飞秒激光微小切口基质透镜取出术（SMILE）切削中心的临床研究

发布时间：2018-02-22 00:10

本文关键词： 飞秒激光微小切口基质透镜取出术切削中心瞳孔中心EPC 角膜最高点CV kappa角高阶像差　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：观察飞秒激光微小切口基质透镜取出术(SMILE)的切削中心与瞳孔中心EPC、角膜最高点CV的位置关系,评价SMILE术中定位方法的有效性。方法：选取于我院行SMILE手术的病例共54人(105眼),使用Orbscan II角膜地形图仪测定患者术前及术后3月的角膜地形图,通过两种不同方法从地形图上测定切削中心,观察切削中心与CV、EPC的位置关系。分析κ角大小、方向对切削中心的影响,并对偏心距离与术后高阶像差的关系进行相关性分析。结果：SMILE术后3月时105眼相对CV平均偏心距离分别为0.219±0.130mm(方法1)和0.261±0.167mm(方法2),切削中心相对CV在水平方向偏鼻侧,垂直方向偏上方。切削中心与EPC距离分别为0.245±0.141mm(方法1)和0.261±0.161mm(方法2),切削中心相对EPC在水平方向偏鼻侧,垂直方向随机分布。切削中心分布与kappa角分布模式一致者分别占70%(方法1)和67%(方法2)。kappa角大小与切削中心相对CV距离无明显相关性,与方法1测定的切削中心相对EPC距离呈正相关(r=0.303,p=0.002)。SMILE术后总高阶像差、球差、垂直彗差、水平彗差均较术前显著增加,多重线性回归显示偏心距离与术后水平彗差变化量(方法1：β=0.241,p=0.015；方法2：β=0.457,p=0.000)和彗差变化量(方法1：β=0.253,p=0.007；方法2：β=0.335,p=0.000)相关,与球差、垂直彗差、总高阶像差的变化量无明显相关性。结论：SMILE术中定位方式有效,切削中心更靠近CV。切削中心分布与kappa角分布模式基本一致,kappa角大小对切削偏心距离无明显影响。偏心距离与术后水平彗差、彗差变化量呈正相关,减小偏心距离有助于提高术后视觉质量。
[Abstract]:Objective: to observe the relationship between the cutting center of femtosecond laser microincision matrix lens extraction (Smil) and the position of the center of pupil and the highest point of cornea CV, and to evaluate the effectiveness of the localization method in SMILE. Methods: a total of 54 patients (105 eyes) who underwent SMILE operation in our hospital were selected. The corneal topographic maps of the patients before and after March were measured by Orbscan II corneal topographic instrument, and the cutting center was measured from the topographic maps by two different methods. The position relationship between cutting center and CVN EPC was observed, the effect of 魏 angle and direction on cutting center was analyzed, and the relationship between eccentric distance and postoperative high order aberration was analyzed. Results the mean eccentric distance of relative CV in 105 eyes was 0.219 卤0.130mm (method 1) and 0.261 卤0.167mm (method 2) on March after the operation. The distance between cutting center and EPC is 0.245 卤0.141mm (method 1) and 0.261 卤0.161mm (method 2). The distribution of cutting center was consistent with the pattern of kappa angle distribution in 70 cases (method 1) and 67 parts (method 2. Kappa angle size had no significant correlation with the relative CV distance of cutting center, respectively). The relative EPC distance of cutting center measured by method 1 was positively correlated with the total high order aberration, spherical aberration, vertical coma and horizontal coma after operation. Multiple linear regression analysis showed that the eccentric distance was correlated with the changes of horizontal coma (method 1: 尾 = 0.241 p0. 015; method 2: 尾 = 0. 457; method 2: 尾 = 0. 457) and the amount of coma (method 1: 尾 = 0. 253, p0. 007; method 2: 尾 = 0. 335, P 0. 000), but not correlated with spherical aberration, vertical aberration, and total higher order aberration. ConclusionThe operative localization method is effective and the cutting center is closer to the kappa. The distribution of the cutting center and the distribution pattern of the kappa angle have no significant effect on the eccentric distance of the cutting, and the eccentric distance is positively correlated with the horizontal coma and the change of the coma after operation. Reducing eccentric distance is helpful to improve postoperative visual quality.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R779.63

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