| Background: The incidence of myopia is increasing year by year,and it is characterized by younger age,rapid progress,and more serious.The prevention and control of myopia is imminent.Under the positive effect of the national “eye-loving” initiative,myopia has been paid more attention by residents.Most of the inherent misunderstandings of myopia have been scientifically corrected.Myopia with a refractive power greater than-6.0D belongs to high myopia,which is often accompanied by pathological changes of the eye,especially damage to the fundus.The myopia with pathological changes is called pathological myopia、degenerative myopia,which is different from ordinary myopia.Low refractive power myopia and high myopia often continue to progress after adulthood,showing lifelong development.Due to the continuous expansion of the eye axis length and the degeneration of the vitreous body with age,the eyeball is mechanically stretched and damaged,and the retina is physiologically affected.The function of each layer of the choroid and the interlayer function damage the optic cells and optic nerve,and eventually cause blindness.Pathological myopia has become the first irreversible blindness disease in China.Research on the mechanism of myopia and the complete cure of myopia has always been a hot spot in ophthalmology.Experts and scholars from all over the world have worked tirelessly and devoted themselves to research.Hypotheses from different levels have sprung up and are used in clinical practice.The correction and treatment of myopia are also changing with each passing day.,Tends to mature.Posterior sclera reinforcement surgery is currently the only recognized method that starts from the "cause",through the posterior sclera implant and its own sclera,to delay the growth of the axis of the eye,so as to control the development of myopia.Chinese medicine has an early understanding of myopia.High myopia belongs to the category of Chinese medicine "near sight".Chinese medicine has a good research prospect in the prevention and control of myopia,and perioperative Chinese medicine treatment has a good effect in reducing complications.Posterior sclera reinforcement combined with traditional Chinese medicine to treat high myopia is a new direction for the prevention and treatment of myopia with integrated traditional Chinese and western medicine.Purpose:To retrospectively analyze the efficacy and safety of posterior scleral reinforcement combined with perioperative Chinese medicine in the prevention and treatment of high myopia.Methods: From December 2017 to February 2020,the Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine was evaluated for surgical indicators and post-scleral reinforcement surgery,combined with oral Chinese medicine from 1 week before the operation to 1-3 months after the operation,for calming the liver and clearing heat,In patients with high myopia who had the treatment of activating blood circulation and reducing swelling and had a follow-up period of more than 1 year after the operation,the cases that met the inclusion criteria and had complete data were selected for retrospective analysis.A total of41 cases(62 eyes)were enrolled,including 20 cases of monocular surgery(20 eyes),21 cases of binocular surgery(42 eyes),and 20 cases of monocular surgery.Divide into two parts for analysis.Part 1: Analysis of all surgical eyes(1)Compare the changes of uncorrected visual acuity,best corrected visual acuity,intraocular pressure,axial length,and refractive power of all cases before and 1 month,6 months,and 12 months after operation,analyze surgical complications and treatment methods,and evaluate posterior sclera Reinforce the effect and safety of combined Chinese medicine therapy(hereinafter referred to as treatment)in the entire population;(2)Compare all cases according to different criteria,compare the changes of the above indicators before and after the operation,and evaluate the effect and safety of the treatment in different groups of people.The criteria for grouping are as follows:(1)Divided into juvenile group(<18 years old)and adult group(≥18 years old)according to age(2)According to the length of the eye axis,it is divided into short eye axis group(<30.00mm) and long eye axis group(≥30.00mm)Part 2: Analysis of cases of monocular surgery The cases of monocular surgery were divided into juvenile group(<18 years old)and adult group(≥18 years old)according to age.(1)Compare the differences of the two groups of patients with the uncorrected visual acuity,best corrected visual acuity,axial length,and refractive power of the two groups of patients 1 year after surgery and non-surgical eyes,and evaluate the differences in the progress of myopia with and without treatment.Further clarify the treatment effect;(2)Analyze the surgical eyes and non-surgical eyes,compare the differences between minors and adults 1 year after surgery compared with the changes in the above indicators before surgery,evaluate the differences in the progression of myopia among people of different ages,and analyze the different treatment effects.Differences in the effects of age groups.Results:Part one(1)UCVA(log MAR): In all cases,the changes in 1 month,6 months,and 1 year after surgery were statistically significant(p<0.05).Compared with preoperative changes in the minor group,the changes were statistically significant at 1 month,6 months,and 1 year after operation(p<0.05).The change in the adult group was statistically significant at 6 months after the operation compared with that before the operation,and there was no statistical significance at 1 month and 1 year after the operation.In the short axis group,the changes were statistically significant at 6 months and 1 year after the operation,and there was no statistical significance at 1 month after the operation.The changes in the long axis group were statistically significant at 6 months after the operation,but there was no statistical significance at 1 month and 1 year after the operation.(2)BCVA(log MAR): In all cases,the change was statistically significant one year after the operation compared with the preoperative change,and there was no statistical significance in the one and six months after the operation.The minor group had statistically significant changes at 6 months and 1 year after the operation,and no statistical significance at 1 month after the operation.Compared with the preoperative changes,the adult group had statistically significant changes at 1 year after surgery,and there was no statistically significant at 1 month and 6 months after surgery.The changes in the short axis group at 1 month,6 months and 1 year after the operation were statistically significant.The changes in the long axis group were statistically significant at 1 year after the operation,and there was no statistical significance at1 and 6 months after the operation.(3)IOP: There was no statistically significant change in intraocular pressure in all cases and in each group at 1 month,6 months,and 12 months after surgery.(4)AL: In all cases,the changes in 1 month,6 months,and 1 year after surgery were statistically significant.There were no statistically significant changes in the minor group at 1month,6 months,and 1 year after surgery.The changes in the adult group at 1 month,6 months,and 1 year after surgery were statistically significant.The changes in the short axis group were statistically significant at 1 month after the operation,and there was no statistical significance at 6 months and 1 year after the operation.The changes in the long axis group at1 month,6 months,and 1 year after the operation were statistically significant.(5)SE: In all cases,the changes were statistically significant at 1 month after surgery,6 months after surgery,and 1 year after surgery.There were no statistically significant changes in the minor group at 1 month,6 months,and 1 year after surgery.The changes in the adult group at 1 month,6 months,and 1 year after surgery were statistically significant.There were no statistically significant changes in the short axis group at 1 month,6 months,and 1 year after the operation.The changes in the long axis group at 1 month,6 months,and 1 year after the operation were statistically significant.(6)Complications: conjunctival congestion and edema in 23 eyes(37%),visual distortion in 5eyes(8%),eyelid edema in 5 eyes(8%),subconjunctival hemorrhage in 1 eye(1%),sclera Inflammation in 2 eyes(3%)and diplopia in 1 eye(1%)occurred 1-20 days after surgery,and resolved 20 days to half a year after treatment.No serious complications such as retinal detachment,endophthalmitis,or macular hole occurred in all patients.Part two(1)Juvenile group: There is no statistically significant difference in the difference between the surgical eye and the non-surgical eye at 1 year after the operation compared with the preoperative naked eye,best corrected visual acuity,and equivalent spherical lens(p>0.05);the axial length is poor The difference in value was statistically significant(p<0.05);the adult group: the difference in the difference between the unoperated and non-surgical eyes at 1 year after the preoperative naked eye,best corrected visual acuity,and axial length was statistically significant;the difference of equivalent spherical lens difference is not statistically significant.(2)In the surgical eyes,the difference in the axial length between minors and adults at 1 year after surgery was statistically significant.The changes in naked eyesight,best corrected visual acuity,and equivalent spherical lens The difference was not statistically significant;in the unoperated eyes,the difference between the naked eyesight,best corrected visual acuity,eye axis,and equivalent spherical lens of minors and adults before and after surgery was statistically significant.Conclusions:(1)Posterior scleral reinforcement surgery is effective in the prevention and treatment of high myopia,and there are differences among different groups of people;(2)Posterior scleral reinforcement combined with perioperative use of traditional Chinese medicine is safe,and traditional Chinese medicine has advantages in reducing postoperative reactions;(3)The progression of myopia in minors is dominated by diopter and eye axis growth,and in adults,the main focus is on visual impairment,and the diopter and axis of the eye are basically stable. |
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