角膜屈光术后人工晶状体度数计算方法对比研究

发布时间：2018-05-07 17:16

本文选题：近视 + 远视　；参考：《天津医科大学》2015年博士论文

【摘要】：目的:比较Holladay IOL Consultant Surgical Outcomes Assessment Program(HICSOAP)及American Society of Cataract and Refractive Surgery IOL Power Calculator(ASCRS-IPC)中不同计算方法对角膜屈光术后IOL度数计算准确性。方法:前瞻回顾性系列病例研究。对既往有角膜屈光手术史并于2011年1月至2013年1月接受白内障超声乳化吸除联合IOL植入术,且术后3个月以上的患眼共120眼(按既往角膜屈光手术方式分为三组:A组(近视LASIK/PRK组):有临床病史资料的17眼(9例)——A1组,无临床病史资料的62眼(33例)——A2组;B组(远视LASIK/PRK组):有部分临床病史资料的8眼(4例)——B1组,无临床病史资料的15眼(9例)——B2组;C组(RK组):均无临床病史资料,共18眼(9例)),分别采用HICSOAP及ASCRS-IPC软件中不同IOL度数计算方法计算IOL度数,根据目标术后屈光度、已植入的IOL度数及术后实际屈光度回推计算最优IOL度数,比较不同IOL度数计算方法的预测准确性。比较同一样本用Holladay II-LK、Holladay II-PK、Holladay II-AK三种计算方法的IOL度数预测准确性,借此评估Len Star,Pentacam,Atlas测量角膜屈光术后角膜曲率的准确性,并与Holladay II-Flat K及Holladay II-His K方法进行横向比较。采用Graph Pad Prism统计学软件(version 5.0)对所有数据进行统计学分析。结果:1.HICSOAP及ASCRS-IPC两种计算软件中不同计算方法引起的屈光度误差及IOL度数误差(绝对值)比较1.1近视LASIK/PRK组A1组(有临床病史资料,17眼)应用HICSOAP及ASCRS-IPC两种计算软件中13种IOL度数计算方法经组内比较,引起的屈光度误差(F=2.790,P=0.0017)及IOL度数误差(F=2.790,P=0.0017)的绝对值均有统计学差异。Holladay II-PK、Holladay II-Flat K、Holladay II-LK、ASCRS-AWH、Modified-Masket、ASCRS-Min、Holladay II-AK、Holladay II-His K、Wang-Koch-Maloney这9种计算方法引起的IOL度数计算误差及屈光误差最小(组内比较,之间均无统计学差异,F=0.8201,P=0.5865),其次为ASCRS-ANH、Shammas-no history、Haigis-L及ASCRS-Max方法,组间两两比较差异均有统计学意义(P0.05),后4种计算方法组内比较无统计学差异(F=0.6449,P=0.5905)。A2组(无临床病史资料,62眼)应用的10种IOL度数计算方法中,Holladay II-Flat K引起的屈光误差及IOL度数误差最小,与Holladay II-PK比较差异有统计学意义(t=1.989,P=0.0256);ASCRS-Max引起的屈光误差及IOL度数误差最大,与Haigis-L比较差异有统计学意义(t=3.491,P=0.0004);引起的屈光误差及IOL度数误差位居第二的是Holladay II-PK、Holladay II-LK、ASCRS-Min及Wang-Koch-Maloney方法(组内比较差异无统计学意义F=0.2551,P=0.8577);位居第三的是ASCRS-ANH、Holladay II-AK、Shammas-no history及Haigis-L方法(组内比较差异无统计学意义F=0.8777,P=0.4532)Wang-Koch-Maloney引起的屈光误差及IOL度数误差小于ASCRS-ANH,差异有统计学意义(t=1.957,P=0.0275)。1.2远视LASIK/PRK组(B组)B1组(有临床病史资料)中6种IOL度数计算方法(Holladay II-PK,Holladay II-Flat K,Holladay II-LK,Holladay II-AK,Modified-Masket及Haigis-L)引起的屈光度误差及IOL度数误差绝对值,经重复测量方差分析,均无统计学差异(F=0.7482,P=0.5930)。B2组(无临床病史资料)中5种IOL度数计算方法(Holladay II-PK,Holladay II-Flat K,Holladay II-LK,Holladay II-AK及Haigis-L)引起的屈光度误差及IOL度数误差绝对值,经重复测量方差分析,均无统计学差异(F=1.658,P=0.1727)。1.3近视RK组(C组)C组中5种IOL度数计算方法(Holladay II-LK,Holladay II-AK,Holladay II-PK,Holladay II-Flat K及Atlas1-4)引起的屈光度误差及IOL度数误差绝对值,经重复测量方差分析,均无统计学差异(F=0.6736,P=0.6139)。2.HICSOAP及ASCRS-IPC两种计算软件中不同计算方法引起的屈光度误差趋势(算数值及中间值)在近视LASIK/PRK组中(包括A1和A2),HICSOAP计算软件中除了Holladay II-His K(使用临床病史资料,A1组中)引起的屈光误差算数值有轻度近视偏移倾向外,其余4种计算方法Holladay II-PK、Holladay II-Flat K、Holladay II-LK及Holladay II-AK引起的屈光误差算数值均有轻度远视偏移倾向。而ASCRS-IPC计算软件中8种计算方法引起的屈光误差算数值均有轻度近视偏移倾向。在远视LASIK/PRK组中(包括B1、B2),HICSOAP计算软件中4种计算方法Holladay II-PK,Holladay II-Flat K,Holladay II-LK and Holladay II-AK引起的屈光误差算数值均有轻度近视偏移倾向。ASCRS-IPC计算软件中Haigis-L计算方法引起的屈光误差算数值亦有轻度近视偏移倾向,而Modified-Masket(使用部分临床病史资料,B1组中)计算方法引起的屈光误差算数值则有轻度远视偏移倾向。在近视RK组(C组)中,应用HICSOAP及ASCRS-IPC两种计算软件中5种IOL度数计算方法导致的屈光误差算数值,除了Holladay II-PK计算方法有轻度远视偏移倾向外,其余4种计算方法(Holladay II-LK、Holladay II-AK、Holladay II-Flat K及Atlas1-4)均有轻度近视偏移倾向。3.不同仪器测量角膜K值比较及对Holladay II公式计算误差影响3.1近视LASIK/PRK组在近视LASIK/PRK组,尤其是A2组中,Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR三者间的差异有显著统计学意义(F=8.763,P=0.0003)。Pentacam EKR最小,与Lenstar AKR、Atlas(0~3mm)AKR相比,差异有统计学意义(t=1.964,P=0.0271;t=3.308,P=0.0008);Atlas(0~3mm)AKR最大,与Lenstar AKR相比,差异有统计学意义(t=2.873,P=0.0028)。Pentacam EKR、Lenstar AKR、Atlas(0~3mm)AKR三种测量结果被选作Flat K(最低角膜曲率值)的百分比依次为53.23%(33次)、27.42%(17次)、19.35%(12次),前两者比较差异有统计学意义(Fisher's exact test,P0.01),后两者比较差异无统计学意义(Fisher's exact test,P0.05)。A2组中,Holladay II公式应用不同K值计算IOL度数,结果显示,Holladay II-Flat K引起的屈光误差及IOL度数误差最小,与Holladay II-PK、Holladay II-LK、Holladay II-AK比较,差异均有统计学意义(t=1.989,P=0.0256;t=2.307,P=0.0122;t=2.533,P=0.0070),虽然后三种计算方法比较差异无统计学意义(F=1.036,P=0.3569),但Pentacam EKR被选为Flat K的百分比最高(53.23%,33次)。3.2远视LASIK/PRK组远视LASIK/PRK组角膜曲率测量值从数值看,从小至大均依次为Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR。但经重复测量方差分析,B1组内及B2组内Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR三者间的差异均无统计学意义(F1=1.183,P1=0.3353;F2=0.4654,P2=0.6327)。在Holladay II计算公式中,Holladay II-PK、Holladay II-LK、Holladay II-AK引起的屈光误差及IOL度数误差亦无统计学意义(P0.05)。3.3近视RK组近视RK组中,Pentacam EKR、Lenstar AKR、Atlas(1~4mm)AKR三者间的差异有统计学意义(F=7.978,P=0.0025),Pentacam EKR最大,与Lenstar AKR、Atlas(1~4mm)AKR相比差异均有统计学意义(t1=2.813,P10.05;t2=3.563,P20.05);后两者相比,差异无统计学意义(t=1.050,P0.05)。在Holladay II计算公式中,Holladay II-PK、Holladay II-LK、Holladay II-AK导致的屈光误差及IOL度数误差绝对值却无统计学差异(F=0.6736,P=0.6139)。结论:1.在HICSOAP软件及ASCRS-IPC软件中,应用临床病史资料的计算方法如Holladay II-His K、ASCRS-AWH、Modified-Masket,在IOL度数预测准确性上,较无临床病史资料的计算方法如Holladay II-PK、Holladay II-Flat K、Holladay II-LK、ASCRS-Min、Holladay II-AK、Wang-Koch-Maloney并未显示突出优势。2.对于缺乏临床病史资料的近视LASIK/PRK术后IOL度数计算而言,HICSOAP软件中的Holladay IIFlat K方法IOL度数预测准确性最佳。在Holladay II计算公式中,Pentacam EKR被选作Flat K的频次最高,与该公式契合度最好。3.如果没有HICSOAP软件,ASCRS-IPC软件中的ASCRS-Min及Wang-Koch-Maloney方法同样显示较好的IOL度数预测准确性。4.受样本量限制,对于远视LASIK/PRK术后及近视RK术后IOL度数计算而言,HICSOAP及ASCRS-IPC两种计算软件中所有计算方法IOL度数预测准确性均未显示统计学差异。5.根据不同角膜屈光手术方式,HICSOAP及ASCRS-IPC软件中不同IOL度数计算方法引起的屈光度误差有远视或近视偏移倾向。
[Abstract]:Objective: To compare the accuracy of Holladay IOL Consultant Surgical Outcomes Assessment Program (HICSOAP) and American Society of Cataract. Method: a prospective retrospective series of case studies. Cataract phacoemulsification and IOL implantation were performed from January 2011 to January 2013, and 120 eyes with 3 months after surgery were divided into three groups: group A (group LASIK/PRK): 17 eyes (9 cases) with clinical history data (9 cases) - 62 eyes (33 cases) without clinical history data (33 cases) - A2 Group B (group LASIK/PRK): 8 eyes (4 cases) with some clinical history data - B1 group, 15 eyes (9 cases) without clinical history data (9 cases), group C (group RK): no clinical history data, 18 eyes (9 cases)), respectively, using HICSOAP and ASCRS-IPC software to calculate IOL degrees by different IOL degrees calculation method, according to the refractive index after the target operation, already planted The optimal IOL degree of the IOL degrees and the actual refraction after the operation were calculated, and the accuracy of the different IOL degrees calculation method was compared. The accuracy of the IOL degrees of the three methods of Holladay II-LK, Holladay II-PK, Holladay II-AK was compared with the same sample, and the Len Star was evaluated. The accuracy of the rate is compared with the Holladay II-Flat K and the Holladay II-His K method. All data are statistically analyzed with Graph Pad Prism statistics software (version 5). Results: the refractive error caused by different calculation methods in 1.HICSOAP and ASCRS-IPC two computing software and the degree error (absolute value) are compared 1.. 1 A1 group of LASIK/PRK group of myopia (clinical history data, 17 eyes) applied 13 IOL degrees calculation method in two computing software of HICSOAP and ASCRS-IPC. The absolute values of the refractive error (F=2.790, P=0.0017) and IOL degree error (F=2.790, P=0.0017) were statistically difference.Holladay II-PK. LK, ASCRS-AWH, Modified-Masket, ASCRS-Min, Holladay II-AK, Holladay II-His K, Wang-Koch-Maloney, which cause the IOL degree calculation error and the minimization of the refractive error. The difference was statistically significant (P0.05), and there was no statistical difference (F=0.6449, P=0.5905) in group.A2 (no clinical history data, 62 eyes) in the 10 IOL degrees calculation method, Holladay II-Flat K caused by the minimum of refractive error and IOL degree error, and Holladay II-PK was statistically significant difference (t=1.) 989, P=0.0256); the error of the refractive error and the degree of IOL degree caused by ASCRS-Max is the largest, and there is a significant difference between the Haigis-L and the Haigis-L (t=3.491, P=0.0004). The error caused by the refractive error and the degree of IOL degree error are Holladay II-PK, Holladay II-LK, ASCRS-Min and the method (there is no statistically significant difference within the group. 0.8577); the third one was ASCRS-ANH, Holladay II-AK, Shammas-no history and Haigis-L method (the difference of F=0.8777, P=0.4532) in the group was not statistically significant and the IOL degree error was less than ASCRS-ANH. The 6 IOL degrees calculation methods (Holladay II-PK, Holladay II-Flat K, Holladay II-LK, Holladay II-AK, Modified-Masket and Haigis-L) are the absolute values of the refractive error and the degree error, and there are no statistical differences in the 5 degrees of statistical difference (no clinical history data). The calculation methods (Holladay II-PK, Holladay II-Flat K, Holladay II-LK, Holladay II-AK and Haigis-L) are the absolute values of the refractive error and IOL degree error. There are no statistical differences after the repeated measurement of variance analysis. The diopter error and the absolute value of the IOL degree error caused by II-PK, Holladay II-Flat K and Atlas1-4 have no statistical difference (F=0.6736, P=0.6139).2.HICSOAP and ASCRS-IPC two kinds of computing software, the refractive error tendency (numerical value and intermediate value) in the myopia LASIK/PRK group (package) In addition to A1 and A2), in the HICSOAP computing software, the refractive error caused by the Holladay II-His K (using the clinical history data, the A1 group) has a slight deviation from the mild myopia, and the other 4 methods are Holladay II-PK, Holladay II-Flat K, and the calculated values of the refractive error are slight hyperopia deviation. There are slight myopia deviation in the calculation of the refractive error caused by 8 methods in the ASCRS-IPC computing software. In the hyperopia LASIK/PRK group (including B1, B2), the 4 calculation methods of the HICSOAP computing software are Holladay II-PK, Holladay II-Flat K, and Holladay II-LK. In the.ASCRS-IPC computing software of offset tendency, the numerical value of refractive error caused by Haigis-L calculation method also has the tendency of slight nearsightedness, while Modified-Masket (using partial clinical history data, B1 group) the calculation method of refractive error caused by the calculation method has mild hyperopia deviation. In the RK group of myopia (C group), HICSOAP and ASCRS-IPC are applied. In the two computing software, the refractive error calculated by 5 IOL degrees calculation method is calculated. In addition to the Holladay II-PK calculation method, there is a slight hyperopia deviation and the other 4 kinds of calculation methods (Holladay II-LK, Holladay II-AK, Holladay II-Flat K and Atlas1-4) have a slight deviation of myopia. Laday II formula calculation error affects 3.1 myopia LASIK/PRK group in group LASIK/PRK, especially in group A2, Atlas (0~3mm) AKR, Lenstar AKR, Pentacam EKR, there are significant differences between the three. P=0.0008); Atlas (0~3mm) AKR was the largest, compared with Lenstar AKR, the difference was statistically significant (t=2.873, P=0.0028).Pentacam EKR, Lenstar AKR. The percentages of the three measurements were 53.23% (33 times), 27.42% (17) and 19.35% (12 times). Her's exact test, P0.01), there is no significant difference in the latter two (Fisher's exact test, P0.05).A2 group, Holladay II formula is used to calculate the degree of different K values. The results show that the error of refraction and the degree error is the smallest. T=1.989, P=0.0256; t=2.307, P=0.0122; t=2.533, P=0.0070), although there was no statistical difference between the last three methods (F=1.036, P=0.3569), but Pentacam EKR was selected as the percentage of Flat K (53.23%, 33). Tlas (0~3mm) AKR, Lenstar AKR, Pentacam EKR., but by repeated measurements of variance analysis, B1 group and B2 group Atlas (0~3mm) AKR. The error and IOL degree error also had no statistical significance (P0.05).3.3 myopia RK group myopia RK group, Pentacam EKR, Lenstar AKR, Atlas (1~4mm) AKR three differences were statistically significant. There was no statistical difference (t=1.050, P0.05). In the Holladay II formula, the absolute values of the refractive error and IOL degree error caused by Holladay II-PK, Holladay II-LK and Holladay II-AK were not statistically different (F=0.6736,). Such as Holladay II-His K, ASCRS-AWH, Modified-Masket, in the accuracy of the prediction of IOL degree, there are no clinical history data such as Holladay II-PK, Holladay II-Flat K, Holladay, etc. In the number calculation, the Holladay IIFlat K method in the HICSOAP software is the best for the IOL degree prediction. In the Holladay II formula, Pentacam EKR is selected as the highest frequency of Flat K. The accuracy of the degree prediction was limited by the sample size. For the IOL degree calculation after the hyperopic LASIK/PRK operation and the myopia RK operation, the accuracy of all the calculation methods of IOL degrees in all the two computing software of HICSOAP and ASCRS-IPC did not show statistical difference.5. based on different corneal refractive surgery methods, HICSOAP and ASCRS-IPC software of different IOL degree. The diopter errors caused by the number calculation method tend to be hyperopic or myopic.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R779.6

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