近视眼角膜体积值及其角膜屈光手术后变化与角膜生物力学特性相关性研究
发布时间：2018-08-14 13:25
【摘要】：目的:利用Pentacam眼前节分析仪测量正常人群角膜体积的正常值范围及其空间区域分布特点;探讨飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)光学区大小对术后角膜体积变化量及角膜生物力学特性的影响;并对SMILE与飞秒激光辅助的准分子激光原位角膜磨镶术(femtosecond laser in situ keratomileusis,FS-LASIK)术后早期不同区域角膜体积随时间变化的情况进行对比研究,探讨术后角膜体积变化与角膜生物力学特性变化的关系。方法:1.横断面研究,共纳入2911例(5301眼),行Pentacam三维眼前节分析仪检查测量角膜体积值(corneal volume,CV),角膜厚度值(corneal thickness,CT)以及角膜前、后表面曲率和曲率半径(K1,K2,Km,Rf,Rs,Rm)。采用Pearson线性相关分析评估角膜体积值与年龄以及角膜形态学参数间的相关关系。2.回顾性病历对照研究。纳入行SMILE手术的近视患者119例119眼,根据光学区大小分为两组,其中A组光学区直径为6.2mm,46例(46眼);B组光学区直径为6.5mm,73例(73眼)。所有研究对象于术前及术后1个月、3个月进行眼反应分析仪(ORA)检查,记录角膜滞后量(corneal hysteresis,CH)及角膜阻力因子(corneal resistance factor,CRF),同时行Pentacam检查记录CV。3.回顾性病历对照研究。纳入SMILE组患者50例(50眼),FS-LASIK组患者47例(47眼),于术前、术后1天、1周、1个月、3个月测量两组患者CV,并依据测量直径将中央5mm直径角膜体积(CV5)定义为中央区,将5mm到10mm直径角膜体积(CV5-10)定义为周边区;应用ORA测量CH、CRF值,计算手术前后角膜体积减少量(△CV)、CH值和CRF值减少量(△CH和△CRF)。结果:1.随着分析区域的增大,角膜体积以及角膜厚度值随之增大;随着年龄增加角膜体积及厚度随之下降,周边区域减少量大于中央区域;角膜体积值与后表面曲率半径和曲率值存在较强的负相关关系,且越靠近周边区域角膜厚度对角膜后表面曲率的影响越大。2.在术后1个月、3个月时光学区6.5mm组角膜3/5/7mm区域角膜体积值(CV3/5/7)均少于光学区6.2mm组,差异具有统计学意义(均P0.05);术后3个月时光学区6.5mm组不同观察区域角膜体积减少量(ΔCV3/5/7/10)均多于光学区6.2mm组,差异均具有统计学意义(均P0.05);术后3个月时两组之间ΔCH和ΔCRF差异无统计学差异(均P0.05);术前CV3、CV5、CV7和CV10与CH值和CRF值均呈中等程度正相关关系(均P0.05)。3.术后1天时,SMILE组和FS-LASIK组两组患者中央及周边区域CV值均减小,与术前相比差异有统计学意义(P0.05);术后1天至术后3个月SMILE组和FS-LASIK组中央区角膜体积增加量分别为0.11±0.16mm3,0.20±0.13mm3,差异有统计学意义(P=0.004);两组患者术后中央区△CV5与△SE存在较强的负相关关系(SMILE组:r=-0.746,P0.001;FS-LASIK组:r=-0.798,P0.001);SMILE组△CV5与△CRF,△CH存在较强的正相关关系(分别为:r=0.498,P0.001;r=0.374,P0.001);FS-LASIK组仅△CV5与△CRF有正相关关系(r=0.363,P=0.012)。结论:1.正常人群角膜体积值及角膜厚度值从中央区到周边区逐渐增加;随着年龄的增加两者均有所下降,而厚度下降主要表现在角膜周边区域;角膜组织量与角膜后表面的形态特征存在较强相关关系,且越往周边区域,影响越大。2.角膜体积值与角膜生物力学参数间存在正相关关系;SMILE手术会引起角膜生物力学特性改变,光学区大小对角膜生物力学的影响较小;随着光学区增大角膜组织减少量随之增加,因此在一定范围内,可以适当扩大光学区,从而减少角膜术后波前像差的引入。3.SMILE组及FS-LASIK组术后早期角膜体积均发生波动性变化;术后角膜体积减少量与角膜生物力学特性减少量、有效矫正的屈光度均存在较强的正相关关系。
[Abstract]:Objective: To measure the normal range of corneal volume and its spatial distribution in normal people by Pentacam anterior segment analyzer, and to investigate the effect of the size of optical zone on corneal volume and corneal biomechanical characteristics after small incision lenticular extraction (SMILE). The changes of corneal volume in different areas after FS-LASIK and SMILE were compared with those of femtosecond laser in situ keratomileusis (FS-LASIK), and the relationship between corneal volume and corneal biomechanical characteristics was discussed. Methods: 1. Cross-sectional study. A total of 2911 patients (5301 eyes) were enrolled in the study. Corneal volume (CV), corneal thickness (CT), corneal surface curvature and radius of curvature (K1, K2, Km, Rf, Rs, Rm) were measured by Pentacam three-dimensional anterior segment analyzer. Pearson linear correlation analysis was used to evaluate corneal volume, age and corneal morphological parameters. A retrospective case-control study was conducted. 119 eyes of 119 myopic patients who underwent SMILE were divided into two groups according to the size of the optical area. The optical area diameter of group A was 6.2 mm, 46 cases (46 eyes), group B was 6.5 mm, 73 cases (73 eyes). Corneal hysteresis (CH) and corneal resistance factor (CRF) were recorded, and CV.3 was recorded by Pentacam. A retrospective case-control study was conducted. 50 patients (50 eyes) in SMILE group and 47 patients (47 eyes) in FS-LASIK group were enrolled. CV was measured before surgery, 1 day, 1 week, 1 month and 3 months after surgery. Corneal volume of 5 mm in diameter (CV5) was defined as central area by measuring diameter, and corneal volume of 5 mm to 10 mm in diameter (CV5-10) was defined as peripheral area. Corneal volume reduction (delta CV), CH value and CRF value reduction (delta CH and delta CRF) before and after operation were calculated by measuring CH and CRF value with ORA. Results: 1. Corneal volume and angle increased with the analysis area. The thickness of the cornea increased with age, the volume and thickness of the cornea decreased with age, and the decrease of the peripheral area was greater than that of the central area. The 3/5/7 mm corneal volume (CV3/5/7) of the 6.5 mm group was less than that of the 6.2 mm group (all P 0.05), and the decrease of the corneal volume (CV3/5/7/10) of the 6.5 mm group was more than that of the 6.2 mm group (all P 0.05). CV3, CV5, CV7 and CV10 were positively correlated with CH and CRF values (all P 0.05). 3. On the first day after operation, CV values in the central and peripheral regions of SMILE group and FS-LASIK group decreased, and there was a significant difference between the two groups (P 0.05). Corneal volume increment in central area of SMILE group and FS-LASIK group was 0.11 (-0.16mm3) and 0.20 (-0.13mm3) at 3 months, respectively, with significant difference (P = 0.004); there was a strong negative correlation between Delta CV5 and delta SE in central area of SMILE group (r =-0.746, P 0.001; FS-LASIK group: R =-0.798, P 0.001); Delta CV5 and delta CRF, Delta CH in SMILE group were strong. There was a positive correlation (r = 0.498, P 0.001; r = 0.374, P 0.001), and only a positive correlation (r = 0.363, P = 0.012) between Delta CV5 and delta CRF in FS-LASIK group. Corneal volume and corneal biomechanical parameters were positively correlated. SMILE surgery could cause corneal biomechanical characteristics change, and the size of optical area had little effect on corneal biomechanics. The volume of cornea in SMILE group and FS-LASIK group fluctuated at the early stage after operation, and the volume of cornea decreased with the decrease of corneal biomechanical properties. There was a strong positive correlation between diopter.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2182996
[Abstract]:Objective: To measure the normal range of corneal volume and its spatial distribution in normal people by Pentacam anterior segment analyzer, and to investigate the effect of the size of optical zone on corneal volume and corneal biomechanical characteristics after small incision lenticular extraction (SMILE). The changes of corneal volume in different areas after FS-LASIK and SMILE were compared with those of femtosecond laser in situ keratomileusis (FS-LASIK), and the relationship between corneal volume and corneal biomechanical characteristics was discussed. Methods: 1. Cross-sectional study. A total of 2911 patients (5301 eyes) were enrolled in the study. Corneal volume (CV), corneal thickness (CT), corneal surface curvature and radius of curvature (K1, K2, Km, Rf, Rs, Rm) were measured by Pentacam three-dimensional anterior segment analyzer. Pearson linear correlation analysis was used to evaluate corneal volume, age and corneal morphological parameters. A retrospective case-control study was conducted. 119 eyes of 119 myopic patients who underwent SMILE were divided into two groups according to the size of the optical area. The optical area diameter of group A was 6.2 mm, 46 cases (46 eyes), group B was 6.5 mm, 73 cases (73 eyes). Corneal hysteresis (CH) and corneal resistance factor (CRF) were recorded, and CV.3 was recorded by Pentacam. A retrospective case-control study was conducted. 50 patients (50 eyes) in SMILE group and 47 patients (47 eyes) in FS-LASIK group were enrolled. CV was measured before surgery, 1 day, 1 week, 1 month and 3 months after surgery. Corneal volume of 5 mm in diameter (CV5) was defined as central area by measuring diameter, and corneal volume of 5 mm to 10 mm in diameter (CV5-10) was defined as peripheral area. Corneal volume reduction (delta CV), CH value and CRF value reduction (delta CH and delta CRF) before and after operation were calculated by measuring CH and CRF value with ORA. Results: 1. Corneal volume and angle increased with the analysis area. The thickness of the cornea increased with age, the volume and thickness of the cornea decreased with age, and the decrease of the peripheral area was greater than that of the central area. The 3/5/7 mm corneal volume (CV3/5/7) of the 6.5 mm group was less than that of the 6.2 mm group (all P 0.05), and the decrease of the corneal volume (CV3/5/7/10) of the 6.5 mm group was more than that of the 6.2 mm group (all P 0.05). CV3, CV5, CV7 and CV10 were positively correlated with CH and CRF values (all P 0.05). 3. On the first day after operation, CV values in the central and peripheral regions of SMILE group and FS-LASIK group decreased, and there was a significant difference between the two groups (P 0.05). Corneal volume increment in central area of SMILE group and FS-LASIK group was 0.11 (-0.16mm3) and 0.20 (-0.13mm3) at 3 months, respectively, with significant difference (P = 0.004); there was a strong negative correlation between Delta CV5 and delta SE in central area of SMILE group (r =-0.746, P 0.001; FS-LASIK group: R =-0.798, P 0.001); Delta CV5 and delta CRF, Delta CH in SMILE group were strong. There was a positive correlation (r = 0.498, P 0.001; r = 0.374, P 0.001), and only a positive correlation (r = 0.363, P = 0.012) between Delta CV5 and delta CRF in FS-LASIK group. Corneal volume and corneal biomechanical parameters were positively correlated. SMILE surgery could cause corneal biomechanical characteristics change, and the size of optical area had little effect on corneal biomechanics. The volume of cornea in SMILE group and FS-LASIK group fluctuated at the early stage after operation, and the volume of cornea decreased with the decrease of corneal biomechanical properties. There was a strong positive correlation between diopter.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
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