Keratograph对不同阶段圆锥角膜干眼特征参数的检测及各参数对圆锥角膜的诊断价值

发布时间：2018-04-01 21:16

本文选题：干眼　切入点：圆锥角膜　出处：《眼科新进展》2017年11期

【摘要】：目的应用非侵入式眼表综合分析仪Keratograph比较不同阶段圆锥角膜和正常角膜的干眼特征参数,探讨干眼特征参数在圆锥角膜诊断中的作用。方法选取2015年5月至2016年12月就诊于我院的圆锥角膜患者35例(44眼)作为圆锥角膜组,另选拟进行激光角膜屈光手术患者45例(45眼)作为正常角膜组。两组患者年龄差异无统计学意义(P0.05)。根据Amsler-Krumeich分级法将圆锥角膜患者按照严重程度分为轻度圆锥角膜19眼,中度15眼,重度10眼。利用眼表综合分析仪Keratograph检测患者双眼非侵入式首次泪膜破裂时间(tear break-up time,BUT)、平均BUT、泪河高度及眼红指数。采用ROC曲线分析不同指标对圆锥角膜的诊断价值。结果圆锥角膜组的水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度、眼红指数均高于正常角膜组,差异均有统计学意义(均为P0.05)。圆锥角膜组的首次BUT、平均BUT、泪河高度均小于正常角膜组,差异均有统计学意义(均为P0.05)。不同程度圆锥角膜患者的水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度、首次BUT、平均BUT间差异均有统计学有意义(均为P0.05)。中度组和重度组首次BUT、平均BUT均低于轻度组,差异均有统计学意义(均为P0.05),但中度组和重度组间差异均无统计学意义(均为P0.05)。平均BUT与水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度均呈负相关关系(均为P0.05)。而平均BUT与泪河高度和眼红指数间无相关性(均为P0.05)。分别将平均BUT、泪河高度、眼红指数和圆锥角膜指数作为诊断指标,作ROC诊断曲线。圆锥角膜指数的ROC曲线下面积最大,AUC为0.985,95%置信区间为0.963~1.000(P0.001)。此外,ROC曲线下面积平均BUT泪河高度眼红指数,诊断效果均差于圆锥角膜指数,差异均有统计学意义(均为P0.001)。结论眼表综合分析仪Keratograph能够有效地测量角膜的干眼特征参数,其测量参数中平均BUT对圆锥角膜的诊断价值最高,对轻度圆锥角膜患者的诊断更有意义。
[Abstract]:Objective to compare the dry eye characteristic parameters of keratoconus and normal cornea in different stages by using non-invasive ocular surface comprehensive analyzer (Keratograph). To explore the role of dry eye characteristic parameters in the diagnosis of keratoconus. Methods 35 cases (44 eyes) of keratoconus admitted to our hospital from May 2015 to December 2016 were selected as keratoconus group. In addition, 45 patients (45 eyes) with laser corneal refractive surgery were selected as normal cornea group. There was no significant difference in age between the two groups (P 0.05). According to the Amsler-Krumeich classification, the keratoconus patients were divided into 19 eyes of mild keratoconus according to the severity of keratoconus. Moderate 15 eyes, Keratograph was used to detect the time of noninvasive first tear film rupture in the eyes of 10 eyes. The diagnostic value of ROC curve for keratoconus was analyzed by using ROC curve to analyze the diagnostic value of different indexes of ocular keratoconus by using ROC curve to analyze the time of the first tear film rupture, the mean but, the height of the river of tears and the eye red index. Results the horizontal central curvature of keratoconus group, The vertical central curvature, surface variation index, keratoconus index, corneal posterior surface height, eye red index were higher than those in normal cornea group. The difference was statistically significant (all P 0.05). The first But, average Butt, and the height of the river of tears in the keratoconus group were lower than those in the normal cornea group, and the difference was statistically significant (all P 0.05). The horizontal central curvature and vertical central curvature of the keratoconus patients with different degrees were significantly lower than those in the normal cornea group. There were statistically significant differences in surface variation index, keratoconus index, corneal posterior surface height, first but and mean BUT (all P 0.05). The mean BUT in moderate and severe groups was lower than that in mild group. The difference was statistically significant (P 0.05), but there was no significant difference between moderate group and severe group (P 0.05). The mean BUT was associated with horizontal central curvature, vertical central curvature, surface variation index, keratoconus index. There was a negative correlation between the corneal posterior surface height (P0.05) and the mean BUT (P 0.05), but there was no correlation between the mean BUT and the height of the river of tears and the eye red index (P 0.05). The mean But, the height of the river of tears, the eye red index and the keratoconus index were used as the diagnostic indexes, respectively. The area under the ROC curve of keratoconus index was 0.985 ~ 95% confidence interval was 0.963 ~ 1.000 (P 0.001). In addition, the average area of BUT under the curve was lower than that of keratoconus cornea index, and the average diagnostic effect was worse than that of keratoconus index. Conclusion Keratograph can effectively measure the dry eye characteristic parameters of cornea, and the average BUT is the most valuable in the diagnosis of keratoconus. The diagnosis of mild keratoconus is more significant.
【作者单位】：西安市第四医院眼科激光视力矫正中心;
【基金】：陕西省科学技术发展研究项目(编号:2017SF-285) 陕西省自然科学基础研究计划面上项目(编号:2017JM8043)~~
【分类号】：R772.2

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