中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2012年
1期
73-77
,共5页
邵彦%胡博杰%刘慧%李筱荣
邵彥%鬍博傑%劉慧%李篠榮
소언%호박걸%류혜%리소영
角膜厚度/中央,周边%经结膜无缝合玻璃体切割术%糖尿病视网膜病变
角膜厚度/中央,週邊%經結膜無縫閤玻璃體切割術%糖尿病視網膜病變
각막후도/중앙,주변%경결막무봉합파리체절할술%당뇨병시망막병변
Corneal thickness/center,periphery%Transconjunctival sutureless vitrectomy%Diabetic retinopathy
背景 玻璃体切割手术对糖尿病患者角膜厚度影响的研究具有理论意义和现实意义. 目的 观察比较糖尿病视网膜病变(DR)眼玻璃体切割术术后角膜厚度的变化趋势. 方法 前瞻性队列研究.收集因DR行单纯玻璃体切割术的连续病例70例75眼,采用Pentacam三维眼前节分析仪,由同一检查医师检查.于术前和术后7d、1个月、3个月测量角膜顶点、角膜最薄处及距角膜顶点4 mm垂直线与右眼240°、120°、60°交点或与左眼300°、120°、60°的交点共5个部位的角膜厚度进行动态分析,采用重复测量的方差分析进行手术前后角膜厚度的比较性研究.进一步研究不同角膜部位是否行23 g玻璃体切割术、手术持续时间、不同玻璃体腔填充物对角膜厚度变化率的影响.结果 玻璃体切割术前,术后7d、1个月、3个月角膜平均厚度分别为(639.9±103.1)、(689.5±119.3)、(666.5±113.7)、(650.8±108.6)μm.按糖尿病病程为13年、年龄为57.2岁水平修正角膜厚度变化率,术后各随访时间点角膜厚度变化率的差异有统计学意义(F=210.928,P=0.000)；不同部位角膜厚度变化率不同(F=24.843,P=0.000),角膜厚度变化率按大小顺序依次为P4 ＞P3 ＞p1＞P2 ＞P5.行23 g经结膜无缝合玻璃体切割术(TSV)对角膜厚度的影响小于传统的20 g手术(F=53.843,P=0.000)；玻璃体内填充惰性气体对角膜厚度的影响明显大于填充平衡盐溶液者(F=5.288,P=0.022)；但是不同的手术持续时间对角膜厚度变化的差异无统计学意义(F=1.233,P=0.293). 结论 DR有晶状体眼行玻璃体切割手术对于角膜是安全的,23 g TSV及平衡盐溶液填充对角膜的影响更小.Pentacam眼前节分析仪不仅能获得中央角膜厚度值,同样可以获得周边角膜厚度信息.
揹景 玻璃體切割手術對糖尿病患者角膜厚度影響的研究具有理論意義和現實意義. 目的 觀察比較糖尿病視網膜病變(DR)眼玻璃體切割術術後角膜厚度的變化趨勢. 方法 前瞻性隊列研究.收集因DR行單純玻璃體切割術的連續病例70例75眼,採用Pentacam三維眼前節分析儀,由同一檢查醫師檢查.于術前和術後7d、1箇月、3箇月測量角膜頂點、角膜最薄處及距角膜頂點4 mm垂直線與右眼240°、120°、60°交點或與左眼300°、120°、60°的交點共5箇部位的角膜厚度進行動態分析,採用重複測量的方差分析進行手術前後角膜厚度的比較性研究.進一步研究不同角膜部位是否行23 g玻璃體切割術、手術持續時間、不同玻璃體腔填充物對角膜厚度變化率的影響.結果 玻璃體切割術前,術後7d、1箇月、3箇月角膜平均厚度分彆為(639.9±103.1)、(689.5±119.3)、(666.5±113.7)、(650.8±108.6)μm.按糖尿病病程為13年、年齡為57.2歲水平脩正角膜厚度變化率,術後各隨訪時間點角膜厚度變化率的差異有統計學意義(F=210.928,P=0.000)；不同部位角膜厚度變化率不同(F=24.843,P=0.000),角膜厚度變化率按大小順序依次為P4 ＞P3 ＞p1＞P2 ＞P5.行23 g經結膜無縫閤玻璃體切割術(TSV)對角膜厚度的影響小于傳統的20 g手術(F=53.843,P=0.000)；玻璃體內填充惰性氣體對角膜厚度的影響明顯大于填充平衡鹽溶液者(F=5.288,P=0.022)；但是不同的手術持續時間對角膜厚度變化的差異無統計學意義(F=1.233,P=0.293). 結論 DR有晶狀體眼行玻璃體切割手術對于角膜是安全的,23 g TSV及平衡鹽溶液填充對角膜的影響更小.Pentacam眼前節分析儀不僅能穫得中央角膜厚度值,同樣可以穫得週邊角膜厚度信息.
배경 파리체절할수술대당뇨병환자각막후도영향적연구구유이론의의화현실의의. 목적 관찰비교당뇨병시망막병변(DR)안파리체절할술술후각막후도적변화추세. 방법 전첨성대렬연구.수집인DR행단순파리체절할술적련속병례70례75안,채용Pentacam삼유안전절분석의,유동일검사의사검사.우술전화술후7d、1개월、3개월측량각막정점、각막최박처급거각막정점4 mm수직선여우안240°、120°、60°교점혹여좌안300°、120°、60°적교점공5개부위적각막후도진행동태분석,채용중복측량적방차분석진행수술전후각막후도적비교성연구.진일보연구불동각막부위시부행23 g파리체절할술、수술지속시간、불동파리체강전충물대각막후도변화솔적영향.결과 파리체절할술전,술후7d、1개월、3개월각막평균후도분별위(639.9±103.1)、(689.5±119.3)、(666.5±113.7)、(650.8±108.6)μm.안당뇨병병정위13년、년령위57.2세수평수정각막후도변화솔,술후각수방시간점각막후도변화솔적차이유통계학의의(F=210.928,P=0.000)；불동부위각막후도변화솔불동(F=24.843,P=0.000),각막후도변화솔안대소순서의차위P4 ＞P3 ＞p1＞P2 ＞P5.행23 g경결막무봉합파리체절할술(TSV)대각막후도적영향소우전통적20 g수술(F=53.843,P=0.000)；파리체내전충타성기체대각막후도적영향명현대우전충평형염용액자(F=5.288,P=0.022)；단시불동적수술지속시간대각막후도변화적차이무통계학의의(F=1.233,P=0.293). 결론 DR유정상체안행파리체절할수술대우각막시안전적,23 g TSV급평형염용액전충대각막적영향경소.Pentacam안전절분석의불부능획득중앙각막후도치,동양가이획득주변각막후도신식.
Background The research of corneal thickness after pars plana vitrectomy in DM patient plays an important role not only theoretically but clinically. Objective Present study was to evaluate the change in corneal thickness after pars plana vitrectomy. Methods A prospective coherent study was designed.Seventy-five eyes of 70 consecutive diabetic retinopathy(DR) patients were collected in Tianjin Medical University Eye Center.Pentacam was used to assess the central and periphery corneal thickness by the same investigator preoperatively and 7 days,1 and 3 months postoperatively,respectively.The thickness values from five corneal zone were obtained,including cornea vertex,the thinnest point of the cornea,periphery cornea near the scleral incision of 4 mm away to vertex of cornea on vertical and 240°,120°,60° meridian ( right eye) or 300°,120°,60° meidian ( left eye ).These results were compared and analyzed with ANOVA of repeated measurement data.Subgroup analysis was performed to evaluate the influence of different corneal positions,the use of conventional 20g or 23g transconjunctival sutureless vitrectomy(TSV) groups,surgery duration,gas or fluid endotamponde on corneal thickness.This study was approved by Ethic Committee of this hospital.Written informed consent was obtained from the subjects before any relative medical procedure. Results The mean corneal thickness was ( 639.9 ± 103.1 ),( 689.5 ± 119.3 ),( 666.5 ±113.7),( 650.8 ± 108.6 ) μm before operation,postperative 7 days,1 and 3 months respectively.As covariates appearing in the model,the corneal thickness change rates were revised as the parameters as following: diabeitc duration =13.0 and age =57.2.The revised corneal thickness was significant different among various time points( F=210.928,P=0.000) and different corneal zones(F=24.843,P=0.000) with the size order in turn P4＞P3＞P1＞P2＞P5.The corneal thickness change rates were less in 23g TSV group compared with conventional 20-g group (F =53.843,P =0.000) and BSS tamponade group compared with gas tamponade group ( F =5.288,P =0.022).But no significant difference was found in the revised corneal thickness among surgery duration ＜ 1 hour group,1-2 hour group and ＞2 hour group( F=1.233,P =0.293). Conclusions Vitrectomy is a safe procedure on the ground of cornea,but TSV and fluid endotamponade appear to be more beneficial to the protection of cornea.Pentacam could offer the reliable data in not only central cornea but also periphery cornea.
