飛秒激光小切口角膜基質(zhì)透鏡取出術(shù)后眼壓變化及其相關(guān)因素分析
發(fā)布時間：2018-10-21 15:28
【摘要】：目的:分析飛秒激光小切口角膜基質(zhì)透鏡取出術(shù)(SMILE)術(shù)后非接觸眼壓測量值的變化趨勢并探究SMILE術(shù)后非接觸眼壓與角膜厚度及曲率的相關(guān)性及回歸方程,為臨床評估SMILE術(shù)后患者的真實眼壓提供參考依據(jù)。方法:收集2016年02月~2016年11月在我院行SMILE手術(shù)的130例(259眼)近視患者資料,按照納入標準和排除標準篩選研究對象。依據(jù)等效球鏡度數(shù)將259眼分為三組:A組為高度近視組(≥-6.00D),共108眼;B組為中度近視組(-3.00D~-6.00D),共110眼;C組為低度近視組(-3.00D),共41眼。三組患者行術(shù)前常規(guī)檢查,排除手術(shù)禁忌后行SMILE手術(shù)。術(shù)后給予糖皮質(zhì)激素滴眼液、抗生素類滴眼液及人工淚液。記錄術(shù)前、術(shù)后1天、1周、1月、3月的非接觸眼壓、3.0mm半徑內(nèi)角膜平均曲率、角膜中央厚度等。采用SPSS18.0統(tǒng)計學軟件,對三組手術(shù)前、后非接觸眼壓進行單因素方差分析、LSD-t檢驗分析組間差異,對三組術(shù)后眼壓及眼壓降低值的相關(guān)因素采用Pearson相關(guān)進行分析,對術(shù)后眼壓及眼壓降低值與各影響因素進行多元線性回歸分析。結(jié)果:(1)A、B、C三組術(shù)前、術(shù)后非接觸眼壓測量值差異均有統(tǒng)計學意義(F=147.264、143.004、72.865,P0.001)。進一步經(jīng)LSD-t多重檢驗后,結(jié)果顯示三組術(shù)后非接觸眼壓較術(shù)前降低,術(shù)后各時段眼壓與術(shù)前眼壓比較均有統(tǒng)計學意義(P0.01),但三組術(shù)后各時段眼壓組間差異均無統(tǒng)計學意義(P0.05)。(2)三組術(shù)后非接觸眼壓測量值與角膜中央厚度、角膜平均曲率的變化均呈正相關(guān),A組眼壓與角膜中央厚度及曲率的相關(guān)系數(shù)r=0.4356、0.295(P0.05),相關(guān)方程為Y=0.0327X-2.739(X表示角膜中央厚度,Y表示非接觸眼壓),R2=0.2057;Y=0.4748X-7.163(X表示角膜平均曲率,Y表示非接觸眼壓),R2=0.08703。B組眼壓與角膜中央厚度及曲率的相關(guān)系數(shù)r=0.2807、0.264(P0.05),相關(guān)方程為Y=0.0295X-1.832(X表示角膜中央厚度,Y表示非接觸眼壓),R2=0.0788;Y=0.3837X-4.199(X表示角膜平均曲率,Y表示非接觸眼壓),R2=0.06971。C組眼壓與角膜中央厚度及曲率的相關(guān)系數(shù)r=0.4101、0.6346(P0.05),相關(guān)方程為Y=0.04658X-8.75(X表示角膜中央厚度,Y表示非接觸眼壓),R2=0.1682;Y=1.257X-35.92(X表示角膜平均曲率,Y表示非接觸眼壓),R2=0.4027。A、B、C三組術(shù)中角膜切削厚度與眼壓降低值均無明顯相關(guān)性(r=0.1269、0.1606、0.1955,P0.05),且手術(shù)前后平均曲率變化值與眼壓降低值均無明顯相關(guān)性(r=0.1397、0.03972、0.04514,P0.05)。(3)將術(shù)后眼壓測量值及手術(shù)前后眼壓降低值(△NCT)與其相關(guān)因素進行多元線性回歸分析,回歸方程分別為:Y=-12.963+0.029X1+0.31X2(Y表示眼壓,X1表示角膜中央厚度,X2表示平均角膜平均曲率);Y=2.276+0.032X1+0.108X2(Y表示△NCT,X1表示△CCT,X2表示平均曲率變化值),回歸方程均有統(tǒng)計學意義(F=29.05、19.394,P0.001)。結(jié)論:(1)SMILE術(shù)后非接觸眼壓測量值較術(shù)前降低,SMILE術(shù)后短期內(nèi)使用糖皮質(zhì)激素滴眼液對術(shù)后眼壓無明顯影響;(2)SMILE術(shù)后非接觸眼壓測量值變化與角膜中央厚度及曲率的變化呈正相關(guān),手術(shù)前后眼壓降低值受術(shù)中角膜切削厚度和角膜平均曲率變化的共同影響。
[Abstract]:Objective: To analyze the changes of non-contact intraocular pressure (IOP) measured by femtosecond laser microincision corneal stroma lens (SMILE) and explore the relationship between non-contact intraocular pressure and corneal thickness and curvature after SMILE operation and regression equation. To provide a reference basis for the clinical evaluation of the actual intraocular pressure of patients after SMILE. Methods: The data of 130 patients with myopia (259 eyes) who underwent SMILE operation in our hospital from February 2016 to November 2016 were collected, and the subjects were screened according to inclusion criteria and exclusion criteria. 259 eyes were divided into three groups according to the equivalent sphere degree: group A was high myopia group (n-6. 00D), 108 eyes were in total; group B was moderate myopia group (-3. 00D ~-6. 00D), 110 eyes; C group was low myopia group (-3. 00D), total 41 eyes. Three sets of patients underwent routine examination prior to operation, excluding the operation of SMILE after surgical taboos. After operation, glucocorticoid eye drops, antibiotics and artificial tears were given. The mean curvature of the cornea, the central thickness of the cornea, etc. were recorded before and after operation for 1 day, 1 week, 1 month, 3 months. Using SPSS18. 0 statistical software, single-factor analysis of variance and LSD-t test were performed for three groups of pre-operative and post-operative intraocular pressure, and Pearson correlation was used to analyze the related factors of intraocular pressure and intraocular pressure in three groups. Multivariate linear regression analysis was performed on postoperative intraocular pressure (IOP) and intraocular pressure (IOP) and intraocular pressure (IOP). Results: (1) Before group A, B and C, the difference of non-contact intraocular pressure measurement was statistically significant (F = 147. 264, 143. 004, 72. 865, P 0.001). After multiple tests of LSD-t, the results showed that there was no significant difference between intraocular pressure and intraocular pressure before operation (P <0.01), but there was no significant difference between intraocular pressure and intraocular pressure (P <0.05). (2) The measured values of non-contact intraocular pressure were positively correlated with the central thickness of cornea and the mean curvature of cornea in group A. The correlation coefficient of intraocular pressure with central thickness and curvature of cornea was 0. 4356, 0. 295 (P0.05). The correlation equation was Y = 0.0327X-2.739 (X represents the central thickness of cornea, Y represents non-contact intraocular pressure), R2 = 0.92057; Y = 0. 4748X-7.163 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure), R2 = 0.08703. Group B, the correlation coefficient of intraocular pressure with the central thickness and curvature of the cornea is 0. 2807, 0. 264 (P0.05). The correlation equation is Y = 0.0295X-1.832 (X represents the central thickness of the cornea, Y represents the non-contact intraocular pressure), R2 = 0. 0788; Y = 0.3837X-4.199 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure). The correlation coefficient between intraocular pressure and central corneal thickness and curvature was 0. 64101, 0.6346 (P0.05). The correlation equation was Y = 0.04658X-8.75 (X represents the central thickness of the cornea, Y represents non-contact intraocular pressure), R2 = 0.91682; Y = 1.257X-35.92 (X represents the average curvature of the cornea, Y represents non-contact intraocular pressure), R2 = 0.4027. A, B, There was no significant correlation between corneal ablation thickness and IOP reduction in three groups (r = 0.01269, 0.1606, 0. 1955, P0.05), and the mean curvature change before and after operation was not significantly correlated with the decrease of intraocular pressure (r = 0.1397, 0. 03972, 0. 04514, P0.05). (3) Multivariate linear regression analysis was performed on postoperative intraocular pressure measurement and post-operative intraocular pressure reduction (NCT) and its related factors. The regression equation was Y =-12.963 + 0.029X1 + 0.31X2 (Y = intraocular pressure, X1 represents the central thickness of the cornea, X2 represents the mean corneal mean curvature); Y = 2.276 + 0.032X1 + 0.108X2 (Y), The regression equations were statistically significant (F = 29. 05, 19. 394, P 0.001). Conclusion: (1) The measured value of non-contact intraocular pressure after SMILE is lower than that before operation, and it has no obvious effect on postoperative intraocular pressure after SMILE operation; (2) The change of non-contact intraocular pressure measurement after SMILE is positively correlated with the change of central thickness and curvature of cornea. The decrease of intraocular pressure before and after surgery was affected by the thickness of corneal ablation and the change of mean curvature of cornea.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.63
[Abstract]:Objective: To analyze the changes of non-contact intraocular pressure (IOP) measured by femtosecond laser microincision corneal stroma lens (SMILE) and explore the relationship between non-contact intraocular pressure and corneal thickness and curvature after SMILE operation and regression equation. To provide a reference basis for the clinical evaluation of the actual intraocular pressure of patients after SMILE. Methods: The data of 130 patients with myopia (259 eyes) who underwent SMILE operation in our hospital from February 2016 to November 2016 were collected, and the subjects were screened according to inclusion criteria and exclusion criteria. 259 eyes were divided into three groups according to the equivalent sphere degree: group A was high myopia group (n-6. 00D), 108 eyes were in total; group B was moderate myopia group (-3. 00D ~-6. 00D), 110 eyes; C group was low myopia group (-3. 00D), total 41 eyes. Three sets of patients underwent routine examination prior to operation, excluding the operation of SMILE after surgical taboos. After operation, glucocorticoid eye drops, antibiotics and artificial tears were given. The mean curvature of the cornea, the central thickness of the cornea, etc. were recorded before and after operation for 1 day, 1 week, 1 month, 3 months. Using SPSS18. 0 statistical software, single-factor analysis of variance and LSD-t test were performed for three groups of pre-operative and post-operative intraocular pressure, and Pearson correlation was used to analyze the related factors of intraocular pressure and intraocular pressure in three groups. Multivariate linear regression analysis was performed on postoperative intraocular pressure (IOP) and intraocular pressure (IOP) and intraocular pressure (IOP). Results: (1) Before group A, B and C, the difference of non-contact intraocular pressure measurement was statistically significant (F = 147. 264, 143. 004, 72. 865, P 0.001). After multiple tests of LSD-t, the results showed that there was no significant difference between intraocular pressure and intraocular pressure before operation (P <0.01), but there was no significant difference between intraocular pressure and intraocular pressure (P <0.05). (2) The measured values of non-contact intraocular pressure were positively correlated with the central thickness of cornea and the mean curvature of cornea in group A. The correlation coefficient of intraocular pressure with central thickness and curvature of cornea was 0. 4356, 0. 295 (P0.05). The correlation equation was Y = 0.0327X-2.739 (X represents the central thickness of cornea, Y represents non-contact intraocular pressure), R2 = 0.92057; Y = 0. 4748X-7.163 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure), R2 = 0.08703. Group B, the correlation coefficient of intraocular pressure with the central thickness and curvature of the cornea is 0. 2807, 0. 264 (P0.05). The correlation equation is Y = 0.0295X-1.832 (X represents the central thickness of the cornea, Y represents the non-contact intraocular pressure), R2 = 0. 0788; Y = 0.3837X-4.199 (X represents the average curvature of the cornea, Y represents the non-contact intraocular pressure). The correlation coefficient between intraocular pressure and central corneal thickness and curvature was 0. 64101, 0.6346 (P0.05). The correlation equation was Y = 0.04658X-8.75 (X represents the central thickness of the cornea, Y represents non-contact intraocular pressure), R2 = 0.91682; Y = 1.257X-35.92 (X represents the average curvature of the cornea, Y represents non-contact intraocular pressure), R2 = 0.4027. A, B, There was no significant correlation between corneal ablation thickness and IOP reduction in three groups (r = 0.01269, 0.1606, 0. 1955, P0.05), and the mean curvature change before and after operation was not significantly correlated with the decrease of intraocular pressure (r = 0.1397, 0. 03972, 0. 04514, P0.05). (3) Multivariate linear regression analysis was performed on postoperative intraocular pressure measurement and post-operative intraocular pressure reduction (NCT) and its related factors. The regression equation was Y =-12.963 + 0.029X1 + 0.31X2 (Y = intraocular pressure, X1 represents the central thickness of the cornea, X2 represents the mean corneal mean curvature); Y = 2.276 + 0.032X1 + 0.108X2 (Y), The regression equations were statistically significant (F = 29. 05, 19. 394, P 0.001). Conclusion: (1) The measured value of non-contact intraocular pressure after SMILE is lower than that before operation, and it has no obvious effect on postoperative intraocular pressure after SMILE operation; (2) The change of non-contact intraocular pressure measurement after SMILE is positively correlated with the change of central thickness and curvature of cornea. The decrease of intraocular pressure before and after surgery was affected by the thickness of corneal ablation and the change of mean curvature of cornea.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.63
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