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目的观察巩膜外硅胶海绵垫压术和巩膜外环扎联合硅胶垫压术后眼球结构的改变及对眼压的影响。设计回顾性病例系列。研究对象孔源性视网膜脱离住院手术治疗患者64例64眼,其中接受巩膜外单纯硅胶海绵垫压术25眼(海绵组),巩膜外环扎联合硅胶垫压术39眼(联合组)。方法手术前,术后1周、1个月及3个月应用A型超声仪、超声生物显微镜(UBM)对眼球生物参数检测,非接触眼压计检测眼压。主要指标眼压、角膜厚度、角膜曲率、前房深度、晶状体厚度、睫状体厚度、房角开放距离和小梁虹膜夹角。结果术后3个月时64眼全部视网膜解剖复位。眼压、角膜厚度、角膜水平曲率、角膜垂直曲率、晶状体厚度、睫状体厚度,术后1周与术前相比显著增加(P均<0.05)。海绵组术后1个月和3个月眼压与术前相比无显著性差异,而联合组术后3个月眼压(15.41±2.58)mmHg与术前(13.66±3.16)mmHg相比有显著性差异(P=0.009)。海绵组和联合组角膜垂直曲率术后1周分别为(45.03±1.08)D、(44.47±0.90)D(P=0.027)。结论巩膜外硅胶海绵垫压术和巩膜外环扎联合硅胶垫压术对角膜、前房及房角等眼球结构的早期影响较明显;巩膜外环扎联合硅胶垫压术对眼压影响持续时间长,应给予关注和干预。
Objective To observe the change of ocular structure and the effect on intraocular pressure (IOP) after scleral silicone sponge cushion compression and scleral buckling combined with silicone cushion compression. Design retrospective case series. Sixty-four patients (64 eyes) with rhegmatogenous retinal detachment undergoing surgery were enrolled. Among them, 25 eyes (sponge group) underwent scleral buckling and 39 cases underwent scleral buckling combined with silicone cushioning (combined group). Methods Before operation, 1 week, 1 month and 3 months after surgery, the biological parameters of eyeballs were measured by using type A ultrasound and UBM. The intraocular pressure was measured by non-contact tonometer. The main indicators of intraocular pressure, corneal thickness, corneal curvature, anterior chamber depth, lens thickness, ciliary body thickness, open angle and angle of trabecular iris. Results All the retina was resected in 64 eyes at 3 months after operation. Intraocular pressure, corneal thickness, corneal horizontal curvature, corneal vertical curvature, lens thickness and ciliary body thickness were significantly increased at 1 week after operation (P <0.05). The intraocular pressure at 1 month and 3 months postoperatively in the sponge group was not significantly different from that before operation, while the intraocular pressure (15.41 ± 2.58) mmHg in the sponge group was (13.66 ± 3.16) mmHg at 3 months after operation There was a significant difference (P = 0.009). The corneal vertical curvature of the sponge group and the combined group were (45.03 ± 1.08) D and (44.47 ± 0.90) D, respectively, one week after operation (P = 0.027). Conclusions The scleral extracapsular silicone sponge compression and scleral external cerclage combined with silicone padding have significant effect on the early cornea, anterior chamber and angle of the eye. The scleral buckling combined with silicone padding has a significant effect on intraocular pressure Long, attention and intervention should be given.