正常人及角膜屈光手术后角膜生物力学特性（ORA）研究
发布时间：2018-09-18 17:44
【摘要】：目的：本研究旨在借助眼反应分析仪分析正常人群角膜生物力学特性指标的正常值范围及分布特点以及影响角膜生物力学特性的角膜生物学指标,并对LASIK与SBK、Epi-LASIK手术后早期(术后1周与1-2个月)及术后中长期(术后1年)角膜生物力学改变的情况进行比较性研究。 方法： 第一部分：横断面研究,共包括240人480只眼,分别进行眼反应分析仪(Ocular Response Analyzer, Reichert,美国)及Pentacam三维眼前节分析诊断系统(Oculus GmbH, Wetzlar,德国)测量,采用Pearson线性相关分析及单因素方差分析、独立样本的t检验等对数据进行统计分析。 第二部分：为前瞻性研究,术后早期临床观察部分共包括Epi-LASIK 30例30只眼,LASIK 34例34只眼,SBK 22例22只眼,术后随访时间为术后1周及1-2个月。另一组行术后中长期观察,其中Epi-LASIK 20例40只眼,LASIK20例39只眼,术后随访1年。分别进行眼反应分析仪及Pentacam三维眼前节分析诊断系统测量,采用重复测量的方差分析及独立样本的t检验对数据进行统计分析,并应用Pearson线性相关分析对其影响因素进行分析。 结果： 1.角膜滞后值(Corneal Hysteresis, CH)及角膜阻力因子(Corneal Resistance Factor, CRF)呈正态分布,平均为(10.38±1.36) mmHg和(10.70±1.59)mmHg。 2.CH及CRF与中央角膜厚度呈正相关(CH:r=0.54, P=0.000;CRF:r=0.61,P=0.000),与年龄、球镜、柱镜及等效球镜度数无相关。CH与CRF同角膜中央前表面高度呈负相关(CH:r=-0.136*,P=0.002; CRF:r=-0.152*,P=0.001),同角膜前表面Q值呈正相关(CH:r=0.136*, P=0.002; CRF:r=0.132*, P=0.003),球差与CH、CRF间也呈正相关(CH:r=0.184*,P=0.000;CRF:r=0.191*,P=0.000)。 3.CH与CRF同以角膜中央为圆心直径分别为1、1.5、2、2.5、3、3.5、4、4.5、5、5.5、6mm相隔各0.5mm的同心圆区域角膜范围的角膜容积(Cornea Volume, CV)值均呈中度以上的相关关系。 4. Epi-LASIK、LASIK及SBK三种手术后早期各手术方式组间CH与CRF间差异无统计学意义(CH:F= 0.623, P=0.539; CRF:F=0.038, P= 0.963)。 5.手术后1年Epi-LASIK及LASIK两种手术方式间CH与CRF间差异无统计学意义(CH:t=-0.270,P=0.308:CRF:t=-0.989,P=0.630). 6.切削深度在Epi-LASIK与SBK组中与术后1周及术后1-2个月CH.CRF变化量间均无明显相关关系,但在LASIK组中与术后1周与1-2个月CH.CRF变化量间均呈明显正性相关关系。切削深度与术后1年CH、CRF变化量在Epi-LASIK组无明显相关关系(CH:r=0.086,P=0.604;CRF:r=0.214,P=0.191), LASIK组中与CRF呈中度相关关系(CH:r=0.291,P=0.077;CRF:r=0.499*,P=0.001)。 结论： 1.角膜滞后值CH及角膜阻力因子CRF呈正态分布,与中央角膜厚度呈中度以上的正性相关关系,与年龄及屈光度无明显相关关系,并且同各范围内角膜容积量均呈中度以上的相关关系,CRF较CH表现出更强的相关性。 2.CH与CRF与角膜形态有较强的相关性,同角膜中央前表面高度呈较弱的负性相关关系,说明角膜中央越凸出,角膜生物力学特性越弱,这与角膜前表面Q值同CH、CRF间的相关关系一致。同时,球差与CH、CRF间呈现了较弱的正向相关关系,即角膜球差越大,生物力学指标越高。 3.Epi-LASIK.LASIK与SBK三种手术后CH与CRF间差异无统计学意义,可见,在一定矫正屈光度数范围内,板层手术与表层手术在对相似人群特征角膜生物力学特性影响上,无论在术后早期还是中长期差异不是十分明显。 4.术后早期Epi-LASIK生物力学指标变化无明显差别,LASIK与SBK手术后1-2个月时CH较术后1周明显提高,CRF也有一定程度的提高。说明术后板层手术角膜生物力学特性恢复较表层手术提前,CH较CRF明显。 5.切削深度在Epi-LASIK与SBK组中与术后CH.CRF变化量间均无相关,但在LASIK组中与术后CH、CRF变化量间均呈明显正性相关关系,说明对于切削层面较表浅的Epi-LASIK与SBK切削量对其生物力学特性的作用不及切削层面较深的LASIK明显,即LASIK手术切削量越多,手术对角膜生物力学特性影响越大,其术后生物力学特性越弱。
[Abstract]:OBJECTIVE: To analyze the normal range and distribution of corneal biomechanical properties and the corneal biomechanical parameters affecting the corneal biomechanical properties in normal people with the aid of an eye response analyzer, and to evaluate the corneal biology after LASIK and SBK, Epi-LASIK at the early stage (1 week and 1-2 months after surgery) and at the middle and long term (1 year after surgery). A comparative study of mechanical changes was conducted.
Method:
Part I: A cross-sectional study involving 240 people and 480 eyes was conducted using Ocular Response Analyzer (Reichert, USA) and Pentacam three-dimensional anterior segment analysis and diagnosis system (Oculus GmbH, Wetzlar, Germany). The data were analyzed by Pearson linear correlation analysis, one-way ANOVA and t test of independent samples. Statistical analysis was carried out.
The second part: For prospective study, the early clinical observation included 30 eyes of Epi-LASIK, 34 eyes of LASIK, 22 eyes of SBK. The follow-up time was 1 week and 1-2 months after operation. The other group was followed up for 1 year, including 40 eyes of 20 cases of Epi-LASIK, 39 eyes of 20 cases of LASIK. The analysis instrument and Pentacam three-dimensional anterior segment analysis and diagnosis system were used to measure the data. The analysis of variance of repeated measurements and t-test of independent samples were used to analyze the data. Pearson linear correlation analysis was used to analyze the influencing factors.
Result:
1. Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF) showed normal distribution, with an average of (10.38 (+ 1.36) mmHg and (10.70 (+ 1.59) mmHg.
2. CH and CRF were positively correlated with central corneal thickness (CH: r = 0.54, P = 0.000; CRF: r = 0.61, P = 0.000), but not with age, spherical, columnar and equivalent spherical lenses. CH and CRF were negatively correlated with anterior central corneal surface height (CH: r = - 0.136 *, P = 0.002; CRF: r = - 0.152 *, P = 0.001), and positively correlated with anterior corneal surface Q (CH: r = 0.136 *, P = 0.002). 32* (P=0.003), spherical aberration is positively correlated with CH and CRF (CH:r=0.184*, P=0.000, CRF:r=0.191*, P=0.000).
3. CH and CRF were moderately correlated with Cornea Volume (CV) values in the concentric circle region 0.5mm apart from the central cornea, with the diameter of 1,1.5,2,2.5,3,3.5,4,4.5,5.5,6 mm respectively.
4. There was no significant difference between CH and CRF among the three early postoperative groups (CH: F = 0.623, P = 0.539; CRF: F = 0.038, P = 0.963).
5. There was no significant difference between CH and CRF between Epi-LASIK and LASIK one year after operation (CH: t = - 0.270, P = 0.308: CRF: t = - 0.989, P = 0.630).
6. There was no significant correlation between the cutting depth in Epi-LASIK and the changes of CH.CRF in SBK group at 1 week and 1-2 months after operation, but there was a significant positive correlation between the cutting depth and the changes of CH.CRF in Epi-LASIK group at 1 week and 1-2 months after operation. CRF: r = 0.214, P = 0.191, and moderately correlated with CRF in LASIK group (CH: r = 0.291, P = 0.077; CRF: r = 0.499 *, P = 0.001).
Conclusion:
1. Corneal hysteresis value CH and corneal resistance factor CRF showed normal distribution, and had a positive correlation with central corneal thickness above moderate, and had no significant correlation with age and diopter, and had a moderate correlation with corneal volume above all ranges. CRF showed stronger correlation than CH.
2. There is a strong correlation between CH and CRF and corneal morphology, and a weak negative correlation between CH and anterior central surface height of cornea, indicating that the more prominent the central cornea, the weaker the corneal biomechanical properties, which is consistent with the correlation between Q value of anterior corneal surface and CH, CRF. At the same time, there is a weak positive correlation between spherical aberration and CH, CRF. The larger the spherical aberration, the higher the biomechanical index.
3. There was no significant difference between CH and CRF after Epi-LASIK. LASIK and SBK. It can be seen that the effect of lamellar surgery and surface surgery on corneal biomechanical characteristics of similar populations in a certain range of corrective diopters was not very significant in the early or middle and long term after surgery.
4. There was no significant difference in the changes of biomechanical parameters of Epi-LASIK in the early postoperative period. CH and CRF were significantly increased at 1-2 months after LASIK and SBK compared with 1 week after SBK, which indicated that the corneal biomechanical characteristics of lamellar surgery were recovered earlier than that of surface surgery, and CH was more obvious than that of CRF.
5. There was no correlation between cutting depth and postoperative CH. CRF in Epi-LASIK and SBK groups, but there was a significant positive correlation between the changes of CH and CRF in LASIK group and postoperative CH and CRF, indicating that the effect of epi-LASIK and SBK cutting depth on its biomechanical properties was less significant than LASIK cutting depth, that is, LASIK surgery. The more the amount of cutting, the greater the effect of surgery on corneal biomechanical properties, and the less biomechanical characteristics.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63
本文编号：2248651
[Abstract]:OBJECTIVE: To analyze the normal range and distribution of corneal biomechanical properties and the corneal biomechanical parameters affecting the corneal biomechanical properties in normal people with the aid of an eye response analyzer, and to evaluate the corneal biology after LASIK and SBK, Epi-LASIK at the early stage (1 week and 1-2 months after surgery) and at the middle and long term (1 year after surgery). A comparative study of mechanical changes was conducted.
Method:
Part I: A cross-sectional study involving 240 people and 480 eyes was conducted using Ocular Response Analyzer (Reichert, USA) and Pentacam three-dimensional anterior segment analysis and diagnosis system (Oculus GmbH, Wetzlar, Germany). The data were analyzed by Pearson linear correlation analysis, one-way ANOVA and t test of independent samples. Statistical analysis was carried out.
The second part: For prospective study, the early clinical observation included 30 eyes of Epi-LASIK, 34 eyes of LASIK, 22 eyes of SBK. The follow-up time was 1 week and 1-2 months after operation. The other group was followed up for 1 year, including 40 eyes of 20 cases of Epi-LASIK, 39 eyes of 20 cases of LASIK. The analysis instrument and Pentacam three-dimensional anterior segment analysis and diagnosis system were used to measure the data. The analysis of variance of repeated measurements and t-test of independent samples were used to analyze the data. Pearson linear correlation analysis was used to analyze the influencing factors.
Result:
1. Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF) showed normal distribution, with an average of (10.38 (+ 1.36) mmHg and (10.70 (+ 1.59) mmHg.
2. CH and CRF were positively correlated with central corneal thickness (CH: r = 0.54, P = 0.000; CRF: r = 0.61, P = 0.000), but not with age, spherical, columnar and equivalent spherical lenses. CH and CRF were negatively correlated with anterior central corneal surface height (CH: r = - 0.136 *, P = 0.002; CRF: r = - 0.152 *, P = 0.001), and positively correlated with anterior corneal surface Q (CH: r = 0.136 *, P = 0.002). 32* (P=0.003), spherical aberration is positively correlated with CH and CRF (CH:r=0.184*, P=0.000, CRF:r=0.191*, P=0.000).
3. CH and CRF were moderately correlated with Cornea Volume (CV) values in the concentric circle region 0.5mm apart from the central cornea, with the diameter of 1,1.5,2,2.5,3,3.5,4,4.5,5.5,6 mm respectively.
4. There was no significant difference between CH and CRF among the three early postoperative groups (CH: F = 0.623, P = 0.539; CRF: F = 0.038, P = 0.963).
5. There was no significant difference between CH and CRF between Epi-LASIK and LASIK one year after operation (CH: t = - 0.270, P = 0.308: CRF: t = - 0.989, P = 0.630).
6. There was no significant correlation between the cutting depth in Epi-LASIK and the changes of CH.CRF in SBK group at 1 week and 1-2 months after operation, but there was a significant positive correlation between the cutting depth and the changes of CH.CRF in Epi-LASIK group at 1 week and 1-2 months after operation. CRF: r = 0.214, P = 0.191, and moderately correlated with CRF in LASIK group (CH: r = 0.291, P = 0.077; CRF: r = 0.499 *, P = 0.001).
Conclusion:
1. Corneal hysteresis value CH and corneal resistance factor CRF showed normal distribution, and had a positive correlation with central corneal thickness above moderate, and had no significant correlation with age and diopter, and had a moderate correlation with corneal volume above all ranges. CRF showed stronger correlation than CH.
2. There is a strong correlation between CH and CRF and corneal morphology, and a weak negative correlation between CH and anterior central surface height of cornea, indicating that the more prominent the central cornea, the weaker the corneal biomechanical properties, which is consistent with the correlation between Q value of anterior corneal surface and CH, CRF. At the same time, there is a weak positive correlation between spherical aberration and CH, CRF. The larger the spherical aberration, the higher the biomechanical index.
3. There was no significant difference between CH and CRF after Epi-LASIK. LASIK and SBK. It can be seen that the effect of lamellar surgery and surface surgery on corneal biomechanical characteristics of similar populations in a certain range of corrective diopters was not very significant in the early or middle and long term after surgery.
4. There was no significant difference in the changes of biomechanical parameters of Epi-LASIK in the early postoperative period. CH and CRF were significantly increased at 1-2 months after LASIK and SBK compared with 1 week after SBK, which indicated that the corneal biomechanical characteristics of lamellar surgery were recovered earlier than that of surface surgery, and CH was more obvious than that of CRF.
5. There was no correlation between cutting depth and postoperative CH. CRF in Epi-LASIK and SBK groups, but there was a significant positive correlation between the changes of CH and CRF in LASIK group and postoperative CH and CRF, indicating that the effect of epi-LASIK and SBK cutting depth on its biomechanical properties was less significant than LASIK cutting depth, that is, LASIK surgery. The more the amount of cutting, the greater the effect of surgery on corneal biomechanical properties, and the less biomechanical characteristics.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63
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