个性化显微斜视矫正术在儿童斜视的临床研究

发布时间：2018-06-30 19:31

本文选题：角膜地形图 + 散光　；参考：《南昌大学》2012年硕士论文

【摘要】：目的：探讨角膜地形图引导下的显微斜视矫正术对儿童斜视患者眼表症状及泪膜稳定性的影响和术后角膜地形图的特点。方法：40例(60只眼)儿童斜视患者行斜视矫正术,随机分为A、B组。A组采用显微镜下常规角膜缘结膜切口斜视矫正术20例(30眼)，B组在显微镜下并根据角膜地形图引导下作特定部位结膜切口行斜视矫正术20例(30眼)，，分别于术前、术后1周及术后2周时测裸眼视力,眼表症状、眼表指数（Ocular Surface DiseaseIndex，OSDI）、泪膜四项及角膜地形图检查，角膜地形图分别记录：中心平均屈光度（Km）及散光值和离角膜中央3mm、3.5mm、4mm和4.5mm半径光学区,放射方向于0°、90°、180°和270°即角膜上：Sup、下:Inf、鼻:Nas、颞:Temp4个子午线)的角膜偏心率（分别计为Se3、Se3.5、Se4、Se4.5，Ie3、Ie3.5、Ie4、Ie4.5，Ne3、Ne3.5、Ne4、Ne4.5, Te3、Te3.5、Te4、Te4.5）、角膜表面不对称系数：表面变异指数（ISV），高度不对称性指数（IHA），垂直不对称指数（IVA）及高度离心指数（IHD）。结果：术前两组角膜中心平均屈光度、散光值、角膜表明不规则指数、角膜周边偏心率、眼表症状、OSDI、及泪膜四项相比，差异均无统计学意义。术后1周患者角膜前表面平均屈光度及散光值与术前相比： A组明显增加，差异有统计学意义，B组变化不明显，差异无统计学意义；术后2周2组患者角膜前表面平均屈光度及散光值与术前相比：A组恢复至术前水平，差异无统计学意义，B组变化不明显，差异无统计学意义。术后1周两组患者眼表症状眼数、OSDI、BUT、FL、ST及泪河高度相比,差异均有统计学意义；至术后第2周时两组患者的眼表症状眼数、OSDI、BUT、ST及泪河高度相比,差异均有统计学意义。术后1周与术前相比：两组患者眼表症状眼数、OSDI、FL、BUT、ST及泪河高度均变化明显，差异均有统计学意义；术后2周与术前相比：两组患者眼表症状眼数、OSDI、BUT、ST、泪河高度及FL均恢复至术前水平，差异均无统计学意义。ISV、IHA、IVA、IHD等参数：A组术后1w与术前相比有明显差异（P0.05），A组术后2w与术前、B组术后1w、2w与术前相比均无明显差异（P0.05）。Se3、Se3.5、Se4、Se4.5，Ie3、Ie3.5、Ie4、Ie4.5，Ne3、Ne3.5、Ne4、Ne4.5, Te3、Te3.5、Te4、Te4.5等参数:两组术后1w、2w与术前相比均无明显差异（P0.05）结论：对于儿童斜视患者，在角膜地形图引导下行显微斜视矫正术对术后角膜散光影响小，可以较早稳定泪膜、减轻眼表症状，可以提高患者的视觉质量。角膜地形图引导下的显微斜视矫正术对儿童斜视术后角膜地形图的变化几乎无影响，为斜视手术结膜切口的选择提供一种新的方式。
[Abstract]:Objective: to investigate the effect of corneal topography guided micro-strabismus correction on ocular symptoms and lacrimal film stability in children with strabismus and the characteristics of postoperative corneal topography. Methods 40 children (60 eyes) with strabismus were treated with strabismus correction. Group A was randomly divided into group A and group A, 20 patients (30 eyes) were treated with conventional conjunctival incision strabismus correction under microscope, and 20 cases (30 eyes) were treated with conjunctival incision under microscope and guided by corneal topography. Visual acuity, ocular surface symptoms, ocular surface index (OSDI), four items of tear film and corneal topography were measured 1 week after operation and 2 weeks after operation. The corneal topography recorded the mean central diopter (km) and astigmatism, and the optical region of 3 mm to 3.5 mm and 4 mm from the center of cornea and 4.5mm radius, respectively. Corneal eccentricity in the radiation direction of 90 掳90 掳180 掳and 270 掳above: supp, lower: Inf, nasal: Nas, temporal: Temp4 meridians) (Se3Se3.5Se 4.5, Ie4.5Ne3.5Ne3.5Ne3.5Ne4, Te3Te3.5Te4Te4.5), corneal surface asymmetry coefficient: surface variability index (ISV), high asymmetry index (IHA), vertical asymmetric finger. Number (IVA) and height centrifugal index (IHD). Results: there was no significant difference in corneal central diopter, astigmatism, corneal irregularity index, corneal peripheral eccentricity, OSDI and tear film between the two groups. 1 week after operation, the mean corneal surface diopter and astigmatism were significantly increased in group A (P < 0.01), but the difference was not significant in group B (P < 0.05). At 2 weeks after operation, the mean corneal surface diopter and astigmatism of the two groups returned to the preoperative level compared with those of the preoperative group. There was no significant difference between group B and group B. there was no significant difference between the two groups. There were significant differences in the number of eye surface symptoms and the height of the lacrimal river between the two groups at 1 week after operation, and by the second week after operation, there were significant differences between the two groups in the number of OSDI BUTST and the height of the lacrimal river. At 1 week after operation, the number of ocular surface symptoms and OSDI FLBUTST and the height of the lacrimal river were significantly changed in the two groups, and the difference was statistically significant. Two weeks after operation, the number of ocular surface symptoms, the height of the lacrimal river and the level of FL returned to the preoperative level in the two groups. There was no significant difference between the two groups (P0.05). There was no significant difference between two groups (P0.05). There was no significant difference between the two groups (P0.05). Se3Se3.5Se4.5Ie3.5Ie4.5Ie4.5Ie4.5Ie4.5ne4.5Ne3.5Ne3Ne3.5Ne4Ne4.5. Te3Te3.5Te4Te4.5, and Te3Te3.5Te4Te4.5 were all compared with those before operation at 1w after operation in group A (P0.05), and there was no significant difference between group A (group A) and group B before operation (P 0.05). The parameters of group A, group A and group B were significantly different from those of group B at 1 week after operation (P0.05). There was no significant difference (P0.05) conclusion: for children with strabismus, Microstrabismus correction guided by corneal topographic map had little effect on postoperative corneal astigmatism, could stabilize tear film earlier, alleviate ocular surface symptoms, and improve the visual quality of the patients. Under the guidance of corneal topographic map, microstrabismus correction has little effect on the change of corneal topography after strabismus in children, which provides a new way for the choice of conjunctival incision in strabismus surgery.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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