角膜塑形镜对儿童角膜周边屈光力及眼轴增长的影响

发布时间：2018-06-13 22:33

本文选题：角膜塑型镜 + 近视　；参考：《复旦大学》2014年博士论文

【摘要】：第一部分角膜塑形镜对角膜径线屈光力的影响及与眼轴增长的相关性目的探讨儿童配戴角膜塑形镜(OK镜)后角膜各径线屈光力分布特点及径线屈光力变化与眼轴增长的相关性方法32名9-14岁儿童验配OK镜。入选条件：最佳矫正视力≥20/20；等效球镜屈光度(SER)-1.00--4.50D；顺规散光≤-1.50D；角膜中央屈光力41.5-44.5D；无远近显斜视；既往未使用角膜接触镜或其它近视控制疗法；无活动性眼部炎症及影响泪膜的眼表疾病。戴镜前,戴镜后3月、6月、12月、18月、24月随访评估裸眼视力、裂隙灯荧光染色、眼轴长度(AL)、角膜地形图等。角膜地形图上以角膜顶点为中心,每隔lmm记录鼻侧、颞侧和下方三个径线上的角膜矢向屈光力(N1～N4, T1～T4,I1～I4),取三条径线屈光力相对角膜顶点屈光力(Apex)增加值最大的点记为maxN, maxT和maxI。分别计算Apex, maxN, maxT和maxI的计算组内标准差、重测重复性和变异系数,考察测量值的可重复性。按照三种分组方式,即小于或大于maxN, maxT, maxI均值分别将完成研究者分为两组(组1,组2),重复测量方差分析(ANOVA)分别比较三种分组方式组1和组2的AL增长。Pearson相关检验maxN, maxT, maxI与AL增长的相关性。p0.05视为有显著性差异。结果27名儿童完成2年随访研究,共14男13女,起始年龄、SER、AL、角膜顶点屈光力分别为10.4±1.2岁,-2.57±0.90 D,24.50±0.60 mm,43.46±1.02 D;三种分组方式两亚组比较基线数据值均无显著差异。3次重复测量Apex,maxN, maxT和maxI均无显著差异(p≥0.93)。Apex, maxN, maxT, maxI的重测重复性值分别为0.06D,0.27D,0.18D,0.44D；变异系数分别为0.05%,0.22%,0.16%,0.36%。戴镜后鼻侧2mm和3mm,颞侧3mm,下方2mm、3mm、4mm处屈光力相对角膜顶点屈光力显著增大(p0.05)。24月随访期内AL显著延长(p0.001)。三种分组方式均对AL延长量有显著影响(鼻侧p=0.001;颞侧p=0.011;下方p=0.001);三条径线上组2的AL延长量较组1少54%-69%。maxN, maxT和maxI均与2年AL延长量负相关(p0.05)。结论配戴OK镜后Apex, maxN, maxT和maxI测量值具有良好的可重复性。戴镜后各径线角膜周边屈光力显著大于中央屈光力。径线角膜相对周边屈光力变化最大值与眼轴增长量负相关。均与2年AL延长量负相关(p0.05)。第二部分角膜塑形镜对角膜屈光力相对近视漂移的影响及与眼轴增长的相关性目的探讨配戴OK镜后角膜环平均屈光力的分布特点。探讨角膜屈光力相对近视漂移(CPRMS)对眼轴增长的影响。方法88名7-12岁儿童验配OK镜,入选条件：最佳矫正视力≥20/20；SER-1.00～-4.50D：顺规散光≤-1.50D；角膜中央屈光力41.5～44.5D；无远近显斜视；既往未使用角膜接触镜或其它近视控制疗法；无活动性眼部炎症及影响泪膜的眼表疾病。戴镜前,戴镜后3月、6月、12月、18月和24月随访评估视力、扩瞳自动验光、裂隙灯荧光染色、AL、角膜地形图等。Pentacam眼前节分析系统测量以角膜顶点为圆心,直径0.5-7.2m(每个环直径间隔0.1mm)环平均屈光力和角膜顶点屈光力(Apex),戴镜后环平均屈光力与角膜顶点屈光力比较(单因素ANOVA, Bonferroni检验)。角膜顶点屈光力和环平均屈光力输入MATLAB,样条插值法计算角膜屈光力相对近视漂移(CPRMS).比较各随访时间点SER、AL、角膜顶点屈光力、AL增长、角膜顶点屈光力变化(CAPC)和CPRMS(重复测量ANOVA, Bonferroni检验)。比较戴镜后各环平均屈光力与角膜顶点屈光力(单因素ANOVA, Bonferroni检验)。控制年龄、性别的影响,偏相关分析分别检验暗瞳直径、基线SER、CPRMS、CAPC与2年眼轴延长量的相关性。Pearson相关检验CAPC与CPRMS相关性。p0.05视为有显著性差异。结果完成2年随访研究者(64人)基线年龄、性别(男/女)、SER、AL、角膜顶点屈光力分别为：9.6±1.7岁、23/41、-2.88±0.96D、24.53±0.61mm、43.47±1.03D,与脱落者(24人)比较各基线数据统计值均无显著差异。64人SER由-2.88±0.96D降至戴镜3月-0.20±0.85D,以后各时间点无显著差异(p≥0.453)：2年AL延长0.37±0.27mm,18月、24月AL比基线显著增长(p0.05);CAPC戴镜3月后2.86±1.01D,以后各时间点无显著差异(p≥0.229);CPRMS戴镜3月10.84±5.28D·mm,以后各时间点无显著差异(p0.999)。戴镜3月角膜顶点屈光力由43.47±1.03D降至40.61±1.23D,环平均屈光力中央到周边逐渐增大,直径5.8m环达最大值42.80±1.O1D,其中2.8-7.2m环平均屈光力显著大于角膜顶点屈光力(p0.05)。暗瞳直径与AL增长量无显著相关性(p=0.169);基线SER与AL增长量显著正相关(p=0.042,r=0.298)；CPRMS与眼轴增长量显著负相关(p0.001,r=0.624)；CAPC与眼轴增长量显著负相关(p0.001,r=0.592)。CAPC与CPRMS紧密正相关(p0.001,r=0.916)。结论配戴OK镜后角膜环平均屈光力中央减小,周边显著大于中央。角膜屈光力相对近视漂移和角膜顶点屈光力变化均与眼轴增长量显著负相关,角膜顶点屈光力变化与角膜屈光力相对近视漂移紧密正相关。
[Abstract]:Part 1 the effect of corneal plastic lens on the refractive power of corneal diameter and the correlation with the growth of ocular axis in order to investigate the characteristics of the refractive power distribution and the correlation between the changes of corneal diopter and the axial growth of the cornea after the OK lens, 32 9-14 year old children of 9-14 years old. The best corrected visual acuity is more than 2. 0/20; equivalent spherical refractive index (SER) -1.00--4.50D; CIS astigmatism less than -1.50D; central corneal refractive power 41.5-44.5D; no distant and near apparent strabismus; previously unused contact lens or other myopia control therapy; inactive ocular inflammation and ocular surface disease affecting tear film. Before wearing glasses, after wearing glasses, March, June, December, 18 months, and 24 months of follow-up evaluation Naked eye vision, slit lamp fluorescent staining, eye axis length (AL), corneal topography and so on. Corneal topography was centered on the vertex of cornea. The cornea sagittal refraction (N1 to N4, T1 to T4, I1 to I4) was recorded at the three diameter lines of the nasal side, temporal and lower, and the maximum value of three lines of refraction relative to the corneal vertex refractive power (Apex) was added to the corneal topography. MaxN, maxT and maxI. calculated the standard deviation in the calculation group of Apex, maxN, maxT and maxI respectively, retested the repeatability and variation coefficient, and examined the repeatability of the measured values. According to the three grouping methods, the researchers were divided into two groups (group 1, group 2), respectively, and the mean of repeated measurements of variance analysis (ANOVA) were respectively compared. Compared to three groups of group 1 and group 2 AL growth.Pearson correlation test, maxN, maxT, maxI and AL growth correlated.P0.05 as significant differences. Results 27 children completed 2 year follow-up studies, 14 male 13 women, SER, AL, and corneal vertex refractive power were 10.4 + 1.2, -2.57 + 0.90 D, 24.50 + 0.60 mm, 43.46 + 1.02; There was no significant difference in baseline data between group two subgroups and group two. There were no significant differences in Apex, maxN, maxT and maxI (P > 0.93).Apex, maxN, maxT, and maxI, respectively, 0.06D, 0.27D, and 0.16%, respectively, 0.05%, 0.22%, 0.16%, respectively. The refractive power of 4mm was significantly higher than that of the corneal apex (P0.05) during the.24 month follow-up period (p0.001). The three grouping methods had significant influence on the extension of AL (nasal p=0.001, temporal p=0.011, and lower p=0.001), and the AL extension of the three line group 2 was less 54%-69%.maxN than that in the group 1. 05). Conclusion the measured values of Apex, maxN, maxT and maxI were more repeatable after wearing the OK mirror. The corneal refractive power around the cornea was significantly greater than that of the central refraction after wearing the mirror. The maximum change of the relative refractive power of the diameter line cornea was negatively correlated with the growth of the ocular axis. It was negatively correlated with the 2 year AL lengthening (P0.05). The second part of the corneal plastic lens diagonal. The influence of membrane diopter relative to the drift of myopia and the correlation with the growth of ocular axis to investigate the distribution of the mean refraction of the corneal ring after wearing OK mirror. The effect of corneal refractive power relative myopia drift (CPRMS) on the eye axis growth. Methods 88 7-12 year old children were examined with OK mirror, the best corrected visual acuity was more than 20/20; SER-1.00 to -4 .50D: conformed astigmatism less than -1.50D; central corneal refractive power of 41.5 to 44.5D; no distant and near apparent strabismus; previously unused contact lenses or other myopia control therapies; inactive ocular inflammation and ocular surface diseases affecting tear film. Before wearing glasses, after wearing glasses, March, June, December, 18 months and 24 months of follow-up evaluation of visual acuity, slit lamp Fluorescence staining, AL, corneal topography and other.Pentacam anterior segment analysis system measured the average refractive power and corneal vertex refractive power (Apex) of the center of the cornea, diameter 0.5-7.2m (each ring diameter interval 0.1mm) and corneal vertex refraction (single factor ANOVA, Bonferroni test) after wearing the lens. Corneal vertex refraction. MATLAB and spline interpolation were used to calculate the relative myopic drift (CPRMS) of corneal refractive power (CPRMS). The follow-up time points SER, AL, corneal vertex refraction, AL growth, corneal vertex refraction (CAPC) and CPRMS (repeated measurements of ANOVA, Bonferroni test) were compared. Single factor ANOVA, Bonferroni test) control age, gender effect, partial correlation analysis of dark pupil diameter, baseline SER, CPRMS, CAPC and 2 years of axial lengthening correlation.Pearson correlation test CAPC and CPRMS related.P0.05 apparent difference. Results completed 2 year follow-up researchers (64 people) baseline age, sex (male / female), SER, SER. AL, the refractive power of the corneal apex was 9.6 + 1.7 years, 23/41, -2.88 + 0.96D, 24.53 + 0.61mm, 43.47 + 1.03D. There was no significant difference in the statistical values of the baseline data from the shedding persons (24 people). The.64 SER from -2.88 + 0.96D decreased to the March -0.20 + 0.85D, and there was no significant difference at all time points (0.453). L was significantly higher than baseline (P0.05); CAPC wearing mirror was 2.86 + 1.01D after March, and there was no significant difference at all time points (P > 0.229), CPRMS wearing mirror was 10.84 + 5.28D. Mm in March, and there was no significant difference at all time points (p0.999). In March, the corneal vertex refractive power dropped from 43.47 + 1.03D to 40.61 + 1.23D, and the center of the ring mean refractive power increased gradually to the periphery and diameter 5.8m. The maximum ring reach was 42.80 + 1.O1D, and the average refractive power of the 2.8-7.2m ring was significantly greater than the corneal vertex refraction (P0.05). There was no significant correlation between the dark pupil diameter and the AL growth (p=0.169); the baseline SER was positively correlated with the AL growth (p=0.042, r=0.298); CPRMS was negatively correlated with the growth of the eye axis (p0.001, r=0.624), and the growth of the eye axis was significant The negative correlation (p0.001, r=0.592).CAPC was closely related to CPRMS (p0.001, r=0.916). Conclusion the mean refraction center of the corneal ring was reduced and the periphery was significantly greater than that of the central area. The relative myopia drift and the change of corneal vertex refractive power were all negatively correlated with the eye axis growth Liang Xian, the change of corneal vertex refraction and corneal refractive power. The relative myopia drift is closely related.
【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】：R778.11

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