FD-OCT对不同年龄正常人群角膜及角膜缘上皮厚度的测量研究

发布时间：2018-04-27 16:35

本文选题：角膜上皮 + 角膜缘　；参考：《复旦大学》2014年博士论文

【摘要】：作为角膜的最外层组织,角膜上皮不仅是眼表重要的生物学屏障,它在维持泪膜稳定性、角膜透明性、正常视功能等方面都发挥着重要的作用。角膜上皮的更新和修复有赖于角膜缘上皮基底部干细胞的不断增殖、分化和迁移。随着人们对角膜和眼表疾病认识的加深,角膜和角膜缘上皮厚度的应临床用价值得到了越来越多的关注。精确测量角膜和角膜缘上皮厚度不仅可以为早期诊断圆锥角膜、指导屈光手术的开展、评估手术疗效等提供重要的参考依据,也对干眼症、角膜缘干细胞缺乏、角膜手术后上皮愈合不良等有一定的提示作用。近年来,应用眼前节光学相干断层成像系统(optical coherence tomography, OCT)定量分析角膜和角膜缘上皮成为眼科研究中的热点。既往对正常人角膜上皮厚度的研究多局限于某个年龄段或角膜的某个区域,对于其在整个角膜的分布特点及其年龄变化规律等特征描绘甚少。本研究应用傅里叶域OCT (Fourier-domain OCT, FD-OCT)观察不同年龄段正常人群的角膜和角膜缘的形态结构,在不同方位对其上皮厚度进行测量,分析角膜和角膜缘上皮厚度在不同方位、不同各年龄组之间的差异及其与年龄的相关性,总结其空间分布特点和随年龄变化的规律。一方面为正常人角膜及角膜缘上皮厚度数据库补充中国人群的资料,另一方面有助于临床医生在充分了解角膜和角膜缘上皮特征的基础上开展诊疗工作。第一部分FD-OCT对不同年龄正常人群角膜上皮厚度的测量研究目的：应用FD-OCT观察不同年龄正常人群角膜并测量其上皮厚度值,分析角膜上皮厚度的空间分布特点及其随年龄变化的规律。方法：横断面研究。招募健康受试者180例(80男100女),根据年龄分为4组：A组(≤20岁)45例,B组(21-40岁)45例,C组(41-60岁)54例,D组(60岁)36例。随机选取受试者单眼(正常眼)进行FD-OCT检查。利用RTVue-100OCT仪Pachymetry模式扫描受试者中央6mm角膜,系统内置软件可自动探测角膜上皮的前后边界并计算出前后界之间的上皮厚度,然后绘制出扫描区域内的角膜上皮厚度图。在每张图上,中央6mm角膜被划分为17个区域：中央2mm区,内环(2-5mm)8个区,外环(5-6mm)8个区；各区域均有其角膜上皮厚度平均值的直观呈现。对各年龄组各区域的角膜上皮厚度进行统计分析。结果：(1)总体人群中央6mm角膜上皮厚度平均值为(52.4±2.7)μm,各区域角膜上皮厚度不同：中央2mm区为(53.2±2.9)μm,上半区为(51.9±2.9)μn,下半区为(53.1±3.0)μm,下半区角膜上皮比上半区厚(P0.05)；外环上1/8区(50.2±3.3)μm为最薄,内环下1/8区(53.4±3.1)μm为最厚,最薄点与最厚点的厚度差值为(-7.2±3.6)μm。(2)中央6mm角膜上皮平均厚度,男性为(53.2±2.9)μm,女性为(51.7±2.4)μm；在各区域,男性角膜上皮均比女性厚。(3) A, B, C, D各组中央6mm角膜上皮厚度平均值分别为(53.21±2.39) μm、 (52.91±2.72) μm、(51.88±2.42) μm、(51.33±3.15) μm,差异有统计学意义(P=0.004)。各区域角膜上皮厚度的统计学分析显示：在中央2mm区域,A、B、C、D组角膜上皮厚度分别为(53.4±2.8)μm、(53.4±2.7) μm、(53.2±3.0) μm、(52.9±3.3)μm,各年龄组间无显著性差异(P=0.848)；在旁中央2-6mmm区域,除内环颞下方1/8区外,其余区域角膜上皮厚度与年龄均呈负相关(P0.05)。随年龄增大,中央6mm角膜上皮厚度以0.34μm/10y的平均速率递减；外环区的递减速率较内环区大,分别为0.51μm/10y和0.30μm/10y。此外,上皮厚度最小最大值之差(Min-Max)和上皮厚度变异度(Std-Dev)均与年龄呈负相关(ρ=-0.326, P0.001; ρ=+0.348, P0.001)。结论：中央6mm角膜上皮并非均一厚度层,其厚度的空间分布差异表现为：下厚上薄,中央略高于鼻颞侧。年龄越大,角膜上皮厚度在各区域的分布越不均匀。年龄对中央2mm角膜上皮厚度无明显影响。旁中央角膜上皮随年龄增长而变薄；越靠近中央,变薄速率越小。第二部分FD-OCT对不同年龄正常人群角膜缘上皮厚度的测量研究目的：应用FD-OCT观察不同年龄正常人群角膜缘并测量其上皮厚度值,分析角膜缘上皮厚度的空间分布特点及其随年龄变化的规律。方法：横断面研究。招募健康受试者180例(80男100女),根据年龄分为4组：A组(≤20岁)45例,B组(21-40岁)45例,C组(41-60岁)54例,D组(60岁)36例。随机选取受试者单眼(正常眼)进行FD-OCT检查。利用RTVue-100OCT仪Cross-Line模式扫描受试者鼻侧、颞侧、上方、下方的角膜缘,并记录各方位角膜缘的横截面图。在OCT图上,采用手动法对角膜缘各层结构进行划分并测量角膜缘上皮厚度。然后对各方位、各年龄组的角膜缘上皮厚度进行统计分析。结果：(1) FD-OCT测量正常人鼻侧、颞侧、上方、下方的角膜缘上皮厚度值分别为(53.4±6.8) μm、(54.2±7.4) μm、(67.4±10.6)μm、(67.7±10.7)μm。统计学分析表明,四个方位角膜缘上皮厚度存在显著性差异(P=0.000)。Tamhane法进行各方位的两两比较分析表明,鼻、颞侧角膜缘上皮明显薄于上、下方(P=0.000),鼻侧和颞侧相近(P=0.947),下方略比上方厚、但二者无统计学差异(P=1.000)。各年龄组角膜缘上皮厚度的空间分布特点与总体人群相同。(2)对各年龄组同一方位的角膜缘上皮厚度进行比较：在鼻、颞侧,A组的测量值比其余三组大(P0.05)；在上、下方,B组的测量值最大,但各组间无显著性差异。各方位角膜缘上皮厚度与年龄的相关性分析结果为：鼻侧(p=-0.332,P=0.000)、颞侧(p=-0.372,P=0.000)、上方(p=-0.048,P=0.594)、下方(p=-0.032,P=0.725)。随着年龄增大,鼻侧、颞侧、上方、下方角膜缘上皮厚度的递减速率分别为1.12pm/10y、1.31μm/10y、0.37μm/10y、0.21μm/10y。结论：正常人角膜缘上皮厚度存在空间分布差异,鼻、颞侧角膜缘上皮较薄,上、下方较厚。出生后随着年龄的增长,鼻、颞侧角膜缘上皮逐渐变薄；而上、下方角膜缘上皮呈现先厚再薄的变化规律,其厚度值在成年后达到最大。睑裂处水平方位的角膜缘上皮厚度更易受年龄影响,其变化速率大于垂直方位的角膜缘上皮。
[Abstract]:The corneal epithelium is not only an important biological barrier in the ocular surface, but also plays an important role in maintaining tear film stability, corneal transparency and normal visual function. Corneal epithelium regeneration and repair depend on the proliferation, differentiation and migration of the stem cells in the basal limbal epithelium. More and more attention has been paid to the clinical value of corneal and ocular surface diseases. The accurate measurement of corneal and limbal epithelium thickness can not only provide important reference for early diagnosis of keratoconus, guide the development of refractive surgery, and evaluate the effect of the operation, but also for dry eye and angle. In recent years, the quantitative analysis of corneal and limbal epithelium with optical coherence tomography (OCT) has become a hot spot in the study of Ophthalmology. A certain area of the cornea or a certain area of the cornea is rarely described in the characteristics of the distribution of the whole cornea and the law of age change. This study used Fourier domain OCT (Fourier-domain OCT, FD-OCT) to observe the morphological structure of the cornea and limbus of normal people of different ages, and measure the thickness of the epithelium at different directions. To analyze the difference of corneal and limbal epithelium thickness between different azimuth, different age groups and their correlation with age, sum up their spatial distribution characteristics and the regularity with age. On the one hand, the data of the normal people's cornea and limbal epithelial thickness database are supplemented by the Chinese population, on the other hand it is helpful to the clinicians. On the basis of understanding the characteristics of corneal and limbal epithelium, diagnosis and treatment work. Part 1 FD-OCT measurement of corneal epithelium thickness in normal people of different ages: the use of FD-OCT to observe the corneal thickness in normal people of different ages and to measure the thickness of the epithelial thickness of the cornea, and to analyze the spatial distribution of the corneal thickness and its age. Method: cross sectional study. 180 healthy subjects (80 men and 100 women) were recruited and divided into 4 groups according to age: group A (< 20 years old) 45 cases, group B (21-40 years) 45, group C (41-60 year old) 54, and group D (60 years old) 36. Random selected subjects (normal eyes) performed FD-OCT examination. RTVue-100OCT instrument Pachymetry mode was used to scan the central 6mm cornea of subjects. In each picture, the central 6mm cornea is divided into 17 regions: the central 2mm region, the inner ring (2-5mm) 8 regions, the outer ring (5-6mm) 8 regions, and the cornea in each region. Visual presentation of the average thickness of epithelial thickness. Results: (1) the average thickness of the central 6mm corneal epithelium was (52.4 + 2.7) mu m in the population of the population, and the thickness of corneal epithelium in each region was different: the central 2mm area was (53.2 + 2.9) mu m, the upper half was (51.9 + 2.9) n, and the lower half was (53.1 + 3) m, The lower half area of the corneal epithelium was thicker than the upper half area (P0.05); the 1/8 region on the outer ring (50.2 + 3.3) mu m was the thinnest, the 1/8 region under the inner ring (53.4 + 3.1) mu m was the thickest, the thickness difference between the thinnest point and the thickest point was (-7.2 + 3.6) mu m. (2) Central 6mm corneal epithelium average thickness, male was (53.2 + 2.9) u m, and the female was (51.7 + 2.4) mu m; in all regions, the male corneal epithelium was all (3) A, B, C, the mean values of corneal epithelial thickness in the central 6mm were (53.21 + 2.39) mu m, (52.91 + 2.72) mu m, (51.88 + 2.42) micron m and (51.33 + 3.15) m (P=0.004). Statistical analysis of corneal epithelium thickness in all regions showed that the thickness of corneal epithelium in central 2mm region was 53. 4 + 2.8) mu m, (53.4 + 2.7) mu m, (53.2 + 3) mu m and (52.9 + 3.3) mu m, there was no significant difference between all age groups (P=0.848). In the adjacent central 2-6mmm region, the corneal epithelium thickness was negatively correlated with age except the 1/8 region below the inner ring temporal region (P0.05), and the central 6mm corneal epithelial thickness decreased with the average rate of 0.34 u m/10y with age. The rate of deceleration in the outer ring area was larger than that of the inner ring area, 0.51 m/10y and 0.30 m/10y. respectively. The difference of the minimum thickness of the epithelial thickness (Min-Max) and the epithelial thickness variation (Std-Dev) were all negatively correlated with age (P =-0.326, P0.001; P =+0.348, P0.001). Conclusion: the central 6mm corneal epithelium is not a homogeneous thickness, and the spatial distribution of its thickness is poor. The difference in the thickness of the lower thickness was slightly higher than the nasal temporal side. The older the age was, the more uneven the thickness of the corneal epithelium was in each region. Age had no obvious influence on the thickness of the central 2mm corneal epithelium. The adjacent central corneal epithelium thinned with age; the closer to the central area, the thinner the thinner the rate was. The second part of the FD-OCT was to the normal population of different ages. Objective: To observe the thickness of corneal limbal epithelium. FD-OCT was used to observe the corneal edge of normal people of different ages and to measure the thickness of the epithelial thickness. The spatial distribution of the thickness of the limbal epithelium and its regularity with age. Methods: a cross-sectional study. 180 healthy subjects (80 men and 100 women) were recruited and divided into 4 groups according to age: group A ( 20 years old) 45 cases, B group (21-40 year old) 45 cases, C group (41-60 year old) 54 cases, D group (60 year old) 36 cases. Randomly selected the subjects' single eye (normal eye) for FD-OCT examination. Use RTVue-100OCT Cross-Line mode to scan the nasal side, temporal, upper and lower cornea margin of the subjects, and record the cross section of the corneal limbus in each direction. On the OCT map, the manual diagonal diagonal method is used. The thickness of corneal limbus epithelium in all directions and age groups was statistically analyzed. Results: (1) FD-OCT measured the thickness of normal human nasal, temporal, upper, and lower limbal epithelial thickness (53.4 + 6.8) mu m, (54.2 + 7.4) mu m, (67.4 + 10.6) mu m, (67.7 + 10.7) mu m. The analysis showed that there was a significant difference between the four azimuth corneal limbal epithelium (P=0.000).Tamhane method. The 22 comparison of the azimuth showed that the nasal epithelium and the temporal limbal epithelium were obviously thinner than the upper, lower (P=0.000), the nasal side and the temporal side (P=0.947), and the lower part of the cornea was slightly thicker than the upper part, but there was no statistical difference between the two groups (P=1.000). The spatial distribution of the thickness of the epithelia of the membrane was the same as that in the general population. (2) the thickness of the limbal epithelium in the same azimuth of all age groups was compared: in the nasal and temporal side, the measured values of the A group were larger than the other three groups (P0.05); in the upper, lower, group B, the measured values were the largest, but there was no significant difference between the groups. The thickness of the corneal limbal epithelium and the age in each azimuth. The results of correlation analysis were: p=-0.332 (P=0.000), temporal (p=-0.372, P=0.000), above (p=-0.048, P=0.594), lower (p=-0.032, P=0.725). With age, the decreasing rate of the thickness of the limbal epithelium at the lateral, temporal, upper and lower limbal epithelium was respectively 1.12pm/10y, 1.31 mu m/10y, 0.37 mu m/10y, 0.21 micron m/10y. conclusion: normal corneal limbal epithelium. The thickness of the nasal and temporal limbal epithelium was thinner and thicker. As the age increased, the nasal epithelium and the temporal limbal epithelium gradually thinned, and the upper limbal epithelium showed a thicker and thinner change in the lower limbal epithelium. The thickness of the cornea was the largest in the adult. The thickness of the corneal limbal epithelium at the level of the eyelid fissure was more thick. It is susceptible to age and the rate of change is greater than that of the limbal epithelium.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R770.4

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