飞秒激光小切口角膜基质透镜取出术后眼压变化及其相关因素分析
发布时间：2018-10-21 15:28
【摘要】：目的:分析飞秒激光小切口角膜基质透镜取出术(SMILE)术后非接触眼压测量值的变化趋势并探究SMILE术后非接触眼压与角膜厚度及曲率的相关性及回归方程,为临床评估SMILE术后患者的真实眼压提供参考依据。方法:收集2016年02月~2016年11月在我院行SMILE手术的130例(259眼)近视患者资料,按照纳入标准和排除标准筛选研究对象。依据等效球镜度数将259眼分为三组:A组为高度近视组(≥-6.00D),共108眼;B组为中度近视组(-3.00D~-6.00D),共110眼;C组为低度近视组(-3.00D),共41眼。三组患者行术前常规检查,排除手术禁忌后行SMILE手术。术后给予糖皮质激素滴眼液、抗生素类滴眼液及人工泪液。记录术前、术后1天、1周、1月、3月的非接触眼压、3.0mm半径内角膜平均曲率、角膜中央厚度等。采用SPSS18.0统计学软件,对三组手术前、后非接触眼压进行单因素方差分析、LSD-t检验分析组间差异,对三组术后眼压及眼压降低值的相关因素采用Pearson相关进行分析,对术后眼压及眼压降低值与各影响因素进行多元线性回归分析。结果:(1)A、B、C三组术前、术后非接触眼压测量值差异均有统计学意义(F=147.264、143.004、72.865,P0.001)。进一步经LSD-t多重检验后,结果显示三组术后非接触眼压较术前降低,术后各时段眼压与术前眼压比较均有统计学意义(P0.01),但三组术后各时段眼压组间差异均无统计学意义(P0.05)。(2)三组术后非接触眼压测量值与角膜中央厚度、角膜平均曲率的变化均呈正相关,A组眼压与角膜中央厚度及曲率的相关系数r=0.4356、0.295(P0.05),相关方程为Y=0.0327X-2.739(X表示角膜中央厚度,Y表示非接触眼压),R2=0.2057;Y=0.4748X-7.163(X表示角膜平均曲率,Y表示非接触眼压),R2=0.08703。B组眼压与角膜中央厚度及曲率的相关系数r=0.2807、0.264(P0.05),相关方程为Y=0.0295X-1.832(X表示角膜中央厚度,Y表示非接触眼压),R2=0.0788;Y=0.3837X-4.199(X表示角膜平均曲率,Y表示非接触眼压),R2=0.06971。C组眼压与角膜中央厚度及曲率的相关系数r=0.4101、0.6346(P0.05),相关方程为Y=0.04658X-8.75(X表示角膜中央厚度,Y表示非接触眼压),R2=0.1682;Y=1.257X-35.92(X表示角膜平均曲率,Y表示非接触眼压),R2=0.4027。A、B、C三组术中角膜切削厚度与眼压降低值均无明显相关性(r=0.1269、0.1606、0.1955,P0.05),且手术前后平均曲率变化值与眼压降低值均无明显相关性(r=0.1397、0.03972、0.04514,P0.05)。(3)将术后眼压测量值及手术前后眼压降低值(△NCT)与其相关因素进行多元线性回归分析,回归方程分别为:Y=-12.963+0.029X1+0.31X2(Y表示眼压,X1表示角膜中央厚度,X2表示平均角膜平均曲率);Y=2.276+0.032X1+0.108X2(Y表示△NCT,X1表示△CCT,X2表示平均曲率变化值),回归方程均有统计学意义(F=29.05、19.394,P0.001)。结论:(1)SMILE术后非接触眼压测量值较术前降低,SMILE术后短期内使用糖皮质激素滴眼液对术后眼压无明显影响;(2)SMILE术后非接触眼压测量值变化与角膜中央厚度及曲率的变化呈正相关,手术前后眼压降低值受术中角膜切削厚度和角膜平均曲率变化的共同影响。
[Abstract]:Objective: To analyze the changes of non-contact intraocular pressure (IOP) measured by femtosecond laser microincision corneal stroma lens (SMILE) and explore the relationship between non-contact intraocular pressure and corneal thickness and curvature after SMILE operation and regression equation. To provide a reference basis for the clinical evaluation of the actual intraocular pressure of patients after SMILE. Methods: The data of 130 patients with myopia (259 eyes) who underwent SMILE operation in our hospital from February 2016 to November 2016 were collected, and the subjects were screened according to inclusion criteria and exclusion criteria. 259 eyes were divided into three groups according to the equivalent sphere degree: group A was high myopia group (n-6. 00D), 108 eyes were in total; group B was moderate myopia group (-3. 00D ~-6. 00D), 110 eyes; C group was low myopia group (-3. 00D), total 41 eyes. Three sets of patients underwent routine examination prior to operation, excluding the operation of SMILE after surgical taboos. After operation, glucocorticoid eye drops, antibiotics and artificial tears were given. The mean curvature of the cornea, the central thickness of the cornea, etc. were recorded before and after operation for 1 day, 1 week, 1 month, 3 months. Using SPSS18. 0 statistical software, single-factor analysis of variance and LSD-t test were performed for three groups of pre-operative and post-operative intraocular pressure, and Pearson correlation was used to analyze the related factors of intraocular pressure and intraocular pressure in three groups. Multivariate linear regression analysis was performed on postoperative intraocular pressure (IOP) and intraocular pressure (IOP) and intraocular pressure (IOP). Results: (1) Before group A, B and C, the difference of non-contact intraocular pressure measurement was statistically significant (F = 147. 264, 143. 004, 72. 865, P 0.001). After multiple tests of LSD-t, the results showed that there was no significant difference between intraocular pressure and intraocular pressure before operation (P <0.01), but there was no significant difference between intraocular pressure and intraocular pressure (P <0.05). (2) The measured values of non-contact intraocular pressure were positively correlated with the central thickness of cornea and the mean curvature of cornea in group A. The correlation coefficient of intraocular pressure with central thickness and curvature of cornea was 0. 4356, 0. 295 (P0.05). The correlation equation was Y = 0.0327X-2.739 (X represents the central thickness of cornea, Y represents non-contact intraocular pressure), R2 = 0.92057; Y = 0. 4748X-7.163 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure), R2 = 0.08703. Group B, the correlation coefficient of intraocular pressure with the central thickness and curvature of the cornea is 0. 2807, 0. 264 (P0.05). The correlation equation is Y = 0.0295X-1.832 (X represents the central thickness of the cornea, Y represents the non-contact intraocular pressure), R2 = 0. 0788; Y = 0.3837X-4.199 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure). The correlation coefficient between intraocular pressure and central corneal thickness and curvature was 0. 64101, 0.6346 (P0.05). The correlation equation was Y = 0.04658X-8.75 (X represents the central thickness of the cornea, Y represents non-contact intraocular pressure), R2 = 0.91682; Y = 1.257X-35.92 (X represents the average curvature of the cornea, Y represents non-contact intraocular pressure), R2 = 0.4027. A, B, There was no significant correlation between corneal ablation thickness and IOP reduction in three groups (r = 0.01269, 0.1606, 0. 1955, P0.05), and the mean curvature change before and after operation was not significantly correlated with the decrease of intraocular pressure (r = 0.1397, 0. 03972, 0. 04514, P0.05). (3) Multivariate linear regression analysis was performed on postoperative intraocular pressure measurement and post-operative intraocular pressure reduction (NCT) and its related factors. The regression equation was Y =-12.963 + 0.029X1 + 0.31X2 (Y = intraocular pressure, X1 represents the central thickness of the cornea, X2 represents the mean corneal mean curvature); Y = 2.276 + 0.032X1 + 0.108X2 (Y), The regression equations were statistically significant (F = 29. 05, 19. 394, P 0.001). Conclusion: (1) The measured value of non-contact intraocular pressure after SMILE is lower than that before operation, and it has no obvious effect on postoperative intraocular pressure after SMILE operation; (2) The change of non-contact intraocular pressure measurement after SMILE is positively correlated with the change of central thickness and curvature of cornea. The decrease of intraocular pressure before and after surgery was affected by the thickness of corneal ablation and the change of mean curvature of cornea.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.63
[Abstract]:Objective: To analyze the changes of non-contact intraocular pressure (IOP) measured by femtosecond laser microincision corneal stroma lens (SMILE) and explore the relationship between non-contact intraocular pressure and corneal thickness and curvature after SMILE operation and regression equation. To provide a reference basis for the clinical evaluation of the actual intraocular pressure of patients after SMILE. Methods: The data of 130 patients with myopia (259 eyes) who underwent SMILE operation in our hospital from February 2016 to November 2016 were collected, and the subjects were screened according to inclusion criteria and exclusion criteria. 259 eyes were divided into three groups according to the equivalent sphere degree: group A was high myopia group (n-6. 00D), 108 eyes were in total; group B was moderate myopia group (-3. 00D ~-6. 00D), 110 eyes; C group was low myopia group (-3. 00D), total 41 eyes. Three sets of patients underwent routine examination prior to operation, excluding the operation of SMILE after surgical taboos. After operation, glucocorticoid eye drops, antibiotics and artificial tears were given. The mean curvature of the cornea, the central thickness of the cornea, etc. were recorded before and after operation for 1 day, 1 week, 1 month, 3 months. Using SPSS18. 0 statistical software, single-factor analysis of variance and LSD-t test were performed for three groups of pre-operative and post-operative intraocular pressure, and Pearson correlation was used to analyze the related factors of intraocular pressure and intraocular pressure in three groups. Multivariate linear regression analysis was performed on postoperative intraocular pressure (IOP) and intraocular pressure (IOP) and intraocular pressure (IOP). Results: (1) Before group A, B and C, the difference of non-contact intraocular pressure measurement was statistically significant (F = 147. 264, 143. 004, 72. 865, P 0.001). After multiple tests of LSD-t, the results showed that there was no significant difference between intraocular pressure and intraocular pressure before operation (P <0.01), but there was no significant difference between intraocular pressure and intraocular pressure (P <0.05). (2) The measured values of non-contact intraocular pressure were positively correlated with the central thickness of cornea and the mean curvature of cornea in group A. The correlation coefficient of intraocular pressure with central thickness and curvature of cornea was 0. 4356, 0. 295 (P0.05). The correlation equation was Y = 0.0327X-2.739 (X represents the central thickness of cornea, Y represents non-contact intraocular pressure), R2 = 0.92057; Y = 0. 4748X-7.163 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure), R2 = 0.08703. Group B, the correlation coefficient of intraocular pressure with the central thickness and curvature of the cornea is 0. 2807, 0. 264 (P0.05). The correlation equation is Y = 0.0295X-1.832 (X represents the central thickness of the cornea, Y represents the non-contact intraocular pressure), R2 = 0. 0788; Y = 0.3837X-4.199 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure). The correlation coefficient between intraocular pressure and central corneal thickness and curvature was 0. 64101, 0.6346 (P0.05). The correlation equation was Y = 0.04658X-8.75 (X represents the central thickness of the cornea, Y represents non-contact intraocular pressure), R2 = 0.91682; Y = 1.257X-35.92 (X represents the average curvature of the cornea, Y represents non-contact intraocular pressure), R2 = 0.4027. A, B, There was no significant correlation between corneal ablation thickness and IOP reduction in three groups (r = 0.01269, 0.1606, 0. 1955, P0.05), and the mean curvature change before and after operation was not significantly correlated with the decrease of intraocular pressure (r = 0.1397, 0. 03972, 0. 04514, P0.05). (3) Multivariate linear regression analysis was performed on postoperative intraocular pressure measurement and post-operative intraocular pressure reduction (NCT) and its related factors. The regression equation was Y =-12.963 + 0.029X1 + 0.31X2 (Y = intraocular pressure, X1 represents the central thickness of the cornea, X2 represents the mean corneal mean curvature); Y = 2.276 + 0.032X1 + 0.108X2 (Y), The regression equations were statistically significant (F = 29. 05, 19. 394, P 0.001). Conclusion: (1) The measured value of non-contact intraocular pressure after SMILE is lower than that before operation, and it has no obvious effect on postoperative intraocular pressure after SMILE operation; (2) The change of non-contact intraocular pressure measurement after SMILE is positively correlated with the change of central thickness and curvature of cornea. The decrease of intraocular pressure before and after surgery was affected by the thickness of corneal ablation and the change of mean curvature of cornea.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.63
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