The Changes of Ocular Axial Length and Corneal Curvatyres after Scleral Buckling For Retinal Detachment

視網膜剝離鞏膜外箍術後屈光要素的變化

王惠珠(Wei-Zu Wang) ； 陳明琮(Ming-Tsong Chen) ； 張丞賢(Cheng-Hsien Chang) ； 蔡明琪(Ming-Chee Tsai) ； 吳文權(Wen-Chen Wu) ； 鍾欽彬(Chin-Bing Chung)

《The Kaohsiung Journal of Medical Sciences》 10卷2期 (1994/02) Pp. 77-83

https://doi.org/10.6452/KJMS.199402.0077

摘要

眼球近視性變化與視網膜剝離有相當的關聯。而視網膜剝離手術後眼球屈光要素之變化亦可能與視網膜再剝離有關。因此為探求視網膜剝離術後屈光要素的變化，我們採用前膽性方法研究追蹤44眼裂孔性視網膜剝離，其術前及術後的角膜弧度、眼軸長度、前房深度、水晶體厚度及玻璃體長度的變化。手術方式包括環狀鞏膜簸術12眼和局部鞏膜箍術32眼。所有病人皆術後追蹤6個月。角膜弧度以角膜弧度儀測量，屈光要素之各種長度則以超音波A - Scan測量。取連續三次測量值之平均，以Palr-TTest做比較。同時比較手術所使用之不同材料及方法的產生之差異。
結果顯示角膜弧度的變化呈現術後一週屈光力降低然後再增加之屈勢。但僅在術後第一週的垂直軸角膜屈度及第四週的水平軸角膜弧度之變化有統計學上之意義。眼軸長之變化則在環形外箍術呈術後眼軸增長，但僅術後一週之增長量具統計學上之意義”在局部鞏膜外箍術後則呈眼球縮短，但僅於術後第2、4、6週之縮短量具統計學上意義。進一步分析眼軸中各成份之變化則發現局部鞏膜外箍術後第二、四週的玻璃體縮短與第四週的前房變淺有統計學上的意義。
由手術所使用之材質及方式推測本研究中局部鞏膜外箍術後眼軸長縮短的原因可能在於使用較寬的矽質海綿，前後徑較大的Mattres，Suture，水平徑較大的Scleral bite造成相當程度的鞏膜內凹所致。
綜觀本研究之結果：視網膜剝離鞏膜外箍術後眼球屈光要素之變化為角膜屈光力短暫性減少後增加。眼軸長度之變化則在環狀鞏膜外箍術後短暫增長；局部鞏膜外簸術後呈暫時性縮短，約延續6週之久。

並列摘要

As myopia plays an important role in the pathogenesis of retinal detachment, alterations of refractive components after scleral buckling procedures for retinal detachment may be an important factor for retinal redetachment. To find out the refractive change following retinal detachment surgery, we prospectively followed up the alterations of corneal curvature, and axial components (axial length, anterior chamber depth, lens thickness, and vitreous length) of 44 eyes of rhegmatogenous retinal detachment .before and - after operations. The procedures consisted of encircling scieral buckling (12 eyes) and segmental scieral buckling (32 eyes). All patients were followed for 6 months postoperatively. The corneal curvatures were measured with a keratometer, the axial length and axial components were measured with an A-scan ultrasonography. The methods and materials used in operation were recorded in detail to correlate with the refractive changes.
The corneal curvature showed a trend to flatten early after operation (the 1st week), and gradually reversed to steepening. But, the difference was statistically significant only at the K2 (vertical meridian) in the 1st postoperative week and the Ki (horizontal meridian) in the 4th postoperative week. Lengthening of eyeballs were noted in the encircling group (12 eyes), but only the elongation in the 1st postoperative week was statistically significant. While in segmental buckling group, the axial length of the eyeballs was transiently shortened. The shortening was significant in the 2nd, 4th, and 6 th week after operation. The reduction of eyeball¡¦s axial length was related to the shortening of vitreous length and shallowing of anterior chamber. The possible reasons for the shortening after our segmental scleral buckling may be a high scleral invagination made by the broad silicon sponges, large mattress sutures, and wide scleral bites.
In conclusion, our study on the changes of refractive components after scieral buckling for retinal detachment surgery showed that the refractive power of cornea after scieral buckling procedures transiently reduced and then increased. The axial length showed a transient lengthening change after encircling procedures. A shortening change after segmental buckling procedures was noted for about 6 weeks.

並列關鍵字

Refraction ； Scieral Buckling ； Retinal Detachment