【摘要】目的 ：观察后巩膜加固术( posterior scleral reinforcement surgery, PSR)后眼内屈光手术治疗病理性近视的临床疗效。方法：对178例（323眼）病理性近视患者先行后巩膜加固术,1mo后再行眼内屈光手术，随访18mo。结果： 最佳矫正视力(BCVA)PSR手术前后为4.65±0.38和4.72±0.33,差异有统计学意义(P<0.05)，眼内屈光手术后1，12，18mo为4.80±0.30，4.86±0.29，4.82±0.31,与屈光手术前比较差异均有统计学意义（P<0.05）；屈光度眼内屈光手术前及手术后1，12，18mo分别为16.36±5.03D和–0.98±1.23D，–0.99±1.24D，–0.96±0.99D，术后各时期分别比较差异无统计学意义（P>0.05）；眼轴PSR手术前后为29.92±2.68mm和29.80±2.58mm,差异无统计学意义(P>0.05），眼内屈光手术术后18mo眼轴为29.84±2.56mm,与术前比较差异无统计学意义（P>0.05）;手术无严重并发症发生。结论：对于病理性近视患者，行后巩膜加固术后的眼内屈光手术进行屈光矫正,有效稳定，远期效果尚待进一
【关键词】 病理性近视；后巩膜加固术；眼内屈光手术
Posterior scleral reinforcement surgery combined with intraocular refractive surgery for pathological myopia
Feng Chang, AnQuan Xue, AYong Yu, ShuLin Wang, HeZheng Zhou, ShuangQian Zhu, QinMei Wang
1 School of Optometry and Ophthalmology, Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China;
2 Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, Hubei Province, China
Correspondence to:QinMei Wang. School of Optometry and Ophthalmology, Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China. [email protected]
Abstract AIM:To observe the clinical curative effects of posterior scleral reinforcement surgery（PSR）combined with refractive lens exchange ( RLE ) or phakic intraocular lens ( PIOL ) in treating patients with pathological myopia. METHODS: One hundred and seventyeight pathological myopia patients (323 eyes) were treated with posterior scleral reinforcement surgery, and then were treated with RLE or PIOL 1 month later. The patients had been followed up for 18 months.RESULTS: One month to 12 months,18 months after surgery following up showed that: best corrected visual acuity (BCVA) was seen after PSR from 4.65±0.38 to 4.72±0.33（P<0.05）. No statistically significant changes were seen in BCVA after refractive surgery; no statistically significant changes were seen in the eyes diopter between each period after the refractive surgery (P>0.05); before PSR to 1 month after PSR and 18 months after refractive surgery following up showed that there were no statistical differences（P>0.05）between each period of the average size of ocular axis. No serious complications occurred.CONCLUSION: Posterior scleral reinforcement surgery combined with RLE or PIOL in treating pathological myopia patients is an effective, feasible and safe operation approach. But long time followup is still required.
KEYWORDS: pathological myopia; posterior scleral reinforcement surgery; intraocular refractive surgery
引言
病理性近视是指屈光度数高并伴有明显眼底变性及其他并发症的近视[1]。其特点为眼轴进行性延长，近视度数逐年加深，眼后段扩张，伴视网膜脉络膜退行性变从而引起视功能障碍[2]。患者往往不能接受高
度数的近视眼镜,行角膜屈光手术存在屈光回退及不全矫正等问题。我院对于病理性近视患者先行后巩膜加固术(posterior scleral reinforcement surgery,PSR)以控制眼轴进展,1mo后再行眼内屈光性手术治疗,包括屈光性晶状体置换手术(RLE)，有晶状体眼前房型人工晶状体植入
术(ACPIOL)和有晶状体眼后房型人工晶状体植入术
(PCPIOL)。现报道如下。
1对象和方法
1.1对象
连续收集我院200401/200601就诊的病理性近视患者，共178例（323眼），其中男73例，女105例。年龄：19～66（平均：33.0±10.4）岁。病例选择标准：（1）年龄在18周岁以上;（2）近视屈光度在12D以上;（3）近视呈进展性;（4）眼底有病理性近视的改变；（5）眼前节正常且前房深度≥3.0mm，角膜内皮细胞数量≥2300个/mm2;（6）视网膜检查正常或有格子样变性、干性裂孔等病变已行眼底激光治疗者。
1.2方法
术前检查裸眼视力、最佳矫正视力及近视度数,视力统计参照缪天荣的《标准对数视力表》的五分记录法[3],指数转换成五分记录为3,光感为1;眼轴长度测量采用IOLMaster;检查角膜内皮细胞计数、眼压及眼底。
1.2.1后巩膜加固术
以颞下为中心沿角膜缘剪开球结膜210°，勾取并分离下斜肌，将加固条带从下斜肌肌腹下穿过，条带铺平展开呈“U”形，包兜眼球后极部和葡萄肿区，游离的两端固定于巩膜壁上。术后1mo待手术眼反应消退后行眼内屈光手术。
1.2.2晶状体置换术
颞侧透明角膜切口，行中央连续环形撕囊， U/S超声乳化晶状体，I/A吸除晶状体残余皮质；植入人工晶状体于囊袋内。
1.2.3前房型人工晶状体植入术
上方角膜缘后1mm建立宽约6.2mm弧形巩膜隧道切口,植入前房房角支撑Phakic6H型或者虹膜夹Verisyse型人工晶状体。
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