本文選題：近視　切入點(diǎn)：角膜　出處：《天津醫(yī)科大學(xué)》2011年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：分析和探討幾種準(zhǔn)分子激光角膜屈光手術(shù)(Epi-LASIK、LASIK、SBK)前后角膜生物力學(xué)特性變化的情況,并分析其相關(guān)因素。 方法：前瞻性研究。首先隨機(jī)選擇在天津市眼科醫(yī)院屈光手術(shù)中心接受手術(shù)的89例(160眼)中度近視患者,其中行Epi-LASIK術(shù)36例(65眼),LASIK術(shù)34例(63眼),SBK術(shù)19例(32眼)；其次選取接受SBK手術(shù)的高度近視患者32例(57眼),另選取低中度近視18人(33眼)做為對(duì)照組。分別于術(shù)前后應(yīng)用眼反應(yīng)分析儀(ORA)測(cè)量模擬Goldmann眼壓(IOPg)、角膜補(bǔ)償眼壓(IOPcc)、角膜阻力因子(CRF)、角膜滯后量(CH)及內(nèi)向壓平時(shí)間(TimeIn)和外向壓平時(shí)間(TimeOut)。應(yīng)用配對(duì)t檢驗(yàn)分析各組手術(shù)前后角膜生物力學(xué)參數(shù)和獨(dú)立樣本t檢驗(yàn)比較各組及兩組之間術(shù)后不同時(shí)間的變化值,應(yīng)用Pearson線(xiàn)性相關(guān)分析其相關(guān)因素。 結(jié)果：1. Epi-LASIK組術(shù)前與術(shù)后1個(gè)月之間的IOPcc無(wú)統(tǒng)計(jì)學(xué)意義(t=0.50,P=0.620),余參數(shù)于手術(shù)前后均有統(tǒng)計(jì)學(xué)意義(P0.01)；1周與1個(gè)月間IOPg、 TimeIn、TimeOut和CH-CRF有統(tǒng)計(jì)學(xué)意義(t=-2.50,P=0.014；t=-2.49,P=0.015；t=-2.87,P=0.005：t=2.386,P=0.019)。 2. LASIK組手術(shù)前后各參數(shù)有統(tǒng)計(jì)學(xué)意義(P0.01),術(shù)后1周與1個(gè)月間TimeOut和TimeOut-TimeIn有統(tǒng)計(jì)學(xué)意義(t=-2.82,P=0.006；t=-2.02,P=0.046),余參數(shù)均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 3.SBK組手術(shù)前后各參數(shù)有統(tǒng)計(jì)學(xué)意義(P0.01),術(shù)后1周與1個(gè)月間各參數(shù)無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；高度組術(shù)后CRF、CH、TimeOut值顯著低于對(duì)照組(t=-2.66,P=0.010；t=-5.07,P=0.000；t=-2.91,P=0.005),高度組ΔCRF、 ΔCH、TimeOut明顯高于對(duì)照組(t=2.00,P=0.048；t=3.14,P=0.002；t=2.78,P=0.007)。 4.術(shù)后1周時(shí),Epi-LASIK與SBK組間角膜生物力學(xué)參數(shù)及其變化量無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；1個(gè)月時(shí)IOPcc、TimeIn、CH-CRF、TimeOut-TimeIn、AIOPg、 AIOPcc、ACRF、ATimeIn、A(CH-CRF)與A(TimeOut-TimeIn)有統(tǒng)計(jì)學(xué)意義(t=2.34,P=0.022；t=2.32,P=0.024；t=-2.44,P=0.018；t=-2.30,P=0.025；t=-4.43,P=0.000；t=-4.35,P=0.000；t=-2.06,P=0.044；t=-4.06,P=0.000；t=4.64,P=0.000；t＝4.48,P=0.000)。術(shù)后1周時(shí),LASIK與SBK組間IOPcc有統(tǒng)計(jì)學(xué)意義(t=-2.04,P=0.045)；1個(gè)月時(shí)IOPg、IOPcc、CH、TimeOut、CH-CRF和TimeOut-TimeIn有統(tǒng)計(jì)學(xué)意義(t=-2.40,P=0.019-t=-2.89,P=0.005；t=2.27,P=0.027；t=2.90,P=0.005；t=2.65,P=0.010；t=2.71,P=0.009)。 5.中度近視Epi-LASIK組術(shù)后各參數(shù)變化量與切削量(ablation depth, AD)無(wú)明顯相關(guān)性(P0.05)；術(shù)后1周時(shí),LASIK組ACRF、ACH、ATimeOut值與AD呈正相關(guān)(r=0.419,P=0.005；r=0.386,P=0.010；r=0.447,P=0.002),SBK組ATimeOut值與AD呈正相關(guān)(r=0.385,P=0.039),1個(gè)月時(shí)無(wú)明顯相關(guān)(P0.05)。高度組術(shù)后AIOPg、ACRF、ATimeIn與AD呈正相關(guān)(r=0.335,P=0.011; r=0.427, P=0.001; r=0.338, P=0.010), A(CH-CRF)、A(TimeOut-TimeIn)與AD呈負(fù)相關(guān)(r=-0.286,P=0.031r=-0.306,P=0.020)；對(duì)照組ATimeOut與AD呈正相關(guān)(r=0.548,P=0.003)。 結(jié)論：1. Epi-LASIK、LASIK、SBK三組手術(shù)前后角膜生物力學(xué)變化顯示,角膜屈光手術(shù)方式對(duì)眼壓、角膜整體抵抗能力、角膜變形能力及變形后復(fù)原能力的影響明顯不同：角膜常規(guī)板層手術(shù)大于薄瓣板手術(shù),薄瓣板層手術(shù)大于表層手術(shù)。 2. Epi-LASIK術(shù)后角膜生物力學(xué)參數(shù)隨時(shí)間變化呈恢復(fù)趨勢(shì),角膜板層手術(shù)(LASIK與SBK)術(shù)后角膜生物力學(xué)參數(shù)隨時(shí)間變化不明顯,可能與不同的角膜愈合反應(yīng)有關(guān)。 3.術(shù)后不同時(shí)期Epi-LASIK、LASIK、SBK三組手術(shù)切削量與角膜生物力學(xué)參數(shù)變化量不同的相關(guān)關(guān)系說(shuō)明：術(shù)后1周時(shí)角膜生物力學(xué)變化受手術(shù)方式、切削量影響明顯：角膜板層手術(shù)較角膜表層手術(shù)明顯,薄瓣板層手術(shù)較常規(guī)板層手術(shù)明顯,隨著時(shí)間變化該相關(guān)性不明顯。 4.高度近視組對(duì)眼壓值、角膜整體抵抗能力、角膜滯后量、角膜變形能力及變形后復(fù)原能力等生物力學(xué)的影響明顯大于對(duì)照組,且與切削量有一定的相關(guān)性,說(shuō)明屈光手術(shù)中角膜切削量越大,基質(zhì)切削越深,對(duì)角膜生物力學(xué)特性的影響越明顯。
[Abstract]:Objective: to analyze and discuss the changes of corneal biomechanical properties before and after several Epi-LASIK LASIK (SBK) and analyze the related factors.
Methods: a prospective study. First randomly selected surgery in Tianjin Ophthalmological Hospital refractive surgery center of 89 cases (160 eyes) of myopia, including 36 cases of Epi-LASIK patients (65 eyes), 34 cases of LASIK patients (63 eyes), 19 cases of SBK patients (32 eyes); secondly, selecting 32 high myopia patients received SBK the surgery patients (57 eyes), there were 18 people in low and moderate myopia (33 eyes) as control group. The application of ocular response analyzer (ORA) before and after operation were measured to simulated Goldmann (IOPg), intraocular pressure, corneal compensated intraocular pressure (IOPcc) and corneal resistance factor (CRF), CH (membrane lag angle) and time (TimeIn) and inward applanation applanation time (TimeOut). Outside groups were analyzed using the paired t test before and after the operation of corneal biomechanical parameters and independent samples t test were compared between the two groups and postoperative changes in different time values, using Pearson linear correlation analysis of the related factors.
Results: 1 months after the operation there was no statistical significance of IOPcc 1. Epi-LASIK before surgery (t=0.50, P=0.620), more than the parameters before and after operation were statistically significant (P0.01); 1 weeks and 1 months between IOPg, TimeIn, TimeOut and CH-CRF were statistically significant (t=-2.50, P=0.014; t= -2.49 P=0.015; t=-2.87, P=0.005:t=2.386, P=0.019).
2. LASIK group before and after surgery, the parameters were statistically significant (P0.01), TimeOut and TimeOut-TimeIn were statistically significant (t=-2.82, P=0.006, t=-2.02, P=0.046) between 1 weeks and 1 months after operation, and the remaining parameters were not statistically significant (P0.05).
The 3.SBK group before and after operation parameters were statistically significant (P0.01), after 1 weeks and 1 months between the parameters had no statistical significance (P0.05); high group after CRF, CH, TimeOut was significantly lower than that of the control group (t=-2.66, P=0.010; t=-5.07, P=0.000; t=-2.91, P=0.005), group CRF was highly. CH, TimeOut was significantly higher than the control group (t=2.00, P=0.048; t=3.14, P=0.002; t=2.78, P=0.007).
1 weeks after the 4. surgery, the corneal biomechanical parameters and changes in the amount of Epi-LASIK and SBK between the groups was not statistically significant (P0.05); 1 months IOPcc, TimeIn, CH-CRF, TimeOut-TimeIn, AIOPg, AIOPcc, ACRF, ATimeIn, A (CH-CRF) and A (TimeOut-TimeIn) had statistical significance (t=2.34, t=2.32, P=0.022; P=0.024; t=-2.44, P=0.018; t=-2.30, P=0.025; t=-4.43, P=0.000; t=-4.35, P=0.000; t=-2.06, P=0.044; t=-4.06, P=0.000; t=4.64, P=0.000; t = 4.48, P=0.000). 1 weeks after the operation, LASIK and SBK group IOPcc was statistically significant (t=-2.04, P=0.045); 1 months IOPg IOPcc, CH, TimeOut, CH-CRF and TimeOut-TimeIn, there was statistical significance (t=-2.40, P=0.019-t=-2.89, P=0.005; t=2.27, P=0.027; t=2.90, P=0.005; t=2.65, P=0.010; t=2.71, P=0.009).
The amount of the changes of the parameters of 5. moderate myopia after operation in Epi-LASIK group and cutting (ablation depth, AD) had no significant correlation (P0.05); 1 weeks after operation, LASIK group ACRF, ACH, ATimeOut value was positively correlated with AD (r=0.419, P=0.005; r=0.386, P=0.010; r=0.447, P=0.002), SBK group ATimeOut value positively with AD (r=0.385, P=0.039), 1 months had no significant correlation (P0.05). The height of group after AIOPg, ACRF, ATimeIn was positively correlated with AD (r=0.335, P=0.011; r=0.427, P=0.001; r=0.338, P=0.010), A (CH-CRF), A (TimeOut-TimeIn) was negatively correlated with AD (r=-0.286 P=0.031r=-0.306, P=0.020, ATimeOut); the control group was positively correlated with AD (r=0.548, P=0.003).
Conclusion: 1. Epi-LASIK, LASIK, SBK showed corneal biomechanical changes before and after the operation of the three groups, the corneal refractive surgery on intraocular pressure, corneal overall resistance, impact resilience deformation and the deformation of the cornea was different: corneal lamellar surgery than conventional thin flap in surgery, surgery is more than the surface layer in the thin flap surgery.
After 2. Epi-LASIK, corneal biomechanical parameters showed a trend of recovery with time. Corneal biomechanical parameters after corneal lamellar surgery (LASIK and SBK) did not change significantly with time, which may be related to different corneal healing reactions.
Epi-LASIK, 3. LASIK after operation in different periods, show the correlation between the changes of SBK three group of surgery cutting quantity and corneal biomechanical parameters of different amount: 1 weeks after operation of corneal biomechanical changes by surgery, cutting the amount of influence: lamellar corneal surface ablation surgery is more obvious, thin flap lamellar lamellar operation than conventional surgery obviously, with the change of time the correlation is not obvious.
4. high myopia group on intraocular pressure, corneal resistance ability, corneal hysteresis, corneal deformation capacity and deformation influence resilience biomechanics significantly higher than the control group, and there is a certain correlation with the amount of cutting, that cornea cutting larger matrix cutting deeper influence on the biomechanical properties of the cornea the more obvious.

【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】：2011
【分類(lèi)號(hào)】：R779.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 吳凌;樊瑜波;鄧應(yīng)平;陳曉明;孫曉萍;謝毅;鄒遠(yuǎn)文;黃學(xué)進(jìn);;兔眼LASIK術(shù)后角膜厚度和壓力的關(guān)系[J];國(guó)際眼科雜志;2007年05期

2 王愛(ài)玉;陳維毅;賀瑞;王曉君;劉春生;;兔眼LASIK術(shù)后角膜生物力學(xué)特性的實(shí)驗(yàn)研究[J];生物醫(yī)學(xué)工程學(xué)雜志;2009年02期

3 楊堅(jiān),曾衍鈞,李志輝;人角膜的生物力學(xué)特性[J];生物物理學(xué)報(bào);1999年01期

4 王秀玲;李爽;;正常與病態(tài)眼角膜拉伸力學(xué)的特性[J];中國(guó)組織工程研究與臨床康復(fù);2010年46期

5 陳躍國(guó);;薄瓣是準(zhǔn)分子激光原位角膜磨鑲術(shù)的發(fā)展趨勢(shì)[J];眼科;2010年03期

，

本文編號(hào)：1558774