (0.046 + 0.038) compared to visual acuity increased, the difference was statistically significant (t=2.56, P0.05); 2-24 months after operation were uncorrected visual acuity: the number of /30cm-0.15, an average of 0.064 + 0.043. Compared with the preoperative visual acuity was significantly increased, the difference was statistically significant (t=2.728, P0.01); the postoperative corrected visual acuity: 0.01-1.0, the average was 0.318 + 0.264, compared with the preoperative visual acuity increased, the difference was statistically significant (t=2.192, P0.05); after 2-24 months of corrected visual acuity: 0.01-1.0, an average of 0.387 + 0.258, compared with the preoperative visual acuity increased, the difference was statistically significant (t=2.967, P0.01).
2. postoperative refraction: -7.75 ~ -26.OOD, average D (-16.25 + 4.16), compared with preoperative seems to be reduced, but the difference was not statistically significant (t=0.994, P0.05); after 2-24 months of diopter: -7.75 ~ -26.OOD, the average (-16.39 + 4.32) D, compared with compared with the preoperative seems to be reduced, but there was no statistically significant difference (t=0.902, P0.05).
3., 2-24 months after operation, the anterior posterior diameter was 26.03 to 35.8mm, with an average of (29.96 + 3.02) mm, and there was no statistically significant difference compared with preoperative 25.7-36.05mm (30.03 + 3.11) mm (t=0.276, P0.05).
Expand the physiological blind spot in 31 eyes 4. compared preoperative and postoperative vision center, central relative scotomata, change the paracentral scotoma and general damage morphology were improved obviously after operation; the average light sensitivity defect contrast 31 eyes preoperatively and review the value (MD) and total deviation (PSD) mode of operation. MD -5.14--20.13dB, an average of (-11.61 + 3.98) dB, PSD 1.93-12.7dB, the average (5.46 + 2.86) dB; after 2-24 months of MD -3.98 to -17.94 cB, average (-8.32 + 3.46) dB, PSD 1.56-9.49dB, the average (4.46 + 2.75) dB, differences were statistically statistically significant (t=2.324 and 2.103, P0.01).
5.鏈粍31鐪兼湳鍓嶈鍏夌浉騫叉，

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