發(fā)布時(shí)間：2018-04-13 05:26

  本文選題：近視 + 角膜形狀��； 參考：《天津醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的：研究角膜前表面形態(tài)與角膜高階像差間的相關(guān)關(guān)系,及角膜屈光手術(shù)前后角膜像差與全眼像差的變化與作用機(jī)制。 方法：橫斷面研究,隨機(jī)收集本中心近視患者57例(57眼)。用Pentacam三維眼前節(jié)分析診斷系統(tǒng)(Oculus GmbH, Wetzlar,德國(guó))獲取角膜表面變異系數(shù)(index of surface variance, ISV),角膜高度的非對(duì)稱(chēng)指數(shù)(index of height asymmetry, IHA)、角膜前表面的非球面系數(shù)(Q值)及角膜像差。采用SPSS統(tǒng)計(jì)學(xué)分析軟件(17.0版)對(duì)各指數(shù)與角膜各高階像差及各Zernike項(xiàng)之間的關(guān)系進(jìn)行Pearson相關(guān)分析。另前瞻性研究,隨機(jī)收集行機(jī)械法準(zhǔn)分子激光上皮下角膜磨鑲術(shù)(Epipolis laser in keratomileusis, Epi-LASIK)近視眼患者31例(31眼),用Wavescan波前像差儀(VISX, Santa Clara, CA, USA)測(cè)量全眼像差,采用配對(duì)t檢驗(yàn)比較手術(shù)前后各項(xiàng)像差的變化,獨(dú)立樣本t檢驗(yàn)比較角膜和全眼像差的差異,逐步回歸分析手術(shù)前后總高階像差以及補(bǔ)償因子影響最大的像差項(xiàng)。以P0.05表示有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.近視眼患者整體像差特征：近視眼患者Sh、Z31及Z40在角膜與全眼差異有統(tǒng)計(jì)學(xué)意義(P=0.000, P=0.017, P=0.000)。Z3-1在角膜與全眼差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.202)�？偢唠A像差補(bǔ)償因子的逐步回歸方程為：CF(Sh)=0.033+0.466Z40(全眼)+0.048Z3-1(全眼)。總高階像差的逐步回歸方程為：RMS (Sh)=0.162+0.740Z3-1(全眼)+0.492Z40(全眼)。 2.角膜形態(tài)指標(biāo)與角膜像差作用機(jī)制：①I(mǎi)SV與垂直彗差(Z3-1)、水平彗差(Z31)呈正相關(guān)(r=0.389,P=0.003; r=0.594, P=0.000),與球差(Z40)呈負(fù)相關(guān)(r=-0.400,P=0.002)。ISV與角膜第三階高階像差(S3)呈正相關(guān)(r=0.683,P=0.000),與角膜第四階高階像差(S4)呈負(fù)相關(guān)(r=-0.373,P=0.004)。②IHA與Z3-1呈正相關(guān)(r=0.446,P=0.001),與角膜S3呈正相關(guān)(r=0.445,P=0.001)。③Q值與Z40呈正相關(guān)(r-=0.849,P=0.000),與角膜S4呈明顯正相關(guān)(r=0.761, P=0.000)。ISV與Q值呈負(fù)相關(guān)(r=-0.508,P=0.000)。 3.角膜屈光手術(shù)前后角膜與全眼像差變化及補(bǔ)償機(jī)制：①總高階像差Sh在角膜、全眼均較術(shù)前顯著增加(P--0.000,P=0.000)。垂直彗差Z3-1在角膜和全眼均較術(shù)前顯著增加(P=0.000,P=0.000)。水平彗差Z31在角膜與全眼均較術(shù)前顯著增加(P=0.001,P=0.002)。球差Z40在角膜、全眼均較術(shù)前顯著增加(P=0.000,P=0.000)。術(shù)后Sh、Z3-1、Z40在角膜與全眼差異均有統(tǒng)計(jì)學(xué)意義(P=0.000,P=0.000,P=0.000)。術(shù)后Z31在角膜與全眼差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.064)。②角膜屈光手術(shù)后總高階CF的逐步回歸方程是：CF (Sh)=0.272+0.170Z40+0.112Z3-1。術(shù)后總高階像差逐步回歸方程：RMS (Sh)=0.095+0.427Z40(全眼)+0.352Z3-1(全眼)+0.252Z31(全眼)+0.201Sh(角膜)。 結(jié)論： 1.角膜形態(tài)與角膜像差作用分析：①角膜曲率作為角膜形態(tài)因素之一,其變異程度與角膜Z3-1、Z31以及Z40。密切相關(guān),ISV結(jié)合柱鏡度可以為臨床醫(yī)生從角膜形態(tài)推斷角膜高階像差以及可能的視覺(jué)質(zhì)量提供一定的理論依據(jù)。②IHA、角膜Z3-1等參數(shù)可作為角膜上下高度不對(duì)稱(chēng)的角膜疾病的輔助診斷指標(biāo)。③基于本研究ISV與Q值以及球差的相關(guān)關(guān)系,提示形態(tài)因子ISV也可作為選擇Q值引導(dǎo)角膜屈光手術(shù)的參考指標(biāo)之一。 2.角膜屈光手術(shù)前后角膜與全眼像差變化及補(bǔ)償機(jī)制：①通過(guò)角膜像差與全眼像差的分布,可以初步估計(jì)其補(bǔ)償或迭加,而補(bǔ)償因子的計(jì)算能夠具體描述個(gè)體補(bǔ)償能力的強(qiáng)弱。②角膜屈光手術(shù)后眼內(nèi)對(duì)角膜垂直彗差補(bǔ)償能力增強(qiáng)。③在將角膜和全眼的Z3-1,Z31,Z40納入總高階像差的回歸分析時(shí),對(duì)總高階像差補(bǔ)償能力貢獻(xiàn)越弱的像差項(xiàng),對(duì)全眼總高階像差影響相對(duì)較大。
[Abstract]:Objective: To study the corneal surface morphology and the relationship between corneal higher-order aberrations, changes of corneal aberration and ocular aberration and mechanism before and after corneal refractive surgery.
Methods: a cross-sectional study, 57 cases were randomly collected from the center of myopic patients (57 eyes). Analysis of diagnostic system of Pentacam anterior segment (Oculus GmbH, Wetzlar, Germany) to obtain the corneal surface coefficient of variation (index of surface variance, ISV), non symmetry index (index of height corneal height asymmetry, IHA), non the surface of the anterior corneal spherical coefficient (Q value) and corneal aberration. Using SPSS statistical analysis software (version 17) by Pearson analysis of the relationship between the index and the corneal aberrations and Zernike. Other prospective studies were collected for Epipolis laser epithelial keratomileusis (Epipolis laser in keratomileusis, Epi-LASIK) in 31 cases of myopia patients (31 eyes), Wavescan aberrometer (VISX Santa, Clara, CA, USA) measurement of ocular aberrations, paired t test to compare the aberrations before and after surgery, alone Independent samples t test comparison between corneal and ocular aberrations, stepwise regression analysis before and after the operation of total higher order aberrations and the compensation factor. The largest aberration in P0.05 was statistically significant.
Result錛，

本文編號(hào)：1743120