角膜屈光手术前后角膜生物力学特性变化的临床研究

发布时间：2018-03-03 00:28

本文选题：近视　切入点：角膜　出处：《天津医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：分析和探讨几种准分子激光角膜屈光手术(Epi-LASIK、LASIK、SBK)前后角膜生物力学特性变化的情况,并分析其相关因素。方法：前瞻性研究。首先随机选择在天津市眼科医院屈光手术中心接受手术的89例(160眼)中度近视患者,其中行Epi-LASIK术36例(65眼),LASIK术34例(63眼),SBK术19例(32眼)；其次选取接受SBK手术的高度近视患者32例(57眼),另选取低中度近视18人(33眼)做为对照组。分别于术前后应用眼反应分析仪(ORA)测量模拟Goldmann眼压(IOPg)、角膜补偿眼压(IOPcc)、角膜阻力因子(CRF)、角膜滞后量(CH)及内向压平时间(TimeIn)和外向压平时间(TimeOut)。应用配对t检验分析各组手术前后角膜生物力学参数和独立样本t检验比较各组及两组之间术后不同时间的变化值,应用Pearson线性相关分析其相关因素。结果：1. Epi-LASIK组术前与术后1个月之间的IOPcc无统计学意义(t=0.50,P=0.620),余参数于手术前后均有统计学意义(P0.01)；1周与1个月间IOPg、 TimeIn、TimeOut和CH-CRF有统计学意义(t=-2.50,P=0.014；t=-2.49,P=0.015；t=-2.87,P=0.005：t=2.386,P=0.019)。 2. LASIK组手术前后各参数有统计学意义(P0.01),术后1周与1个月间TimeOut和TimeOut-TimeIn有统计学意义(t=-2.82,P=0.006；t=-2.02,P=0.046),余参数均无统计学意义(P0.05)。 3.SBK组手术前后各参数有统计学意义(P0.01),术后1周与1个月间各参数无统计学意义(P0.05)；高度组术后CRF、CH、TimeOut值显著低于对照组(t=-2.66,P=0.010；t=-5.07,P=0.000；t=-2.91,P=0.005),高度组ΔCRF、 ΔCH、TimeOut明显高于对照组(t=2.00,P=0.048；t=3.14,P=0.002；t=2.78,P=0.007)。 4.术后1周时,Epi-LASIK与SBK组间角膜生物力学参数及其变化量无统计学意义(P0.05)；1个月时IOPcc、TimeIn、CH-CRF、TimeOut-TimeIn、AIOPg、 AIOPcc、ACRF、ATimeIn、A(CH-CRF)与A(TimeOut-TimeIn)有统计学意义(t=2.34,P=0.022；t=2.32,P=0.024；t=-2.44,P=0.018；t=-2.30,P=0.025；t=-4.43,P=0.000；t=-4.35,P=0.000；t=-2.06,P=0.044；t=-4.06,P=0.000；t=4.64,P=0.000；t＝4.48,P=0.000)。术后1周时,LASIK与SBK组间IOPcc有统计学意义(t=-2.04,P=0.045)；1个月时IOPg、IOPcc、CH、TimeOut、CH-CRF和TimeOut-TimeIn有统计学意义(t=-2.40,P=0.019-t=-2.89,P=0.005；t=2.27,P=0.027；t=2.90,P=0.005；t=2.65,P=0.010；t=2.71,P=0.009)。 5.中度近视Epi-LASIK组术后各参数变化量与切削量(ablation depth, AD)无明显相关性(P0.05)；术后1周时,LASIK组ACRF、ACH、ATimeOut值与AD呈正相关(r=0.419,P=0.005；r=0.386,P=0.010；r=0.447,P=0.002),SBK组ATimeOut值与AD呈正相关(r=0.385,P=0.039),1个月时无明显相关(P0.05)。高度组术后AIOPg、ACRF、ATimeIn与AD呈正相关(r=0.335,P=0.011; r=0.427, P=0.001; r=0.338, P=0.010), A(CH-CRF)、A(TimeOut-TimeIn)与AD呈负相关(r=-0.286,P=0.031r=-0.306,P=0.020)；对照组ATimeOut与AD呈正相关(r=0.548,P=0.003)。结论：1. Epi-LASIK、LASIK、SBK三组手术前后角膜生物力学变化显示,角膜屈光手术方式对眼压、角膜整体抵抗能力、角膜变形能力及变形后复原能力的影响明显不同：角膜常规板层手术大于薄瓣板手术,薄瓣板层手术大于表层手术。 2. Epi-LASIK术后角膜生物力学参数随时间变化呈恢复趋势,角膜板层手术(LASIK与SBK)术后角膜生物力学参数随时间变化不明显,可能与不同的角膜愈合反应有关。 3.术后不同时期Epi-LASIK、LASIK、SBK三组手术切削量与角膜生物力学参数变化量不同的相关关系说明：术后1周时角膜生物力学变化受手术方式、切削量影响明显：角膜板层手术较角膜表层手术明显,薄瓣板层手术较常规板层手术明显,随着时间变化该相关性不明显。 4.高度近视组对眼压值、角膜整体抵抗能力、角膜滞后量、角膜变形能力及变形后复原能力等生物力学的影响明显大于对照组,且与切削量有一定的相关性,说明屈光手术中角膜切削量越大,基质切削越深,对角膜生物力学特性的影响越明显。
[Abstract]:Objective: to analyze and discuss the changes of corneal biomechanical properties before and after several Epi-LASIK LASIK (SBK) and analyze the related factors.
Methods: a prospective study. First randomly selected surgery in Tianjin Ophthalmological Hospital refractive surgery center of 89 cases (160 eyes) of myopia, including 36 cases of Epi-LASIK patients (65 eyes), 34 cases of LASIK patients (63 eyes), 19 cases of SBK patients (32 eyes); secondly, selecting 32 high myopia patients received SBK the surgery patients (57 eyes), there were 18 people in low and moderate myopia (33 eyes) as control group. The application of ocular response analyzer (ORA) before and after operation were measured to simulated Goldmann (IOPg), intraocular pressure, corneal compensated intraocular pressure (IOPcc) and corneal resistance factor (CRF), CH (membrane lag angle) and time (TimeIn) and inward applanation applanation time (TimeOut). Outside groups were analyzed using the paired t test before and after the operation of corneal biomechanical parameters and independent samples t test were compared between the two groups and postoperative changes in different time values, using Pearson linear correlation analysis of the related factors.
Results: 1 months after the operation there was no statistical significance of IOPcc 1. Epi-LASIK before surgery (t=0.50, P=0.620), more than the parameters before and after operation were statistically significant (P0.01); 1 weeks and 1 months between IOPg, TimeIn, TimeOut and CH-CRF were statistically significant (t=-2.50, P=0.014; t= -2.49 P=0.015; t=-2.87, P=0.005:t=2.386, P=0.019).
2. LASIK group before and after surgery, the parameters were statistically significant (P0.01), TimeOut and TimeOut-TimeIn were statistically significant (t=-2.82, P=0.006, t=-2.02, P=0.046) between 1 weeks and 1 months after operation, and the remaining parameters were not statistically significant (P0.05).
The 3.SBK group before and after operation parameters were statistically significant (P0.01), after 1 weeks and 1 months between the parameters had no statistical significance (P0.05); high group after CRF, CH, TimeOut was significantly lower than that of the control group (t=-2.66, P=0.010; t=-5.07, P=0.000; t=-2.91, P=0.005), group CRF was highly. CH, TimeOut was significantly higher than the control group (t=2.00, P=0.048; t=3.14, P=0.002; t=2.78, P=0.007).
1 weeks after the 4. surgery, the corneal biomechanical parameters and changes in the amount of Epi-LASIK and SBK between the groups was not statistically significant (P0.05); 1 months IOPcc, TimeIn, CH-CRF, TimeOut-TimeIn, AIOPg, AIOPcc, ACRF, ATimeIn, A (CH-CRF) and A (TimeOut-TimeIn) had statistical significance (t=2.34, t=2.32, P=0.022; P=0.024; t=-2.44, P=0.018; t=-2.30, P=0.025; t=-4.43, P=0.000; t=-4.35, P=0.000; t=-2.06, P=0.044; t=-4.06, P=0.000; t=4.64, P=0.000; t = 4.48, P=0.000). 1 weeks after the operation, LASIK and SBK group IOPcc was statistically significant (t=-2.04, P=0.045); 1 months IOPg IOPcc, CH, TimeOut, CH-CRF and TimeOut-TimeIn, there was statistical significance (t=-2.40, P=0.019-t=-2.89, P=0.005; t=2.27, P=0.027; t=2.90, P=0.005; t=2.65, P=0.010; t=2.71, P=0.009).
The amount of the changes of the parameters of 5. moderate myopia after operation in Epi-LASIK group and cutting (ablation depth, AD) had no significant correlation (P0.05); 1 weeks after operation, LASIK group ACRF, ACH, ATimeOut value was positively correlated with AD (r=0.419, P=0.005; r=0.386, P=0.010; r=0.447, P=0.002), SBK group ATimeOut value positively with AD (r=0.385, P=0.039), 1 months had no significant correlation (P0.05). The height of group after AIOPg, ACRF, ATimeIn was positively correlated with AD (r=0.335, P=0.011; r=0.427, P=0.001; r=0.338, P=0.010), A (CH-CRF), A (TimeOut-TimeIn) was negatively correlated with AD (r=-0.286 P=0.031r=-0.306, P=0.020, ATimeOut); the control group was positively correlated with AD (r=0.548, P=0.003).
Conclusion: 1. Epi-LASIK, LASIK, SBK showed corneal biomechanical changes before and after the operation of the three groups, the corneal refractive surgery on intraocular pressure, corneal overall resistance, impact resilience deformation and the deformation of the cornea was different: corneal lamellar surgery than conventional thin flap in surgery, surgery is more than the surface layer in the thin flap surgery.
After 2. Epi-LASIK, corneal biomechanical parameters showed a trend of recovery with time. Corneal biomechanical parameters after corneal lamellar surgery (LASIK and SBK) did not change significantly with time, which may be related to different corneal healing reactions.
Epi-LASIK, 3. LASIK after operation in different periods, show the correlation between the changes of SBK three group of surgery cutting quantity and corneal biomechanical parameters of different amount: 1 weeks after operation of corneal biomechanical changes by surgery, cutting the amount of influence: lamellar corneal surface ablation surgery is more obvious, thin flap lamellar lamellar operation than conventional surgery obviously, with the change of time the correlation is not obvious.
4. high myopia group on intraocular pressure, corneal resistance ability, corneal hysteresis, corneal deformation capacity and deformation influence resilience biomechanics significantly higher than the control group, and there is a certain correlation with the amount of cutting, that cornea cutting larger matrix cutting deeper influence on the biomechanical properties of the cornea the more obvious.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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