本文選題：角膜地形圖 + 散光　； 參考：《南昌大學(xué)》2012年碩士論文

【摘要】：目的：探討角膜地形圖引導(dǎo)下的顯微斜視矯正術(shù)對兒童斜視患者眼表癥狀及淚膜穩(wěn)定性的影響和術(shù)后角膜地形圖的特點(diǎn)。 方法：40例(60只眼)兒童斜視患者行斜視矯正術(shù),隨機(jī)分為A、B組。A組采用顯微鏡下常規(guī)角膜緣結(jié)膜切口斜視矯正術(shù)20例(30眼)，B組在顯微鏡下并根據(jù)角膜地形圖引導(dǎo)下作特定部位結(jié)膜切口行斜視矯正術(shù)20例(30眼)，，分別于術(shù)前、術(shù)后1周及術(shù)后2周時(shí)測裸眼視力,眼表癥狀、眼表指數(shù)（Ocular Surface DiseaseIndex，OSDI）、淚膜四項(xiàng)及角膜地形圖檢查，角膜地形圖分別記錄：中心平均屈光度（Km）及散光值和離角膜中央3mm、3.5mm、4mm和4.5mm半徑光學(xué)區(qū),放射方向于0°、90°、180°和270°即角膜上：Sup、下:Inf、鼻:Nas、顳:Temp4個(gè)子午線)的角膜偏心率（分別計(jì)為Se3、Se3.5、Se4、Se4.5，Ie3、Ie3.5、Ie4、Ie4.5，Ne3、Ne3.5、Ne4、Ne4.5, Te3、Te3.5、Te4、Te4.5）、角膜表面不對稱系數(shù)：表面變異指數(shù)（ISV），高度不對稱性指數(shù)（IHA），垂直不對稱指數(shù)（IVA）及高度離心指數(shù)（IHD）。 結(jié)果：術(shù)前兩組角膜中心平均屈光度、散光值、角膜表明不規(guī)則指數(shù)、角膜周邊偏心率、眼表癥狀、OSDI、及淚膜四項(xiàng)相比，差異均無統(tǒng)計(jì)學(xué)意義。術(shù)后1周患者角膜前表面平均屈光度及散光值與術(shù)前相比： A組明顯增加，差異有統(tǒng)計(jì)學(xué)意義，B組變化不明顯，差異無統(tǒng)計(jì)學(xué)意義；術(shù)后2周2組患者角膜前表面平均屈光度及散光值與術(shù)前相比：A組恢復(fù)至術(shù)前水平，差異無統(tǒng)計(jì)學(xué)意義，B組變化不明顯，差異無統(tǒng)計(jì)學(xué)意義。術(shù)后1周兩組患者眼表癥狀眼數(shù)、OSDI、BUT、FL、ST及淚河高度相比,差異均有統(tǒng)計(jì)學(xué)意義；至術(shù)后第2周時(shí)兩組患者的眼表癥狀眼數(shù)、OSDI、BUT、ST及淚河高度相比,差異均有統(tǒng)計(jì)學(xué)意義。術(shù)后1周與術(shù)前相比：兩組患者眼表癥狀眼數(shù)、OSDI、FL、BUT、ST及淚河高度均變化明顯，差異均有統(tǒng)計(jì)學(xué)意義；術(shù)后2周與術(shù)前相比：兩組患者眼表癥狀眼數(shù)、OSDI、BUT、ST、淚河高度及FL均恢復(fù)至術(shù)前水平，差異均無統(tǒng)計(jì)學(xué)意義。ISV、IHA、IVA、IHD等參數(shù)：A組術(shù)后1w與術(shù)前相比有明顯差異（P0.05），A組術(shù)后2w與術(shù)前、B組術(shù)后1w、2w與術(shù)前相比均無明顯差異（P0.05）。Se3、Se3.5、Se4、Se4.5，Ie3、Ie3.5、Ie4、Ie4.5，Ne3、Ne3.5、Ne4、Ne4.5, Te3、Te3.5、Te4、Te4.5等參數(shù):兩組術(shù)后1w、2w與術(shù)前相比均無明顯差異（P0.05） 結(jié)論：對于兒童斜視患者，在角膜地形圖引導(dǎo)下行顯微斜視矯正術(shù)對術(shù)后角膜散光影響小，可以較早穩(wěn)定淚膜、減輕眼表癥狀，可以提高患者的視覺質(zhì)量。角膜地形圖引導(dǎo)下的顯微斜視矯正術(shù)對兒童斜視術(shù)后角膜地形圖的變化幾乎無影響，為斜視手術(shù)結(jié)膜切口的選擇提供一種新的方式。
[Abstract]:Objective: to investigate the effect of corneal topography guided micro-strabismus correction on ocular symptoms and lacrimal film stability in children with strabismus and the characteristics of postoperative corneal topography. Methods 40 children (60 eyes) with strabismus were treated with strabismus correction. Group A was randomly divided into group A and group A, 20 patients (30 eyes) were treated with conventional conjunctival incision strabismus correction under microscope, and 20 cases (30 eyes) were treated with conjunctival incision under microscope and guided by corneal topography. Visual acuity, ocular surface symptoms, ocular surface index (OSDI), four items of tear film and corneal topography were measured 1 week after operation and 2 weeks after operation. The corneal topography recorded the mean central diopter (km) and astigmatism, and the optical region of 3 mm to 3.5 mm and 4 mm from the center of cornea and 4.5mm radius, respectively. Corneal eccentricity in the radiation direction of 90 擄90 擄180 擄and 270 擄above: supp, lower: Inf, nasal: Nas, temporal: Temp4 meridians) (Se3Se3.5Se 4.5, Ie4.5Ne3.5Ne3.5Ne3.5Ne4, Te3Te3.5Te4Te4.5), corneal surface asymmetry coefficient: surface variability index (ISV), high asymmetry index (IHA), vertical asymmetric finger. Number (IVA) and height centrifugal index (IHD). Results: there was no significant difference in corneal central diopter, astigmatism, corneal irregularity index, corneal peripheral eccentricity, OSDI and tear film between the two groups. 1 week after operation, the mean corneal surface diopter and astigmatism were significantly increased in group A (P < 0.01), but the difference was not significant in group B (P < 0.05). At 2 weeks after operation, the mean corneal surface diopter and astigmatism of the two groups returned to the preoperative level compared with those of the preoperative group. There was no significant difference between group B and group B. there was no significant difference between the two groups. There were significant differences in the number of eye surface symptoms and the height of the lacrimal river between the two groups at 1 week after operation, and by the second week after operation, there were significant differences between the two groups in the number of OSDI BUTST and the height of the lacrimal river. At 1 week after operation, the number of ocular surface symptoms and OSDI FLBUTST and the height of the lacrimal river were significantly changed in the two groups, and the difference was statistically significant. Two weeks after operation, the number of ocular surface symptoms, the height of the lacrimal river and the level of FL returned to the preoperative level in the two groups. There was no significant difference between the two groups (P0.05). There was no significant difference between two groups (P0.05). There was no significant difference between the two groups (P0.05). Se3Se3.5Se4.5Ie3.5Ie4.5Ie4.5Ie4.5Ie4.5ne4.5Ne3.5Ne3Ne3.5Ne4Ne4.5. Te3Te3.5Te4Te4.5, and Te3Te3.5Te4Te4.5 were all compared with those before operation at 1w after operation in group A (P0.05), and there was no significant difference between group A (group A) and group B before operation (P 0.05). The parameters of group A, group A and group B were significantly different from those of group B at 1 week after operation (P0.05). There was no significant difference (P0.05) conclusion: for children with strabismus, Microstrabismus correction guided by corneal topographic map had little effect on postoperative corneal astigmatism, could stabilize tear film earlier, alleviate ocular surface symptoms, and improve the visual quality of the patients. Under the guidance of corneal topographic map, microstrabismus correction has little effect on the change of corneal topography after strabismus in children, which provides a new way for the choice of conjunctival incision in strabismus surgery.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.6

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