中原地区年龄相关性白内障人群术前角膜散光的分布及非球面性分析

发布时间：2017-12-31 07:30

  本文关键词：中原地区年龄相关性白内障人群术前角膜散光的分布及非球面性分析　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 年龄相关性白内障 角膜散光 角膜Q值 非球面性

【摘要】：背景与目的 年龄相关性白内障（age-related cataract）是全球常见的致盲性眼病。随着现代生活水平的提高及医疗技术的进步，我国人口的平均寿命也在不断的延长。因而，年龄相关性白内障的患病率也逐年增加。目前，对于白内障的治疗仍以手术为主，药物仅用于白内障的初发期延缓病程的发展，但其疗效尚未得到眼科医师的一致认可。随着现代人们生活水平的提高、白内障手术技术和仪器设备的不断改进和完善，白内障患者对术后视觉质量的要求也日益增高。因此，白内障手术已归属为屈光手术。如何提高白内障患者术后人工晶体眼的视觉质量是当代眼科医师所追求的一个新目标。白内障术后影响视觉质量的主要因素是像差。像差分为低阶像差和高阶像差。低阶像差主要是屈光不正，，即远视、近视和散光；而高阶像差主要是角膜的球差。目前，对于白内障患者实施人工晶状体的植入，可以通过准确的生物测量，较好的解决术前存在的近视和远视,而影响白内障患者术后人工晶体眼成像质量的主要因素是角膜的屈光状态和角膜的非球面性。因此，只有充分了解白内障患者术前存在的角膜屈光状态和角膜的非球面性特征即角膜Q值，才能在实施白内障手术时，针对不同的患者，合理的、个体化的设计白内障术式和选择适宜的非球面人工晶状体，有计划的解决角膜术前存在的散光和球差问题，为患者术后能够拥有较好的视觉质量奠定基础。 目前，针对年龄相关性白内障患者术前角膜屈光状态及非球面性分析的研究报道主要是中国南部地区。中原地区的相关研究尚未见报道。因此，本课题主要是针对中原地区年龄相关性白内障患者术前角膜屈光状态及非球面性的特征进行筛查分析，为白内障患者手术方式的设计和人工晶状体的选择提供实验依据。 研究对象 本课题的筛选对象来自于2012年11月至2014年02月来郑州大学第一附属医院住院的年龄相关性白内障患者。病例入选标准：患者年龄在40～90岁的白内障人群，术前眼轴长度（axial length,AL）在22～26mm之间，具有正常人的行为认知能力，依从性佳，患者睑裂能够充分开大，角膜透明且泪膜完整。病例排除标准：术前有影响角膜屈光状态的疾病，如眼外伤、青光眼及高眼压征、角膜变性混浊、翼状胬肉、圆锥角膜、干眼症[1-7]等以及有角膜屈光手术及内眼手术史的患者。 研究方法 所有患者在实施白内障手术之前，都进行了系统完善的术前检查，包括裸眼视力、主觉验光、裂隙灯进行眼前节的检查、眼底检查、角膜内皮细胞计数、视觉电生理的测定、眼内压的测量及眼部B超的检查；Orbscan-Ⅱ眼前节分析仪以及IOLMaster生物测量仪的检测。对于角膜的屈光状态及非球面性特征的筛选，主要是依据Orbscan-Ⅱ眼前节分析仪所测得的数据，结合验光结果及IOLMaster生物测量所得到的角膜曲率综合分析而确定的数值。记录下角膜曲率、散光轴位、散光度数和角膜Q值。并对以上数据从年龄、性别和地域性(城、乡)这三个方面进行统计分析，并分析角膜屈光状态及非球面性的数值与这三因素之间的相关性。 统计学处理应用SPSS16软件包对数据进行分析，计算均数、标准差。用K-S拟合优度来检验变量是否符合正态分布（α=0.05，PPα,差异具有统计学意义）；使用Pearson相关系数来评估均符合正态分布的双变量之间的相关关系，使用Spearman秩相关系数来评估不全符合非正态分布的双变量之间的相关关系（|r|≈1,相关关系越大，r0,正相关，r0，负相关；|r|≈0，无显著相关关系。PP|r|,差异具有统计学意义）。 结果 按入选标准共筛查出年龄相关性白内障患者404例（558只眼），年龄40～86岁，平均为（65.54±10.91）岁。其中，40～49岁患者42例（54只眼），50～59岁患者74例（102只眼），60～69岁患者112例（146只眼），70～79岁患者152例（222只眼），80～86岁患者24例（34只眼）。术前的角膜曲率为40.25～52.30D，平均（45.12±2.05）D，呈正态性分布（P=0.33）；其值与年龄，性别和地域的差异无显著地相关关系。术前的角膜散光度数为0.1～4.5D，平均（1.04±0.77）D，呈非正态性分布（P=0.00）。其中大于等于1.0D的有244只眼，占43.73％；顺规散光约占38.71％，逆规散光约占43.73％，斜轴散光约占17.56％，且随着年龄的增长，散光分布由顺规性散光向逆规性散光转变；散光度数与年龄呈正相关（r=0.827，P=0.003），与性别和地域性的差异无显著相关关系。术前角膜Q值为为-0.75～+0.6，平均（-0.21±2.23），呈正态性分布；其值与年龄，性别和地域性的差异无显著相关关系。角膜曲率、散光度数和角膜Q值三者之间无显著相关关系。 结论 1.年龄相关性白内障人群术前角膜散光的分布呈非正态性分布；随着年龄的增长，散光分布由顺规性散光向逆规性散光转变；约43.73％的患者需在手术当中同时矫正角膜散光；角膜散光与年龄呈正相关，与性别和地域性的差别无相关关系。 2.年龄相关性白内障人群术前角膜曲率的分布呈正态性分布，角膜曲率值与年龄、性别和地域性等差别无显著的相关关系。 3.年龄相关性白内障人群术前角膜Q值的分布呈正态性分布，角膜Q值大多为负值，其值与年龄，性别和地域性等差别无显著的相关关系。 4.年龄相关性白内障人群术前的角膜散光、角膜曲率和角膜Q值，这三者之间均无显着的相关关系。
[Abstract]:Background and purpose
Age related cataract (age-related cataract) is a global common cause of blindness. With the improvement of modern life and the progress of medical technology, the average life expectancy of China's population is constantly extended. Thus, the prevalence of age-related cataract has increased year by year. At present, for the treatment of cataract surgery is the only drug. In the early stage of cataract and delay the development of the course, but its efficacy has not been recognized by ophthalmologists. With the improvement of people's living standard, the cataract surgery technology and equipment of continuous improvement, but also increasing demand for cataract patients with postoperative visual quality. Therefore, cataract surgery has been attributed to refractive surgery how to improve the patients after phacoemulsification. Pseudophakic visual quality is a new goal of modern ophthalmologists pursuit. Effects of after cataract surgery The main factors of visual quality is divided into low order aberration. Aberrations and higher-order aberrations. Low order aberration is mainly the ametropia, hyperopia, myopia and astigmatism and higher-order aberrations; mainly corneal spherical aberration. At present, for the implementation of intraocular lens implantation in cataract patients, through biological measurement accurate, there is better the preoperative myopia and hyperopia, and the main factors affecting the imaging quality of pseudophakic patients after phacoemulsification is corneal asphericity and corneal refractive status. Therefore, only fully understand the aspherity characteristics of cataract patients with preoperative corneal refraction and corneal corneal Q value, in order to implement cataract surgery, different patients, reasonable design, personalized cataract surgery and suitable aspheric intraocular lens, there are plans to solve the problems of preoperative corneal astigmatism and ball The problem is the basis for the patient to have better visual quality after operation.
At present, the cataract surgery corneal refractive status and analysis of asphericity study reported mainly in the southern region of the Central Plains region. Chinese related research has not been reported. Therefore, this project is mainly aimed at screening analysis of patients with age-related cataract in the Central Plains corneal refractive status and characteristics of the asphericity. To provide the experimental basis for the design of operative method in patients with cataract and intraocular lens.
Research object
Screening of this subject from November 2012 to 2014 for 02 months in the First Affiliated Hospital of Zhengzhou University hospitalized patients with age-related cataract. Inclusion criteria: patients aged 40 ~ 90 years old cataract patients, the preoperative axial length (axial, length, AL) between 22 ~ 26mm, with normal human behavior cognitive ability. Good compliance of patients, palpebral fissure can be fully open, transparent and corneal tear film integrity. Exclusion criteria: effects of corneal refraction surgery, such as ocular trauma, glaucoma and ocular hypertension syndrome, degeneration of corneal opacity, pterygium, keratoconus, and [1-7] patients with dry eye and corneal refractive surgery in eyes operation history.
research method
All of the patients before cataract surgery, were perfect preoperative examination, including visual acuity, refraction, slit lamp anterior segment examination, fundus examination, corneal endothelial cell count, determination of visual electrophysiology, measurement of intraocular pressure and ocular B ultrasound examination; Orbscan- II anterior segment analyzer IOLMaster and biological measurement instrument for screening detection. The refraction and corneal aspherity characteristics, is mainly based on the measured Orbscan- II anterior segment analyzer data, combined with the results of optometry and IOLMaster biological measurement of corneal curvature analysis and determine the numerical record. Corneal curvature, axial astigmatism, astigmatism the degree and the corneal Q value. And the data from the age, gender and regional (City, township) of the three aspects of statistical analysis, and analysis of corneal refractive status and asphericity and the numerical The correlation between the three factors.
Statistical analysis using SPSS16 software package for data analysis, the calculation of mean and standard deviation by K-S. The goodness of fit to test whether the variables with normal distribution (alpha =0.05, alpha PP, the difference was statistically significant); using Pearson correlation coefficient to assess compliance with the relevant relationship between the two variables of normal distribution and use Spearman rank correlation coefficient to evaluate the correlation between the non normal distribution of the two variables (|r| = 1, the correlation is large, R0, R0, positive correlation, negative correlation; |r| = 0, no significant correlation between.PP|r|, the difference was statistically significant).
Result
鎸夊叆閫夋爣鍑嗗叡绛涙煡鍑哄勾榫勭浉鍏虫

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