本文關鍵詞：中原地區(qū)年齡相關性白內障人群術前角膜散光的分布及非球面性分析　出處：《鄭州大學》2014年碩士論文　論文類型：學位論文

  更多相關文章： 年齡相關性白內障 角膜散光 角膜Q值 非球面性

【摘要】：背景與目的 年齡相關性白內障（age-related cataract）是全球常見的致盲性眼病。隨著現(xiàn)代生活水平的提高及醫(yī)療技術的進步，我國人口的平均壽命也在不斷的延長。因而，年齡相關性白內障的患病率也逐年增加。目前，對于白內障的治療仍以手術為主，藥物僅用于白內障的初發(fā)期延緩病程的發(fā)展，但其療效尚未得到眼科醫(yī)師的一致認可。隨著現(xiàn)代人們生活水平的提高、白內障手術技術和儀器設備的不斷改進和完善，白內障患者對術后視覺質量的要求也日益增高。因此，白內障手術已歸屬為屈光手術。如何提高白內障患者術后人工晶體眼的視覺質量是當代眼科醫(yī)師所追求的一個新目標。白內障術后影響視覺質量的主要因素是像差。像差分為低階像差和高階像差。低階像差主要是屈光不正，，即遠視、近視和散光；而高階像差主要是角膜的球差。目前，對于白內障患者實施人工晶狀體的植入，可以通過準確的生物測量，較好的解決術前存在的近視和遠視,而影響白內障患者術后人工晶體眼成像質量的主要因素是角膜的屈光狀態(tài)和角膜的非球面性。因此，只有充分了解白內障患者術前存在的角膜屈光狀態(tài)和角膜的非球面性特征即角膜Q值，才能在實施白內障手術時，針對不同的患者，合理的、個體化的設計白內障術式和選擇適宜的非球面人工晶狀體，有計劃的解決角膜術前存在的散光和球差問題，為患者術后能夠擁有較好的視覺質量奠定基礎。 目前，針對年齡相關性白內障患者術前角膜屈光狀態(tài)及非球面性分析的研究報道主要是中國南部地區(qū)。中原地區(qū)的相關研究尚未見報道。因此，本課題主要是針對中原地區(qū)年齡相關性白內障患者術前角膜屈光狀態(tài)及非球面性的特征進行篩查分析，為白內障患者手術方式的設計和人工晶狀體的選擇提供實驗依據。 研究對象 本課題的篩選對象來自于2012年11月至2014年02月來鄭州大學第一附屬醫(yī)院住院的年齡相關性白內障患者。病例入選標準：患者年齡在40～90歲的白內障人群，術前眼軸長度（axial length,AL）在22～26mm之間，具有正常人的行為認知能力，依從性佳，患者瞼裂能夠充分開大，角膜透明且淚膜完整。病例排除標準：術前有影響角膜屈光狀態(tài)的疾病，如眼外傷、青光眼及高眼壓征、角膜變性混濁、翼狀胬肉、圓錐角膜、干眼癥[1-7]等以及有角膜屈光手術及內眼手術史的患者。 研究方法 所有患者在實施白內障手術之前，都進行了系統(tǒng)完善的術前檢查，包括裸眼視力、主覺驗光、裂隙燈進行眼前節(jié)的檢查、眼底檢查、角膜內皮細胞計數、視覺電生理的測定、眼內壓的測量及眼部B超的檢查；Orbscan-Ⅱ眼前節(jié)分析儀以及IOLMaster生物測量儀的檢測。對于角膜的屈光狀態(tài)及非球面性特征的篩選，主要是依據Orbscan-Ⅱ眼前節(jié)分析儀所測得的數據，結合驗光結果及IOLMaster生物測量所得到的角膜曲率綜合分析而確定的數值。記錄下角膜曲率、散光軸位、散光度數和角膜Q值。并對以上數據從年齡、性別和地域性(城、鄉(xiāng))這三個方面進行統(tǒng)計分析，并分析角膜屈光狀態(tài)及非球面性的數值與這三因素之間的相關性。 統(tǒng)計學處理應用SPSS16軟件包對數據進行分析，計算均數、標準差。用K-S擬合優(yōu)度來檢驗變量是否符合正態(tài)分布（α=0.05，PPα,差異具有統(tǒng)計學意義）；使用Pearson相關系數來評估均符合正態(tài)分布的雙變量之間的相關關系，使用Spearman秩相關系數來評估不全符合非正態(tài)分布的雙變量之間的相關關系（|r|≈1,相關關系越大，r0,正相關，r0，負相關；|r|≈0，無顯著相關關系。PP|r|,差異具有統(tǒng)計學意義）。 結果 按入選標準共篩查出年齡相關性白內障患者404例（558只眼），年齡40～86歲，平均為（65.54±10.91）歲。其中，40～49歲患者42例（54只眼），50～59歲患者74例（102只眼），60～69歲患者112例（146只眼），70～79歲患者152例（222只眼），80～86歲患者24例（34只眼）。術前的角膜曲率為40.25～52.30D，平均（45.12±2.05）D，呈正態(tài)性分布（P=0.33）；其值與年齡，性別和地域的差異無顯著地相關關系。術前的角膜散光度數為0.1～4.5D，平均（1.04±0.77）D，呈非正態(tài)性分布（P=0.00）。其中大于等于1.0D的有244只眼，占43.73％；順規(guī)散光約占38.71％，逆規(guī)散光約占43.73％，斜軸散光約占17.56％，且隨著年齡的增長，散光分布由順規(guī)性散光向逆規(guī)性散光轉變；散光度數與年齡呈正相關（r=0.827，P=0.003），與性別和地域性的差異無顯著相關關系。術前角膜Q值為為-0.75～+0.6，平均（-0.21±2.23），呈正態(tài)性分布；其值與年齡，性別和地域性的差異無顯著相關關系。角膜曲率、散光度數和角膜Q值三者之間無顯著相關關系。 結論 1.年齡相關性白內障人群術前角膜散光的分布呈非正態(tài)性分布；隨著年齡的增長，散光分布由順規(guī)性散光向逆規(guī)性散光轉變；約43.73％的患者需在手術當中同時矯正角膜散光；角膜散光與年齡呈正相關，與性別和地域性的差別無相關關系。 2.年齡相關性白內障人群術前角膜曲率的分布呈正態(tài)性分布，角膜曲率值與年齡、性別和地域性等差別無顯著的相關關系。 3.年齡相關性白內障人群術前角膜Q值的分布呈正態(tài)性分布，角膜Q值大多為負值，其值與年齡，性別和地域性等差別無顯著的相關關系。 4.年齡相關性白內障人群術前的角膜散光、角膜曲率和角膜Q值，這三者之間均無顯著的相關關系。
[Abstract]:Background and purpose
Age related cataract (age-related cataract) is a global common cause of blindness. With the improvement of modern life and the progress of medical technology, the average life expectancy of China's population is constantly extended. Thus, the prevalence of age-related cataract has increased year by year. At present, for the treatment of cataract surgery is the only drug. In the early stage of cataract and delay the development of the course, but its efficacy has not been recognized by ophthalmologists. With the improvement of people's living standard, the cataract surgery technology and equipment of continuous improvement, but also increasing demand for cataract patients with postoperative visual quality. Therefore, cataract surgery has been attributed to refractive surgery how to improve the patients after phacoemulsification. Pseudophakic visual quality is a new goal of modern ophthalmologists pursuit. Effects of after cataract surgery The main factors of visual quality is divided into low order aberration. Aberrations and higher-order aberrations. Low order aberration is mainly the ametropia, hyperopia, myopia and astigmatism and higher-order aberrations; mainly corneal spherical aberration. At present, for the implementation of intraocular lens implantation in cataract patients, through biological measurement accurate, there is better the preoperative myopia and hyperopia, and the main factors affecting the imaging quality of pseudophakic patients after phacoemulsification is corneal asphericity and corneal refractive status. Therefore, only fully understand the aspherity characteristics of cataract patients with preoperative corneal refraction and corneal corneal Q value, in order to implement cataract surgery, different patients, reasonable design, personalized cataract surgery and suitable aspheric intraocular lens, there are plans to solve the problems of preoperative corneal astigmatism and ball The problem is the basis for the patient to have better visual quality after operation.
At present, the cataract surgery corneal refractive status and analysis of asphericity study reported mainly in the southern region of the Central Plains region. Chinese related research has not been reported. Therefore, this project is mainly aimed at screening analysis of patients with age-related cataract in the Central Plains corneal refractive status and characteristics of the asphericity. To provide the experimental basis for the design of operative method in patients with cataract and intraocular lens.
Research object
Screening of this subject from November 2012 to 2014 for 02 months in the First Affiliated Hospital of Zhengzhou University hospitalized patients with age-related cataract. Inclusion criteria: patients aged 40 ~ 90 years old cataract patients, the preoperative axial length (axial, length, AL) between 22 ~ 26mm, with normal human behavior cognitive ability. Good compliance of patients, palpebral fissure can be fully open, transparent and corneal tear film integrity. Exclusion criteria: effects of corneal refraction surgery, such as ocular trauma, glaucoma and ocular hypertension syndrome, degeneration of corneal opacity, pterygium, keratoconus, and [1-7] patients with dry eye and corneal refractive surgery in eyes operation history.
research method
All of the patients before cataract surgery, were perfect preoperative examination, including visual acuity, refraction, slit lamp anterior segment examination, fundus examination, corneal endothelial cell count, determination of visual electrophysiology, measurement of intraocular pressure and ocular B ultrasound examination; Orbscan- II anterior segment analyzer IOLMaster and biological measurement instrument for screening detection. The refraction and corneal aspherity characteristics, is mainly based on the measured Orbscan- II anterior segment analyzer data, combined with the results of optometry and IOLMaster biological measurement of corneal curvature analysis and determine the numerical record. Corneal curvature, axial astigmatism, astigmatism the degree and the corneal Q value. And the data from the age, gender and regional (City, township) of the three aspects of statistical analysis, and analysis of corneal refractive status and asphericity and the numerical The correlation between the three factors.
Statistical analysis using SPSS16 software package for data analysis, the calculation of mean and standard deviation by K-S. The goodness of fit to test whether the variables with normal distribution (alpha =0.05, alpha PP, the difference was statistically significant); using Pearson correlation coefficient to assess compliance with the relevant relationship between the two variables of normal distribution and use Spearman rank correlation coefficient to evaluate the correlation between the non normal distribution of the two variables (|r| = 1, the correlation is large, R0, R0, positive correlation, negative correlation; |r| = 0, no significant correlation between.PP|r|, the difference was statistically significant).
Result
鎸夊叆閫夋爣鍑嗗叡絳涙煡鍑哄勾榫勭浉鍏蟲

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