近視眼角膜體積值及其角膜屈光手術(shù)后變化與角膜生物力學(xué)特性相關(guān)性研究
發(fā)布時(shí)間：2018-08-14 13:25
【摘要】：目的:利用Pentacam眼前節(jié)分析儀測(cè)量正常人群角膜體積的正常值范圍及其空間區(qū)域分布特點(diǎn);探討飛秒激光小切口角膜基質(zhì)透鏡取出術(shù)(small incision lenticule extraction,SMILE)光學(xué)區(qū)大小對(duì)術(shù)后角膜體積變化量及角膜生物力學(xué)特性的影響;并對(duì)SMILE與飛秒激光輔助的準(zhǔn)分子激光原位角膜磨鑲術(shù)(femtosecond laser in situ keratomileusis,FS-LASIK)術(shù)后早期不同區(qū)域角膜體積隨時(shí)間變化的情況進(jìn)行對(duì)比研究,探討術(shù)后角膜體積變化與角膜生物力學(xué)特性變化的關(guān)系。方法:1.橫斷面研究,共納入2911例(5301眼),行Pentacam三維眼前節(jié)分析儀檢查測(cè)量角膜體積值(corneal volume,CV),角膜厚度值(corneal thickness,CT)以及角膜前、后表面曲率和曲率半徑(K1,K2,Km,Rf,Rs,Rm)。采用Pearson線性相關(guān)分析評(píng)估角膜體積值與年齡以及角膜形態(tài)學(xué)參數(shù)間的相關(guān)關(guān)系。2.回顧性病歷對(duì)照研究。納入行SMILE手術(shù)的近視患者119例119眼,根據(jù)光學(xué)區(qū)大小分為兩組,其中A組光學(xué)區(qū)直徑為6.2mm,46例(46眼);B組光學(xué)區(qū)直徑為6.5mm,73例(73眼)。所有研究對(duì)象于術(shù)前及術(shù)后1個(gè)月、3個(gè)月進(jìn)行眼反應(yīng)分析儀(ORA)檢查,記錄角膜滯后量(corneal hysteresis,CH)及角膜阻力因子(corneal resistance factor,CRF),同時(shí)行Pentacam檢查記錄CV。3.回顧性病歷對(duì)照研究。納入SMILE組患者50例(50眼),FS-LASIK組患者47例(47眼),于術(shù)前、術(shù)后1天、1周、1個(gè)月、3個(gè)月測(cè)量?jī)山M患者CV,并依據(jù)測(cè)量直徑將中央5mm直徑角膜體積(CV5)定義為中央?yún)^(qū),將5mm到10mm直徑角膜體積(CV5-10)定義為周邊區(qū);應(yīng)用ORA測(cè)量CH、CRF值,計(jì)算手術(shù)前后角膜體積減少量(△CV)、CH值和CRF值減少量(△CH和△CRF)。結(jié)果:1.隨著分析區(qū)域的增大,角膜體積以及角膜厚度值隨之增大;隨著年齡增加角膜體積及厚度隨之下降,周邊區(qū)域減少量大于中央?yún)^(qū)域;角膜體積值與后表面曲率半徑和曲率值存在較強(qiáng)的負(fù)相關(guān)關(guān)系,且越靠近周邊區(qū)域角膜厚度對(duì)角膜后表面曲率的影響越大。2.在術(shù)后1個(gè)月、3個(gè)月時(shí)光學(xué)區(qū)6.5mm組角膜3/5/7mm區(qū)域角膜體積值(CV3/5/7)均少于光學(xué)區(qū)6.2mm組,差異具有統(tǒng)計(jì)學(xué)意義(均P0.05);術(shù)后3個(gè)月時(shí)光學(xué)區(qū)6.5mm組不同觀察區(qū)域角膜體積減少量(ΔCV3/5/7/10)均多于光學(xué)區(qū)6.2mm組,差異均具有統(tǒng)計(jì)學(xué)意義(均P0.05);術(shù)后3個(gè)月時(shí)兩組之間ΔCH和ΔCRF差異無(wú)統(tǒng)計(jì)學(xué)差異(均P0.05);術(shù)前CV3、CV5、CV7和CV10與CH值和CRF值均呈中等程度正相關(guān)關(guān)系(均P0.05)。3.術(shù)后1天時(shí),SMILE組和FS-LASIK組兩組患者中央及周邊區(qū)域CV值均減小,與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后1天至術(shù)后3個(gè)月SMILE組和FS-LASIK組中央?yún)^(qū)角膜體積增加量分別為0.11±0.16mm3,0.20±0.13mm3,差異有統(tǒng)計(jì)學(xué)意義(P=0.004);兩組患者術(shù)后中央?yún)^(qū)△CV5與△SE存在較強(qiáng)的負(fù)相關(guān)關(guān)系(SMILE組:r=-0.746,P0.001;FS-LASIK組:r=-0.798,P0.001);SMILE組△CV5與△CRF,△CH存在較強(qiáng)的正相關(guān)關(guān)系(分別為:r=0.498,P0.001;r=0.374,P0.001);FS-LASIK組僅△CV5與△CRF有正相關(guān)關(guān)系(r=0.363,P=0.012)。結(jié)論:1.正常人群角膜體積值及角膜厚度值從中央?yún)^(qū)到周邊區(qū)逐漸增加;隨著年齡的增加兩者均有所下降,而厚度下降主要表現(xiàn)在角膜周邊區(qū)域;角膜組織量與角膜后表面的形態(tài)特征存在較強(qiáng)相關(guān)關(guān)系,且越往周邊區(qū)域,影響越大。2.角膜體積值與角膜生物力學(xué)參數(shù)間存在正相關(guān)關(guān)系;SMILE手術(shù)會(huì)引起角膜生物力學(xué)特性改變,光學(xué)區(qū)大小對(duì)角膜生物力學(xué)的影響較小;隨著光學(xué)區(qū)增大角膜組織減少量隨之增加,因此在一定范圍內(nèi),可以適當(dāng)擴(kuò)大光學(xué)區(qū),從而減少角膜術(shù)后波前像差的引入。3.SMILE組及FS-LASIK組術(shù)后早期角膜體積均發(fā)生波動(dòng)性變化;術(shù)后角膜體積減少量與角膜生物力學(xué)特性減少量、有效矯正的屈光度均存在較強(qiáng)的正相關(guān)關(guān)系。
[Abstract]:Objective: To measure the normal range of corneal volume and its spatial distribution in normal people by Pentacam anterior segment analyzer, and to investigate the effect of the size of optical zone on corneal volume and corneal biomechanical characteristics after small incision lenticular extraction (SMILE). The changes of corneal volume in different areas after FS-LASIK and SMILE were compared with those of femtosecond laser in situ keratomileusis (FS-LASIK), and the relationship between corneal volume and corneal biomechanical characteristics was discussed. Methods: 1. Cross-sectional study. A total of 2911 patients (5301 eyes) were enrolled in the study. Corneal volume (CV), corneal thickness (CT), corneal surface curvature and radius of curvature (K1, K2, Km, Rf, Rs, Rm) were measured by Pentacam three-dimensional anterior segment analyzer. Pearson linear correlation analysis was used to evaluate corneal volume, age and corneal morphological parameters. A retrospective case-control study was conducted. 119 eyes of 119 myopic patients who underwent SMILE were divided into two groups according to the size of the optical area. The optical area diameter of group A was 6.2 mm, 46 cases (46 eyes), group B was 6.5 mm, 73 cases (73 eyes). Corneal hysteresis (CH) and corneal resistance factor (CRF) were recorded, and CV.3 was recorded by Pentacam. A retrospective case-control study was conducted. 50 patients (50 eyes) in SMILE group and 47 patients (47 eyes) in FS-LASIK group were enrolled. CV was measured before surgery, 1 day, 1 week, 1 month and 3 months after surgery. Corneal volume of 5 mm in diameter (CV5) was defined as central area by measuring diameter, and corneal volume of 5 mm to 10 mm in diameter (CV5-10) was defined as peripheral area. Corneal volume reduction (delta CV), CH value and CRF value reduction (delta CH and delta CRF) before and after operation were calculated by measuring CH and CRF value with ORA. Results: 1. Corneal volume and angle increased with the analysis area. The thickness of the cornea increased with age, the volume and thickness of the cornea decreased with age, and the decrease of the peripheral area was greater than that of the central area. The 3/5/7 mm corneal volume (CV3/5/7) of the 6.5 mm group was less than that of the 6.2 mm group (all P 0.05), and the decrease of the corneal volume (CV3/5/7/10) of the 6.5 mm group was more than that of the 6.2 mm group (all P 0.05). CV3, CV5, CV7 and CV10 were positively correlated with CH and CRF values (all P 0.05). 3. On the first day after operation, CV values in the central and peripheral regions of SMILE group and FS-LASIK group decreased, and there was a significant difference between the two groups (P 0.05). Corneal volume increment in central area of SMILE group and FS-LASIK group was 0.11 (-0.16mm3) and 0.20 (-0.13mm3) at 3 months, respectively, with significant difference (P = 0.004); there was a strong negative correlation between Delta CV5 and delta SE in central area of SMILE group (r =-0.746, P 0.001; FS-LASIK group: R =-0.798, P 0.001); Delta CV5 and delta CRF, Delta CH in SMILE group were strong. There was a positive correlation (r = 0.498, P 0.001; r = 0.374, P 0.001), and only a positive correlation (r = 0.363, P = 0.012) between Delta CV5 and delta CRF in FS-LASIK group. Corneal volume and corneal biomechanical parameters were positively correlated. SMILE surgery could cause corneal biomechanical characteristics change, and the size of optical area had little effect on corneal biomechanics. The volume of cornea in SMILE group and FS-LASIK group fluctuated at the early stage after operation, and the volume of cornea decreased with the decrease of corneal biomechanical properties. There was a strong positive correlation between diopter.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
本文編號(hào)：2182996
[Abstract]:Objective: To measure the normal range of corneal volume and its spatial distribution in normal people by Pentacam anterior segment analyzer, and to investigate the effect of the size of optical zone on corneal volume and corneal biomechanical characteristics after small incision lenticular extraction (SMILE). The changes of corneal volume in different areas after FS-LASIK and SMILE were compared with those of femtosecond laser in situ keratomileusis (FS-LASIK), and the relationship between corneal volume and corneal biomechanical characteristics was discussed. Methods: 1. Cross-sectional study. A total of 2911 patients (5301 eyes) were enrolled in the study. Corneal volume (CV), corneal thickness (CT), corneal surface curvature and radius of curvature (K1, K2, Km, Rf, Rs, Rm) were measured by Pentacam three-dimensional anterior segment analyzer. Pearson linear correlation analysis was used to evaluate corneal volume, age and corneal morphological parameters. A retrospective case-control study was conducted. 119 eyes of 119 myopic patients who underwent SMILE were divided into two groups according to the size of the optical area. The optical area diameter of group A was 6.2 mm, 46 cases (46 eyes), group B was 6.5 mm, 73 cases (73 eyes). Corneal hysteresis (CH) and corneal resistance factor (CRF) were recorded, and CV.3 was recorded by Pentacam. A retrospective case-control study was conducted. 50 patients (50 eyes) in SMILE group and 47 patients (47 eyes) in FS-LASIK group were enrolled. CV was measured before surgery, 1 day, 1 week, 1 month and 3 months after surgery. Corneal volume of 5 mm in diameter (CV5) was defined as central area by measuring diameter, and corneal volume of 5 mm to 10 mm in diameter (CV5-10) was defined as peripheral area. Corneal volume reduction (delta CV), CH value and CRF value reduction (delta CH and delta CRF) before and after operation were calculated by measuring CH and CRF value with ORA. Results: 1. Corneal volume and angle increased with the analysis area. The thickness of the cornea increased with age, the volume and thickness of the cornea decreased with age, and the decrease of the peripheral area was greater than that of the central area. The 3/5/7 mm corneal volume (CV3/5/7) of the 6.5 mm group was less than that of the 6.2 mm group (all P 0.05), and the decrease of the corneal volume (CV3/5/7/10) of the 6.5 mm group was more than that of the 6.2 mm group (all P 0.05). CV3, CV5, CV7 and CV10 were positively correlated with CH and CRF values (all P 0.05). 3. On the first day after operation, CV values in the central and peripheral regions of SMILE group and FS-LASIK group decreased, and there was a significant difference between the two groups (P 0.05). Corneal volume increment in central area of SMILE group and FS-LASIK group was 0.11 (-0.16mm3) and 0.20 (-0.13mm3) at 3 months, respectively, with significant difference (P = 0.004); there was a strong negative correlation between Delta CV5 and delta SE in central area of SMILE group (r =-0.746, P 0.001; FS-LASIK group: R =-0.798, P 0.001); Delta CV5 and delta CRF, Delta CH in SMILE group were strong. There was a positive correlation (r = 0.498, P 0.001; r = 0.374, P 0.001), and only a positive correlation (r = 0.363, P = 0.012) between Delta CV5 and delta CRF in FS-LASIK group. Corneal volume and corneal biomechanical parameters were positively correlated. SMILE surgery could cause corneal biomechanical characteristics change, and the size of optical area had little effect on corneal biomechanics. The volume of cornea in SMILE group and FS-LASIK group fluctuated at the early stage after operation, and the volume of cornea decreased with the decrease of corneal biomechanical properties. There was a strong positive correlation between diopter.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
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