本文關(guān)鍵詞： 角膜瓣厚度 角膜后表面 高度 角膜地形圖 相干光斷層掃描 飛秒激光 角膜磨鑲術(shù) 激光原位　出處：《天津醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：評(píng)價(jià)Visante Omni眼前節(jié)分析系統(tǒng)在測(cè)量角膜后表面的可重復(fù)性；評(píng)估飛秒激光LASIK(FS-LASIK)制作的角膜瓣的預(yù)測(cè)性、可重復(fù)性和均勻性,并與準(zhǔn)分子激光前彈力層下角膜磨鑲術(shù)(SBK)進(jìn)行比較,從而了解FS-LASIK的制瓣特點(diǎn)；分析FS-LASIK術(shù)后早期的角膜后表面高度的變化情況,并與SBK、機(jī)械法上皮瓣下角膜鑲磨術(shù)(Epi-LASIK)進(jìn)行比較分析。 方法：對(duì)近視患者使用Visante Omni眼前節(jié)分析系統(tǒng),采集不同區(qū)域的角膜后表面高度、8mm范圍角膜后表面最平坦和最陡峭的屈光力、平均Q值,計(jì)算其組內(nèi)標(biāo)準(zhǔn)差(Sw)、精度、可重復(fù)性、組內(nèi)變異系數(shù)(CVw)、組內(nèi)相關(guān)系數(shù)(ICC)等參數(shù)來(lái)評(píng)價(jià)Visante Omni眼前節(jié)分析系統(tǒng)在測(cè)量角膜后表面的可重復(fù)性；對(duì)行飛秒激光LASIK及SBK手術(shù)的患者在術(shù)后應(yīng)用Visante OCT眼前節(jié)分析系統(tǒng)對(duì)角膜瓣厚度進(jìn)行測(cè)量和獲��；對(duì)行FS-LASIK手術(shù)的患者進(jìn)行隨訪(fǎng),應(yīng)用Visante OMNI眼前節(jié)分析系統(tǒng)測(cè)量術(shù)前及術(shù)后不同時(shí)期、不同區(qū)域角膜后表面高度,并與SBK、Epi-LASIK進(jìn)行對(duì)照。 結(jié)果：1.對(duì)于角膜后表面高度,組內(nèi)標(biāo)準(zhǔn)差(SW)最低為0.49,最高為3.95,從頂點(diǎn)到周邊有增加的趨勢(shì)；組內(nèi)變異系數(shù)(CVw)最低為0.16%,最高為2.13%；組內(nèi)相關(guān)系數(shù)(ICC)均高于0.844。對(duì)于角膜后表面屈光力和非球面性(Q值)平均值,除了平坦軸的的組內(nèi)標(biāo)準(zhǔn)差(SW)是6.66,其余的均小于0.1,組內(nèi)變異系數(shù)(CVw)范圍從0.01%到1.47%,所有的組內(nèi)相關(guān)系數(shù)(ICC)均大于0.90。對(duì)三次測(cè)量的多重比較的統(tǒng)計(jì)學(xué)分析結(jié)果顯示P值均大于0.05。在不同屈光力組,組內(nèi)相關(guān)系數(shù)(ICC)值相近。2. FS-LASIK組與SBK組的平均中央角膜瓣厚度分別為(97.49±7.34) μm、(112.93±9.99)μm。FS-LASIK組實(shí)際中央角膜瓣厚度與平均中央角膜瓣厚度差值絕對(duì)值的均數(shù)為5.74±3.98μm, SBK組為8.11±5.75μm,兩者相比差異有統(tǒng)計(jì)學(xué)意義(t=2.83,P=0.005)。角膜瓣的空間形態(tài)：FS-LASIK組在距離角膜頂點(diǎn)不同距離的位置,瓣厚度基本均勻一致(F=1.206,P=0.303); SBK組呈中央薄周邊厚的形態(tài),進(jìn)刀部位角膜瓣厚度高于出刀部位,兩者比較差異有統(tǒng)計(jì)學(xué)意義(t=7.246, P=0.009)。3. FS-LASIK組在角膜頂點(diǎn),術(shù)前、術(shù)后1d、1周、1個(gè)月角膜后表面高度分別是2.03μm,2.26μm、2.16μm、2.06μm；在1mm、2mm區(qū)域,術(shù)后變化趨勢(shì)與角膜頂點(diǎn)相同；在3mm區(qū)域,四個(gè)時(shí)間點(diǎn)角膜后表面高度分別是-4.73μm、-5.39μm、-4.73μm、-4.71μm。SBK組在角膜頂點(diǎn),術(shù)前、術(shù)后1天、1周、1個(gè)月角膜后表面高度分別是1.44μm,1.74μm、1.66μm、1.53μm;在1mm、2mm區(qū)域,術(shù)后變化趨勢(shì)與角膜頂點(diǎn)相一致；在3mm區(qū)域,四個(gè)時(shí)間點(diǎn)角膜后表面高度分別是-5.09μm,-5.48μm、-5.27μm、-5.19μm,術(shù)后發(fā)生了輕微的后移。Epi-LASIK組在角膜頂點(diǎn),術(shù)前、術(shù)后3天、1周、1個(gè)月角膜后表面高度分別是2.47μm,1.55μm、1.55μm、2.37μm,術(shù)后發(fā)生輕微的后移；在1mm、2mm區(qū)域,與角膜頂點(diǎn)術(shù)后變化趨勢(shì)不同,術(shù)后3天角膜后表面高度分別由術(shù)前的1.55μm、-1.87μtm變?yōu)?.92μm、0.24μm,發(fā)生輕微前移；在3mm區(qū)域,變化趨勢(shì)與角膜頂點(diǎn)相同。統(tǒng)計(jì)分析表明,不同的手術(shù)方式(組間差異)及不同時(shí)間點(diǎn)(組內(nèi)差異)的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。于0.05。在不同屈光力組,組內(nèi)相關(guān)系數(shù)(ICC)值相近。 結(jié)論：Visante Omni眼前節(jié)分析系統(tǒng)在測(cè)量頂點(diǎn)和周邊部的角膜后表面都具有相對(duì)較高的可重復(fù)性,可以用于臨床對(duì)角膜后表面的評(píng)估和檢測(cè)；飛秒激光制瓣與機(jī)械刀相比,在預(yù)測(cè)性和可重復(fù)方面更有優(yōu)勢(shì),從中央到周邊角膜瓣厚度均勻一致；FS-LASIK術(shù)后早期中央?yún)^(qū)和旁中央?yún)^(qū)的角膜后表面高度發(fā)生了微小的變化,但隨時(shí)間變化逐漸恢復(fù)至術(shù)前水平,與SBK、Epi-LASIK相比無(wú)明顯差異。FS-LASIK術(shù)后早期角膜后表面高度無(wú)明顯變化,是一種相對(duì)安全的手術(shù)方式。
[Abstract]:Objective: To evaluate the Visante Omni system in the measurement of corneal surface repeatability; evaluation of femtosecond laser LASIK (FS-LASIK) prediction of making corneal flap, repeatability and uniformity, and excimer laser sub Bowman keratomileusis (SBK) were compared, in order to understand the characteristics of flap preparation FS-LASIK; analysis of the changes of the posterior corneal surface height early after FS-LASIK, and SBK, the mechanical method of subepithelial corneal grinding with surgery (Epi-LASIK) were compared and analyzed.
Methods: the anterior segment analysis system of myopia patients using Visante Omni, collected in different regions of the corneal surface height, 8mm range of posterior corneal surface flat and the most steep refractive power, the average Q value, calculate the group standard deviation (Sw), precision, repeatability, coefficient of variation within groups (CVw). The intraclass correlation coefficient (ICC) and other parameters to evaluate the Visante Omni system in the measurement of corneal surface repeatability; anterior segment analysis system were measured and the corneal flap thickness obtained by Visante OCT and SBK LASIK of femtosecond laser surgery in postoperative patients; the patients underwent FS-LASIK surgery were followed up the application of Visante, OMNI anterior segment analysis system in different periods were measured before and after operation, the surface height in different regions of the cornea, and SBK, Epi-LASIK were compared.
Results: 1. for the surface height of the cornea, the within group standard deviation (SW) for a minimum of 0.49, up to 3.95, the surrounding is increasing from the vertex to the group; coefficient of variation (CVw) for a minimum of 0.16%, up to 2.13%; the intraclass correlation coefficient (ICC) was higher than that of 0.844. for posterior corneal surface power and the asphericity (Q value) on average, in addition to the group of flat shaft standard deviation (SW) is 6.66, the rest of the group were less than 0.1, coefficient of variation (CVw) ranging from 0.01% to 1.47%, all the intraclass correlation coefficient (ICC) were more than 0.90. for statistical analysis of multiple comparisons three measurement results show that the P value was greater than 0.05. in different diopter groups, the intraclass correlation coefficient (ICC) values of the average central corneal flap thickness is similar to.2. FS-LASIK group and SBK group respectively (97.49 + 7.34) m, (112.93 + 9.99) m.FS-LASIK group, the actual central corneal flap thickness and the average central the vast difference between the corneal flap thickness 瀵瑰，

本文編號(hào)：1538954