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

  更多相關(guān)文章： 年齡相關(guān)性白內(nèi)障 角膜散光 角膜Q值 非球面性

【摘要】：背景與目的 年齡相關(guān)性白內(nèi)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(shù)的進(jìn)步，我國人口的平均壽命也在不斷的延長。因而，年齡相關(guān)性白內(nèi)障的患病率也逐年增加。目前，對(duì)于白內(nèi)障的治療仍以手術(shù)為主，藥物僅用于白內(nèi)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(rèn)可。隨著現(xiàn)代人們生活水平的提高、白內(nèi)障手術(shù)技術(shù)和儀器設(shè)備的不斷改進(jìn)和完善，白內(nèi)障患者對(duì)術(shù)后視覺質(zhì)量的要求也日益增高。因此，白內(nèi)障手術(shù)已歸屬為屈光手術(shù)。如何提高白內(nèi)障患者術(shù)后人工晶體眼的視覺質(zhì)量是當(dāng)代眼科醫(yī)師所追求的一個(gè)新目標(biāo)。白內(nèi)障術(shù)后影響視覺質(zhì)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(yuǎn)視、近視和散光；而高階像差主要是角膜的球差。目前，對(duì)于白內(nèi)障患者實(shí)施人工晶狀體的植入，可以通過準(zhǔn)確的生物測量，較好的解決術(shù)前存在的近視和遠(yuǎn)視,而影響白內(nèi)障患者術(shù)后人工晶體眼成像質(zhì)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(nèi)障患者術(shù)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(shí)施白內(nèi)障手術(shù)時(shí)，針對(duì)不同的患者，合理的、個(gè)體化的設(shè)計(jì)白內(nèi)障術(shù)式和選擇適宜的非球面人工晶狀體，有計(jì)劃的解決角膜術(shù)前存在的散光和球差問題，為患者術(shù)后能夠擁有較好的視覺質(zhì)量奠定基礎(chǔ)。 目前，針對(duì)年齡相關(guān)性白內(nèi)障患者術(shù)前角膜屈光狀態(tài)及非球面性分析的研究報(bào)道主要是中國南部地區(qū)。中原地區(qū)的相關(guān)研究尚未見報(bào)道。因此，本課題主要是針對(duì)中原地區(qū)年齡相關(guān)性白內(nèi)障患者術(shù)前角膜屈光狀態(tài)及非球面性的特征進(jìn)行篩查分析，為白內(nèi)障患者手術(shù)方式的設(shè)計(jì)和人工晶狀體的選擇提供實(shí)驗(yàn)依據(jù)。 研究對(duì)象 本課題的篩選對(duì)象來自于2012年11月至2014年02月來鄭州大學(xué)第一附屬醫(yī)院住院的年齡相關(guān)性白內(nèi)障患者。病例入選標(biāo)準(zhǔn)：患者年齡在40～90歲的白內(nèi)障人群，術(shù)前眼軸長度（axial length,AL）在22～26mm之間，具有正常人的行為認(rèn)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(biāo)準(zhǔn)：術(shù)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(shù)及內(nèi)眼手術(shù)史的患者。 研究方法 所有患者在實(shí)施白內(nèi)障手術(shù)之前，都進(jìn)行了系統(tǒng)完善的術(shù)前檢查，包括裸眼視力、主覺驗(yàn)光、裂隙燈進(jìn)行眼前節(jié)的檢查、眼底檢查、角膜內(nèi)皮細(xì)胞計(jì)數(shù)、視覺電生理的測定、眼內(nèi)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(duì)于角膜的屈光狀態(tài)及非球面性特征的篩選，主要是依據(jù)Orbscan-Ⅱ眼前節(jié)分析儀所測得的數(shù)據(jù)，結(jié)合驗(yàn)光結(jié)果及IOLMaster生物測量所得到的角膜曲率綜合分析而確定的數(shù)值。記錄下角膜曲率、散光軸位、散光度數(shù)和角膜Q值。并對(duì)以上數(shù)據(jù)從年齡、性別和地域性(城、鄉(xiāng))這三個(gè)方面進(jìn)行統(tǒng)計(jì)分析，并分析角膜屈光狀態(tài)及非球面性的數(shù)值與這三因素之間的相關(guān)性。 統(tǒng)計(jì)學(xué)處理應(yīng)用SPSS16軟件包對(duì)數(shù)據(jù)進(jìn)行分析，計(jì)算均數(shù)、標(biāo)準(zhǔn)差。用K-S擬合優(yōu)度來檢驗(yàn)變量是否符合正態(tài)分布（α=0.05，PPα,差異具有統(tǒng)計(jì)學(xué)意義）；使用Pearson相關(guān)系數(shù)來評(píng)估均符合正態(tài)分布的雙變量之間的相關(guān)關(guān)系，使用Spearman秩相關(guān)系數(shù)來評(píng)估不全符合非正態(tài)分布的雙變量之間的相關(guān)關(guān)系（|r|≈1,相關(guān)關(guān)系越大，r0,正相關(guān)，r0，負(fù)相關(guān)；|r|≈0，無顯著相關(guān)關(guān)系。PP|r|,差異具有統(tǒng)計(jì)學(xué)意義）。 結(jié)果 按入選標(biāo)準(zhǔn)共篩查出年齡相關(guān)性白內(nèi)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(shù)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(guān)關(guān)系。術(shù)前的角膜散光度數(shù)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(zhuǎn)變；散光度數(shù)與年齡呈正相關(guān)（r=0.827，P=0.003），與性別和地域性的差異無顯著相關(guān)關(guān)系。術(shù)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(guān)關(guān)系。角膜曲率、散光度數(shù)和角膜Q值三者之間無顯著相關(guān)關(guān)系。 結(jié)論 1.年齡相關(guān)性白內(nèi)障人群術(shù)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(zhuǎn)變；約43.73％的患者需在手術(shù)當(dāng)中同時(shí)矯正角膜散光；角膜散光與年齡呈正相關(guān)，與性別和地域性的差別無相關(guān)關(guān)系。 2.年齡相關(guān)性白內(nèi)障人群術(shù)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(guān)關(guān)系。 3.年齡相關(guān)性白內(nèi)障人群術(shù)前角膜Q值的分布呈正態(tài)性分布，角膜Q值大多為負(fù)值，其值與年齡，性別和地域性等差別無顯著的相關(guān)關(guān)系。 4.年齡相關(guān)性白內(nèi)障人群術(shù)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(guān)關(guān)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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