圆锥角膜患者发病特点及临床特点分析

发布时间：2018-06-27 15:34

本文选题：圆锥角膜 + 人口统计学　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的 1.对圆锥角膜患者的发病特点及临床资料做出分析,探讨圆锥角膜早期诊断和治疗的相关依据。 2.通过OCULUS Pentacam眼前节成像分析系统检测圆锥角膜患者双眼角膜,对各量化参数进行特点评估及参数间相关性分析,为圆锥角膜的早期诊断提供理论依据。方法 1.收集68例圆锥角膜患者的发病特点(男女患病比例、发病年龄等)进行分析；对圆锥角膜患者的临床特点(发病史及家族史、戴眼镜史、屈光状态、裂隙灯检查、全身病史等)进行分析、比较；进行VF-14问卷调查,并对结果进行统计分析。 2. OCULUS pentacam眼前节成像分析系统检测患者双眼角膜,63例(5例10眼未采集到图像予以排除)109眼采集到图像,对其各项量化参数进行特点评估和参数间相关性分析,并与作为正常对照组的64例(64眼,均为左眼)进行比较分析。采用SPSS17.0对数据进行统计学分析。结果 1.统计发现该研究人群中圆锥角膜患病比率男性高于女性(67.6%/32.4%,p0.05),圆锥角膜确诊时的平均年龄是26.00±8.91岁(年龄范围12.38-51.12岁),10%(7/68)的患者发病年龄小于18岁,57.6%(39/68)的患者发病年龄小于30岁。 2.患者首次眼科就诊的主要主诉是视力下降且框架镜不能矫正83.8%(57/68),进展性的近视22.1%(15/68),头痛及眼痛者5.9%(4/68),无症状的4人(5.9%)。1例(1.5%)伴有圆锥角膜家族史。确诊圆锥角膜眼中角膜近中央局部膨出是最常见的临床体征(59.1%),出现Fleischer's环的比例为53%, Vogt's条纹26%。圆锥角膜眼的平均柱镜度数明显高于可疑圆锥角膜眼(-4.00D/-2.00D,p0.001),logMAR最佳矫正视力可疑圆锥角膜眼明显好于圆锥角膜眼(0.04/0.18,p0.001)。 3.VF-14问卷调查最后得分在8.3-100之间,其中68%在91-100之间,13%在81-90之间,19%在80或以下。在对特定活动进行评估时,约一半(46.7%)患者阅读小字存在困难,而且较多患者存在中等程度困难(25.7%)；约三分之一的患者在读书看报、做精细活或看电视时存在一定困难,存在中等程度困难者分别占22.9%、19.3%和21.1%；还有一定数量的患者(31.2%)在辨认各种标示牌方面存在困难,看不清楼梯或路缘石者占24.8%,近距离认人困难者占17.4%。 4.可疑KC组和正常组前表面最大屈光度和前表面最大高度值之间无显著性差异(P0.05),KC组与可疑KC组、KC组与正常组之间有显著性差异(P0.05)。 5.KC组和可疑KC组角膜后表面最大屈光度和最大高度值均高于正常对照组,KC组、可疑KC组和正常对照组后表面最大高度值两两比较组间均有显著性差异(P0.05)。 6.角膜最薄厚度由对照组到KC组呈递减趋势,各组两两比较均有显著差异(P0.05)。KC组、可疑KC组和正常对照组后表面最大屈光度和最大高度均不位于角膜中心。 7.在KC组角膜最大屈光度与前表面最大高度、后表面最大高度、后表面最大屈光度、角膜最薄点间均有显著相关性(P0.0001)；在可疑KC组角膜前表面最大屈光度与后表面最大屈光度、角膜最薄点有相关性(p0.050)。 8.KC组、可疑KC组及正常组角膜最薄点到角膜中心的平均距离分别为(0.76±0.42)mm、(0.66±0.38)m and(0.61±0.29)mm。KC组(56.0%)和可疑KC组(52.0%)角膜最薄点位置多数在中央lmm圆环外的颞下方,而正常组角膜最薄点位置多数(46.7%)位于中央lmm圆环区域内。结论 1.圆锥角膜多发生于20岁左右的青年人；主诉近视度数增长且框架镜不能矫正的患者应引起高度怀疑；RGP的普及可明显改善圆锥角膜患者的矫正视力,推迟角膜移植时间。 2.由圆锥角膜所致的视功能损害会导致与视力相关的日常活动受到一定程度限制。 3.在诊断圆锥角膜时要将角膜厚度、前后表面屈光度和高度等指标综合分析,若角膜后表面最大屈光度和最大高度均显示增高,而角膜最薄厚度显示降低,则应该高度怀疑圆锥角膜。 4.随病情发展,角膜局限前突的程度加重,角膜逐渐变薄,角膜屈光度的增加与角膜后表面前突和角膜顶点变薄有相关性。 5.KC眼角膜最薄点呈周边化趋势,并不位于角膜中心,当角膜最薄点位于中央1mm圆环区域外的颞下方时,应该引起重视,进一步结合其它角膜地形图参数筛查KC。
[Abstract]:objective
1. to analyze the characteristics and clinical data of keratoconus, and to explore the relevant evidence for early diagnosis and treatment of keratoconus.
2. the OCULUS Pentacam anterior segment imaging analysis system was used to detect the cornea of the eyes of keratoconus. The quantitative parameters were evaluated and the correlation between parameters was analyzed, which provided a theoretical basis for the early diagnosis of keratoconus.
Method
1. to analyze the characteristics of 68 cases of keratoconus (the proportion of men and women, the age of the disease), and to analyze the clinical characteristics of the patients with keratoconus (the history of disease and family history, the history of wearing glasses, the state of refraction, the examination of the slit lamp, the history of the whole body, etc.). The VF-14 questionnaire survey was carried out and the results were statistically analyzed.
The 2. OCULUS Pentacam anterior segment imaging analysis system was used to detect the cornea of the eyes of the patients, 63 cases (5 cases, 10 eyes were not removed) and 109 eyes were collected, and the quantitative parameters were evaluated and the correlation between the parameters was analyzed, and 64 cases (64 eyes, all left eyes) as the normal control group were compared and analyzed. SPSS17.0 pairs were used. The data were analyzed statistically.
Result
1. statistics found that the incidence of keratoconus in the study population was higher than that of women (67.6%/32.4%, P0.05). The average age of keratoconus was 26 + 8.91 years old (age range 12.38-51.12 years), 10% (7/68) patients were less than 18 years old and 57.6% (39/68) patients were less than 30 years old.
The main main complaints in 2. of the first ophthalmology were visual acuity, 83.8% (57/68), progressive myopia, 22.1% (15/68), headache and eye pain, 5.9% (4/68), 4 asymptomatic (5.9%).1 (1.5%) with the family history of keratoconus. The most common clinical sign (59.1%) was confirmed by the near central local bulge of the cornea in the conical angle membrane. The proportion of Fleischer's rings was 53%. The average degree of cylindrical lens in the Vogt's stripe 26%. conus cornea was significantly higher than that of the suspected conical keratoconus (-4.00D/-2.00D, p0.001). The best corrected visual acuity of logMAR was better than that of the keratoconus (0.04/0.18, p0.001).
The final score of the 3.VF-14 questionnaire was between 8.3-100, of which 68% were 91-100, 13% were 81-90, and 19% was 80 or less. About half (46.7%) had difficulty reading small words when evaluating specific activities, and more patients had moderate difficulty (25.7%); about 1/3 were reading and reading newspapers, doing fine work or doing fine work. There were some difficulties in watching TV. There were 22.9%, 19.3% and 21.1% of those with moderate difficulty, and a certain number of patients (31.2%) had difficulties in identifying various signs, and 24.8% of the staircases or road stones were not clear, and the people who were difficult to recognize the difficulty accounted for 17.4%..
4. there was no significant difference between the maximum diopter of the surface and the maximum front surface of the normal group and the normal group (P0.05). There was a significant difference between the KC group and the suspicious KC group, the KC group and the normal group (P0.05).
The maximum refraction and maximum height of posterior corneal surface of 5.KC group and suspicious KC group were higher than that of normal control group. There were significant difference between group KC, suspected KC group and normal control group with the maximum height of 22 (P0.05).
6. the thinnest thickness of the cornea was reduced from the control group to the KC group, and there was a significant difference in the 22 groups (P0.05) group.KC. The maximum diopter and maximum height of the suspected KC group and the normal control group were not located in the center of the cornea.
7. in the KC group, the maximum corneal refractive index and the maximum height of the anterior surface, the maximum posterior surface height, the maximum refraction of the posterior surface and the thinnest point of the cornea have significant correlation (P0.0001). In the suspected KC group, the maximum refraction of the anterior surface of the cornea is related to the maximum refraction of the posterior surface, and the thinnest point of the cornea is correlated (p0.050).
In group 8.KC, the average distance from the thinnest point of the cornea to the center of the cornea in the suspicious KC group and the normal group was (0.76 + 0.42) mm, the (0.66 + 0.38) m and (0.61 + 0.29) mm.KC group (56%) and the suspected KC group (52%) were most of the thinnest point of the cornea below the central LMM circle. Most of the thinnest spots in the normal group (46.7%) were located in the central LMM circle area. Inside.
conclusion
1. keratoconus occurs mostly in young people around 20 years of age; patients who complain about the myopia degree and the frame mirror can not be corrected should be highly suspected. The popularization of RGP can obviously improve the corrected visual acuity of keratoconus and delay the time of corneal transplantation.
2. the impairment of visual function caused by keratoconus can lead to a certain degree of limitation of vision related daily activities.
3. in the diagnosis of keratoconus, the thickness of the cornea, the refractive index of the front and the back surface and the height of the cornea should be analyzed synthetically. If the maximum refraction and maximum height of the posterior corneal surface are increased, and the thinnest thickness of the cornea is shown to decrease, the keratoconus should be highly suspected.
4. with the development of the disease, the degree of corneal localized protrusion increased, and the cornea became thinner. The increase of corneal diopter was associated with the protrusion of the posterior corneal surface and the thinning of the corneal vertex.
The thinnest point in the cornea of 5.KC is not located in the center of the cornea. When the thinnest point of the cornea is located below the central 1mm circle, it should be paid more attention to screening KC. with the parameters of other corneal topographic maps.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R772.2

【参考文献】