角膜塑形术对角膜形态及光学特征影响的临床研究

发布时间：2018-03-14 03:28

本文选题：近视　切入点：角膜塑形术　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的临床观察应用角膜塑形术(Orthokeratology,OK镜)一年的近视眼患者角膜形态、角膜光学特征的动态变化,应用傅立叶分析方法分析在角膜塑形术后角膜光学特征的变化。对象与方法本次研究对象从2015年7月至12月首诊于浙江大学附属第一医院就诊并接受角膜塑形术的近视眼患者中随机选取20名(40眼),平均年龄13.1±2.86岁(年龄范围8～20岁),平均等效球镜度-2.94±0.94D。入选患者均行眼科检查,以排除眼部病变及角膜接触镜禁忌症。所有患者均双眼佩戴夜戴型角膜塑形镜行角膜屈光治疗,分别在戴镜前、戴镜1天、1周、1月、3月、6月、12月时随访观察,予检查未矫正视力、验光,应用Pentacam眼前节分析系统测量角膜前表面与后表面的平均曲率、角膜散光及Q值,测量角膜厚度,获取傅立叶分析中各次傅立叶指数:0次指数球面部分(最小球面半径、球面偏心率)、1次指数非对称部分(最大偏心距离)、2次指数散光部分(中央及外周规则散光)、傅立叶3次以上高阶非规则散光部分。应用SPSS 22.0软件对所采的数据进行统计分析。p0.05认为有统计学意义。结果1.戴镜前后的未矫正视力及等效球镜度均发生明显变化(p0.001)。与戴镜前相比未矫正视力均有明显提高(p0.001),其中前1周内提高明显(p0.001),等效球镜度均有明显降低(p0.001),其中前1周内下降显著(p0.001)。2.戴镜前后的角膜前表面平均曲率、Q值均发生明显变化(p0.001),而角膜散光戴镜前后无明显变化(p0.05)。与戴镜前比较,戴镜后角膜前表面平均曲率均明显减小(p0.001)。与戴镜前比较,戴镜后角膜前表面Q值均有上升(p0.001),戴镜1周内Q值明显上升(p0.001),戴镜1周至1月上升减缓(p0.05),戴镜1月Q值达到最高,之后稍有下降(p0.05)。角膜后表面平均曲率、后表面散光、Q值在戴镜前后均未发生明显变化(p0.05)。戴镜前后中心顶点角膜厚度、角膜最薄点厚度、最薄点偏心距离均无明显差异(p0.05)。3.傅立叶分析:与戴镜前相比,戴镜1天、1周、1月、3月、6月、12月最小球面半径(傅立叶0次指数)均明显增大(p0.001),其中前3月持续增大;球面偏心率(傅立叶0次指数)均下降(p0.001),其中前1周明显下降;最大偏心距离(傅立叶1次指数)均有增加(p0.001),其中前1月持续增加(p0.05);戴镜后中央散光均有增大,其中除戴镜1周外戴镜前后差异均有统计学意义(p0.01),戴镜1周后外周规则散光明显增加(p0.05);与戴镜前相比高次非规则散光均明显增加(p0.05),但戴镜1天无明显变化(p0.05)。结论1.角膜塑形术对近视进行屈光矫正是通过使角膜前表面变平降低角膜曲率实现的,这种变化在戴镜1月内明显,1月后趋于稳定。角膜塑形术对角膜后表面、角膜厚度及最薄点位置影响不大。2.角膜塑形术对傅立叶零次、1次、2次及高次指数均有影响,其中1月内改变明显,1月后趋于稳定。傅立叶分析可以有效反映角膜塑形术对角膜光学特征的变化。
[Abstract]:Objective to observe the dynamic changes of corneal morphology and corneal optical characteristics in myopia patients with orthokeratology (Orthokeratology) for one year. Objects and methods from July 2015 to December, the subjects were first diagnosed at the first affiliated Hospital of Zhejiang University and underwent corneal plastic surgery. Twenty patients with myopia were randomly selected, with an average age of 13.1 卤2.86 years (age range of 820 years, mean equivalent spherical degree of -2.94 卤0.94D). All patients were examined by ophthalmology. In order to exclude ocular lesions and contraindication of contact lens, all the patients were treated with corneal refraction by wearing night-wearing keratoplastic lens. The patients were followed up for 1 week, January, March, June and June before wearing the lens, respectively. Uncorrected visual acuity, optometry, mean curvature, corneal astigmatism and Q value, corneal thickness were measured by Pentacam anterior segment analysis system. In Fourier analysis, every Fourier exponent: 0 exponent spherical part (minimum radius of spherical surface) is obtained. The spherical eccentricity is one order exponential asymmetric part (maximum eccentricity distance and 2 times exponential astigmatism) (central and peripheral regular astigmatism, Fourier 3 times or more irregular astigmatism). The data obtained are entered by SPSS 22.0 software. Statistical analysis. P0.05 showed that there was statistical significance. Results 1. The uncorrected visual acuity and equivalent spherical eyesight were significantly changed before and after wearing the mirror. The uncorrected visual acuity was significantly improved compared with that before wearing the mirror, especially within the first week. In the first week, the mean curvature Q value of the anterior surface of the cornea before and after the wear of the lens was significantly changed (p 0.001), but there was no significant change in the corneal astigmatism before and after the wear of the lens (P 0.05N), compared with that before and after the wear of the lens, the mean curvature of the cornea before and after the wear of the lens was significantly decreased. The mean curvature of the anterior surface of the cornea before and after the wear of the lens was significantly different from that before and after the wear of the lens. The mean curvature of the anterior corneal surface decreased significantly after wearing the lens, compared with that before the lens, the Q value of the anterior surface of the cornea increased significantly after wearing the lens, and the Q value of the anterior surface of the cornea increased significantly within one week (P 0.001a), the increase of the lens decreased from 1 week to January, and the Q value of the anterior corneal surface reached the highest on January. The mean curvature of the posterior corneal surface and the Q value of the posterior surface astigmatism did not change significantly before and after the wear of the lens, and the thickness of the central vertex cornea and the thinnest point of the cornea before and after the wear of the lens were not significantly changed. There was no significant difference in the eccentric distance between the thinnest points (p 0.05). Fourier analysis showed that the minimum spherical radius (Fourier exponent 0) in the first day, January, March, June and June increased significantly compared with that before wearing the mirror, and the mean minimum spherical radius (Fourier 0 exponent) was increased continuously before June. The spherical eccentricity (Fourier exponent 0) decreased by p 0.001g, and the maximum eccentric distance (Fourier index I) increased by p0.001g, and the central astigmatism increased after the wear of the mirror. There were significant differences between the two groups before and after wearing the mirror for one week, the regular astigmatism increased significantly after one week, and the irregular astigmatism of high order increased significantly compared with that before wearing the mirror, but there was no significant change in the astigmatism on the first day after wearing the mirror. Conclusion: there is no significant change on the first day after wearing the mirror. Conclusion: compared with before the mirror wear, the irregular astigmatism of the high order increased significantly (p 0.05). 1. Refractive correction of myopia is achieved by flattening the anterior surface of the cornea and reducing the curvature of the cornea. This change was obvious in January and stabilized after January. Corneal remodeling had little effect on the posterior corneal surface, corneal thickness and the position of the thinnest spot. The changes were obvious in January and stabilized after January. Fourier analysis can effectively reflect the changes of corneal optical characteristics in corneal plastic surgery.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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