CAJ | 학술논문

目的探讨后巩膜加固联合斜视矫正术治疗病理性近视合并斜视的可行性和效果.方法回顾性系列病例研究.2005年3月至2009年8月来温州医学院附属眼视光医院就诊的病理性近视合并斜视患者共33例,男14例,女19例,其中31例为外斜视,2例为内斜视,所有患者斜视度＞15°.53只病理性近视眼的屈光度为-8.00～-30.00 D,矫正视力均低于4.9.根据年龄将患者分为一组(5～18岁)、二组(19～35岁)和三组(36岁以上),并进行效果观察.对这33例患者施行改良的Snyder-Thompson的单条带式后巩膜加固联合斜视矫正术.手术前后的视力和眼轴数据的比较采用配对t检验.结果随访观察1～5.3年,后巩膜加固术的53眼术后视力都保持或好于术前.除一组眼轴稍有增长外(t=-2.56,P＜0.05),二组和三组眼轴与术前比较差异无统计学意义.术后1年随访,光学相干断层扫描(OCT)示,2眼黄斑出血消褪,3眼视网膜劈裂的劈裂腔消失,2眼视网膜劈裂腔缩短.有4例患者的残余斜视度约为10°,29例患者残余斜视度小于5°,33例患者都对外观改善程度满意.结论后巩膜加固联合斜视矫正术能同时达到控制病理性近视进展和改善外观的目的,减少分次手术的黏连反应和操作难度,减轻患者痛苦和经济负担,手术可行,效果满意.
목적 탐토후공막가고연합사시교정술치료병이성근시합병사시적가행성화효과.방법 회고성계렬병례연구.2005년3월지2009년8월래온주의학원부속안시광의원취진적병이성근시합병사시환자공33례,남14례,녀19례,기중31례위외사시,2례위내사시,소유환자사시도＞15°.53지병이성근시안적굴광도위-8.00～-30.00 D,교정시력균저우4.9.근거년령장환자분위일조(5～18세)、이조(19～35세)화삼조(36세이상),병진행효과관찰.대저33례환자시행개량적Snyder-Thompson적단조대식후공막가고연합사시교정술.수술전후적시력화안축수거적비교채용배대t검험.결과 수방관찰1～5.3년,후공막가고술적53안술후시력도보지혹호우술전.제일조안축초유증장외(t=-2.56,P＜0.05),이조화삼조안축여술전비교차이무통계학의의.술후1년수방,광학상간단층소묘(OCT)시,2안황반출혈소퇴,3안시망막벽렬적벽렬강소실,2안시망막벽렬강축단.유4례환자적잔여사시도약위10°,29례환자잔여사시도소우5°,33례환자도대외관개선정도만의.결론 후공막가고연합사시교정술능동시체도공제병이성근시진전화개선외관적목적,감소분차수술적점련반응화조작난도,감경환자통고화경제부담,수술가행,효과만의.
Objective To investigate the effectiveness of posterior scleral reinforcement (PSR)combined with strabismus surgery for treating pathological myopia and strabismus.Methods In this case-series study,33 patients with pathological myopia and strabismus were treated between March 2005 and August 2009 in Eye Hospital of Wenzhou Medical College.Patients ranged in age from 5 to 65 years old.In all cases,the angle of strabismus was greater than 15°; 31 patients were exotropic and 2 were esotropic.Pathological myopia ranged from-8.00 to-30.00 D.All corrected visual acuity was less than 4.9.The patients were divided into 3 groups by age.The modified Snyder-Thompson PSR and strabismus surgery were performed on the 33 patients.Data were analyzed with a paired t test.Results After 1 to 5.3 years of follow-up,only the children's group showed a statistically significant change in the eyes length (t=-2.56,P=0.025).When eyes were rechecked with optical coherence tomography,the macular hemorrhage in 2 eyes had faded,the retina foveoschisis in 3 eyes had disappeared and 2 eyes had became shorter.The residual strabismus of 4 patients was 10°; the residual strabismus in the other patients was less than 5°.All patients were satisfied with the improvement in the eyes' appearance.Conclusion PSR combined with strabismus surgery can prevent or delay the progress of myopia,improve the eyes' appearance,and reduce the pain that would result if each operation were done separately.The combined surgery also reduces adherence restrictions and the difficulty of the operation for doctors.PSR combined with strabismus surgery is feasible and safe.