發(fā)布時間：2018-06-27 15:34

  本文選題：圓錐角膜 + 人口統(tǒng)計學(xué)��； 參考：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的 1.對圓錐角膜患者的發(fā)病特點及臨床資料做出分析,探討圓錐角膜早期診斷和治療的相關(guān)依據(jù)。 2.通過OCULUS Pentacam眼前節(jié)成像分析系統(tǒng)檢測圓錐角膜患者雙眼角膜,對各量化參數(shù)進行特點評估及參數(shù)間相關(guān)性分析,為圓錐角膜的早期診斷提供理論依據(jù)。 方法 1.收集68例圓錐角膜患者的發(fā)病特點(男女患病比例、發(fā)病年齡等)進行分析；對圓錐角膜患者的臨床特點(發(fā)病史及家族史、戴眼鏡史、屈光狀態(tài)、裂隙燈檢查、全身病史等)進行分析、比較；進行VF-14問卷調(diào)查,并對結(jié)果進行統(tǒng)計分析。 2. OCULUS pentacam眼前節(jié)成像分析系統(tǒng)檢測患者雙眼角膜,63例(5例10眼未采集到圖像予以排除)109眼采集到圖像,對其各項量化參數(shù)進行特點評估和參數(shù)間相關(guān)性分析,并與作為正常對照組的64例(64眼,均為左眼)進行比較分析。采用SPSS17.0對數(shù)據(jù)進行統(tǒng)計學(xué)分析。 結(jié)果 1.統(tǒng)計發(fā)現(xiàn)該研究人群中圓錐角膜患病比率男性高于女性(67.6%/32.4%,p0.05),圓錐角膜確診時的平均年齡是26.00±8.91歲(年齡范圍12.38-51.12歲),10%(7/68)的患者發(fā)病年齡小于18歲,57.6%(39/68)的患者發(fā)病年齡小于30歲。 2.患者首次眼科就診的主要主訴是視力下降且框架鏡不能矯正83.8%(57/68),進展性的近視22.1%(15/68),頭痛及眼痛者5.9%(4/68),無癥狀的4人(5.9%)。1例(1.5%)伴有圓錐角膜家族史。確診圓錐角膜眼中角膜近中央局部膨出是最常見的臨床體征(59.1%),出現(xiàn)Fleischer's環(huán)的比例為53%, Vogt's條紋26%。圓錐角膜眼的平均柱鏡度數(shù)明顯高于可疑圓錐角膜眼(-4.00D/-2.00D,p0.001),logMAR最佳矯正視力可疑圓錐角膜眼明顯好于圓錐角膜眼(0.04/0.18,p0.001)。 3.VF-14問卷調(diào)查最后得分在8.3-100之間,其中68%在91-100之間,13%在81-90之間,19%在80或以下。在對特定活動進行評估時,約一半(46.7%)患者閱讀小字存在困難,而且較多患者存在中等程度困難(25.7%)；約三分之一的患者在讀書看報、做精細活或看電視時存在一定困難,存在中等程度困難者分別占22.9%、19.3%和21.1%；還有一定數(shù)量的患者(31.2%)在辨認各種標(biāo)示牌方面存在困難,看不清樓梯或路緣石者占24.8%,近距離認人困難者占17.4%。 4.可疑KC組和正常組前表面最大屈光度和前表面最大高度值之間無顯著性差異(P0.05),KC組與可疑KC組、KC組與正常組之間有顯著性差異(P0.05)。 5.KC組和可疑KC組角膜后表面最大屈光度和最大高度值均高于正常對照組,KC組、可疑KC組和正常對照組后表面最大高度值兩兩比較組間均有顯著性差異(P0.05)。 6.角膜最薄厚度由對照組到KC組呈遞減趨勢,各組兩兩比較均有顯著差異(P0.05)。KC組、可疑KC組和正常對照組后表面最大屈光度和最大高度均不位于角膜中心。 7.在KC組角膜最大屈光度與前表面最大高度、后表面最大高度、后表面最大屈光度、角膜最薄點間均有顯著相關(guān)性(P0.0001)；在可疑KC組角膜前表面最大屈光度與后表面最大屈光度、角膜最薄點有相關(guān)性(p0.050)。 8.KC組、可疑KC組及正常組角膜最薄點到角膜中心的平均距離分別為(0.76±0.42)mm、(0.66±0.38)m and(0.61±0.29)mm。KC組(56.0%)和可疑KC組(52.0%)角膜最薄點位置多數(shù)在中央lmm圓環(huán)外的顳下方,而正常組角膜最薄點位置多數(shù)(46.7%)位于中央lmm圓環(huán)區(qū)域內(nèi)。 結(jié)論 1.圓錐角膜多發(fā)生于20歲左右的青年人；主訴近視度數(shù)增長且框架鏡不能矯正的患者應(yīng)引起高度懷疑；RGP的普及可明顯改善圓錐角膜患者的矯正視力,推遲角膜移植時間。 2.由圓錐角膜所致的視功能損害會導(dǎo)致與視力相關(guān)的日�；顒邮艿揭欢ǔ潭认拗啤� 3.在診斷圓錐角膜時要將角膜厚度、前后表面屈光度和高度等指標(biāo)綜合分析,若角膜后表面最大屈光度和最大高度均顯示增高,而角膜最薄厚度顯示降低,則應(yīng)該高度懷疑圓錐角膜。 4.隨病情發(fā)展,角膜局限前突的程度加重,角膜逐漸變薄,角膜屈光度的增加與角膜后表面前突和角膜頂點變薄有相關(guān)性。 5.KC眼角膜最薄點呈周邊化趨勢,并不位于角膜中心,當(dāng)角膜最薄點位于中央1mm圓環(huán)區(qū)域外的顳下方時,應(yīng)該引起重視,進一步結(jié)合其它角膜地形圖參數(shù)篩查KC。
[Abstract]:objective
1. to analyze the characteristics and clinical data of keratoconus, and to explore the relevant evidence for early diagnosis and treatment of keratoconus.
2. the OCULUS Pentacam anterior segment imaging analysis system was used to detect the cornea of the eyes of keratoconus. The quantitative parameters were evaluated and the correlation between parameters was analyzed, which provided a theoretical basis for the early diagnosis of keratoconus.
Method
1. to analyze the characteristics of 68 cases of keratoconus (the proportion of men and women, the age of the disease), and to analyze the clinical characteristics of the patients with keratoconus (the history of disease and family history, the history of wearing glasses, the state of refraction, the examination of the slit lamp, the history of the whole body, etc.). The VF-14 questionnaire survey was carried out and the results were statistically analyzed.
The 2. OCULUS Pentacam anterior segment imaging analysis system was used to detect the cornea of the eyes of the patients, 63 cases (5 cases, 10 eyes were not removed) and 109 eyes were collected, and the quantitative parameters were evaluated and the correlation between the parameters was analyzed, and 64 cases (64 eyes, all left eyes) as the normal control group were compared and analyzed. SPSS17.0 pairs were used. The data were analyzed statistically.
Result
1. statistics found that the incidence of keratoconus in the study population was higher than that of women (67.6%/32.4%, P0.05). The average age of keratoconus was 26 + 8.91 years old (age range 12.38-51.12 years), 10% (7/68) patients were less than 18 years old and 57.6% (39/68) patients were less than 30 years old.
The main main complaints in 2. of the first ophthalmology were visual acuity, 83.8% (57/68), progressive myopia, 22.1% (15/68), headache and eye pain, 5.9% (4/68), 4 asymptomatic (5.9%).1 (1.5%) with the family history of keratoconus. The most common clinical sign (59.1%) was confirmed by the near central local bulge of the cornea in the conical angle membrane. The proportion of Fleischer's rings was 53%. The average degree of cylindrical lens in the Vogt's stripe 26%. conus cornea was significantly higher than that of the suspected conical keratoconus (-4.00D/-2.00D, p0.001). The best corrected visual acuity of logMAR was better than that of the keratoconus (0.04/0.18, p0.001).
The final score of the 3.VF-14 questionnaire was between 8.3-100, of which 68% were 91-100, 13% were 81-90, and 19% was 80 or less. About half (46.7%) had difficulty reading small words when evaluating specific activities, and more patients had moderate difficulty (25.7%); about 1/3 were reading and reading newspapers, doing fine work or doing fine work. There were some difficulties in watching TV. There were 22.9%, 19.3% and 21.1% of those with moderate difficulty, and a certain number of patients (31.2%) had difficulties in identifying various signs, and 24.8% of the staircases or road stones were not clear, and the people who were difficult to recognize the difficulty accounted for 17.4%..
4. there was no significant difference between the maximum diopter of the surface and the maximum front surface of the normal group and the normal group (P0.05). There was a significant difference between the KC group and the suspicious KC group, the KC group and the normal group (P0.05).
The maximum refraction and maximum height of posterior corneal surface of 5.KC group and suspicious KC group were higher than that of normal control group. There were significant difference between group KC, suspected KC group and normal control group with the maximum height of 22 (P0.05).
6. the thinnest thickness of the cornea was reduced from the control group to the KC group, and there was a significant difference in the 22 groups (P0.05) group.KC. The maximum diopter and maximum height of the suspected KC group and the normal control group were not located in the center of the cornea.
7. in the KC group, the maximum corneal refractive index and the maximum height of the anterior surface, the maximum posterior surface height, the maximum refraction of the posterior surface and the thinnest point of the cornea have significant correlation (P0.0001). In the suspected KC group, the maximum refraction of the anterior surface of the cornea is related to the maximum refraction of the posterior surface, and the thinnest point of the cornea is correlated (p0.050).
In group 8.KC, the average distance from the thinnest point of the cornea to the center of the cornea in the suspicious KC group and the normal group was (0.76 + 0.42) mm, the (0.66 + 0.38) m and (0.61 + 0.29) mm.KC group (56%) and the suspected KC group (52%) were most of the thinnest point of the cornea below the central LMM circle. Most of the thinnest spots in the normal group (46.7%) were located in the central LMM circle area. Inside.
conclusion
1. keratoconus occurs mostly in young people around 20 years of age; patients who complain about the myopia degree and the frame mirror can not be corrected should be highly suspected. The popularization of RGP can obviously improve the corrected visual acuity of keratoconus and delay the time of corneal transplantation.
2. the impairment of visual function caused by keratoconus can lead to a certain degree of limitation of vision related daily activities.
3. in the diagnosis of keratoconus, the thickness of the cornea, the refractive index of the front and the back surface and the height of the cornea should be analyzed synthetically. If the maximum refraction and maximum height of the posterior corneal surface are increased, and the thinnest thickness of the cornea is shown to decrease, the keratoconus should be highly suspected.
4. with the development of the disease, the degree of corneal localized protrusion increased, and the cornea became thinner. The increase of corneal diopter was associated with the protrusion of the posterior corneal surface and the thinning of the corneal vertex.
The thinnest point in the cornea of 5.KC is not located in the center of the cornea. When the thinnest point of the cornea is located below the central 1mm circle, it should be paid more attention to screening KC. with the parameters of other corneal topographic maps.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R772.2

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本文編號：2074393