本文選題：角膜塑型鏡 + 近視��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：第一部分角膜塑形鏡對角膜徑線屈光力的影響及與眼軸增長的相關(guān)性目的探討兒童配戴角膜塑形鏡(OK鏡)后角膜各徑線屈光力分布特點(diǎn)及徑線屈光力變化與眼軸增長的相關(guān)性方法32名9-14歲兒童驗(yàn)配OK鏡。入選條件：最佳矯正視力≥20/20；等效球鏡屈光度(SER)-1.00--4.50D；順規(guī)散光≤-1.50D；角膜中央屈光力41.5-44.5D；無遠(yuǎn)近顯斜視；既往未使用角膜接觸鏡或其它近視控制療法；無活動性眼部炎癥及影響淚膜的眼表疾病。戴鏡前,戴鏡后3月、6月、12月、18月、24月隨訪評估裸眼視力、裂隙燈熒光染色、眼軸長度(AL)、角膜地形圖等。角膜地形圖上以角膜頂點(diǎn)為中心,每隔lmm記錄鼻側(cè)、顳側(cè)和下方三個徑線上的角膜矢向屈光力(N1～N4, T1～T4,I1～I(xiàn)4),取三條徑線屈光力相對角膜頂點(diǎn)屈光力(Apex)增加值最大的點(diǎn)記為maxN, maxT和maxI。分別計(jì)算Apex, maxN, maxT和maxI的計(jì)算組內(nèi)標(biāo)準(zhǔn)差、重測重復(fù)性和變異系數(shù),考察測量值的可重復(fù)性。按照三種分組方式,即小于或大于maxN, maxT, maxI均值分別將完成研究者分為兩組(組1,組2),重復(fù)測量方差分析(ANOVA)分別比較三種分組方式組1和組2的AL增長。Pearson相關(guān)檢驗(yàn)maxN, maxT, maxI與AL增長的相關(guān)性。p0.05視為有顯著性差異。結(jié)果27名兒童完成2年隨訪研究,共14男13女,起始年齡、SER、AL、角膜頂點(diǎn)屈光力分別為10.4±1.2歲,-2.57±0.90 D,24.50±0.60 mm,43.46±1.02 D;三種分組方式兩亞組比較基線數(shù)據(jù)值均無顯著差異。3次重復(fù)測量Apex,maxN, maxT和maxI均無顯著差異(p≥0.93)。Apex, maxN, maxT, maxI的重測重復(fù)性值分別為0.06D,0.27D,0.18D,0.44D；變異系數(shù)分別為0.05%,0.22%,0.16%,0.36%。戴鏡后鼻側(cè)2mm和3mm,顳側(cè)3mm,下方2mm、3mm、4mm處屈光力相對角膜頂點(diǎn)屈光力顯著增大(p0.05)。24月隨訪期內(nèi)AL顯著延長(p0.001)。三種分組方式均對AL延長量有顯著影響(鼻側(cè)p=0.001;顳側(cè)p=0.011;下方p=0.001);三條徑線上組2的AL延長量較組1少54%-69%。maxN, maxT和maxI均與2年AL延長量負(fù)相關(guān)(p0.05)。結(jié)論配戴OK鏡后Apex, maxN, maxT和maxI測量值具有良好的可重復(fù)性。戴鏡后各徑線角膜周邊屈光力顯著大于中央屈光力。徑線角膜相對周邊屈光力變化最大值與眼軸增長量負(fù)相關(guān)。均與2年AL延長量負(fù)相關(guān)(p0.05)。第二部分角膜塑形鏡對角膜屈光力相對近視漂移的影響及與眼軸增長的相關(guān)性目的探討配戴OK鏡后角膜環(huán)平均屈光力的分布特點(diǎn)。探討角膜屈光力相對近視漂移(CPRMS)對眼軸增長的影響。方法88名7-12歲兒童驗(yàn)配OK鏡,入選條件：最佳矯正視力≥20/20；SER-1.00～-4.50D：順規(guī)散光≤-1.50D；角膜中央屈光力41.5～44.5D；無遠(yuǎn)近顯斜視；既往未使用角膜接觸鏡或其它近視控制療法；無活動性眼部炎癥及影響淚膜的眼表疾病。戴鏡前,戴鏡后3月、6月、12月、18月和24月隨訪評估視力、擴(kuò)瞳自動驗(yàn)光、裂隙燈熒光染色、AL、角膜地形圖等。Pentacam眼前節(jié)分析系統(tǒng)測量以角膜頂點(diǎn)為圓心,直徑0.5-7.2m(每個環(huán)直徑間隔0.1mm)環(huán)平均屈光力和角膜頂點(diǎn)屈光力(Apex),戴鏡后環(huán)平均屈光力與角膜頂點(diǎn)屈光力比較(單因素ANOVA, Bonferroni檢驗(yàn))。角膜頂點(diǎn)屈光力和環(huán)平均屈光力輸入MATLAB,樣條插值法計(jì)算角膜屈光力相對近視漂移(CPRMS).比較各隨訪時間點(diǎn)SER、AL、角膜頂點(diǎn)屈光力、AL增長、角膜頂點(diǎn)屈光力變化(CAPC)和CPRMS(重復(fù)測量ANOVA, Bonferroni檢驗(yàn))。比較戴鏡后各環(huán)平均屈光力與角膜頂點(diǎn)屈光力(單因素ANOVA, Bonferroni檢驗(yàn))。控制年齡、性別的影響,偏相關(guān)分析分別檢驗(yàn)暗瞳直徑、基線SER、CPRMS、CAPC與2年眼軸延長量的相關(guān)性。Pearson相關(guān)檢驗(yàn)CAPC與CPRMS相關(guān)性。p0.05視為有顯著性差異。結(jié)果完成2年隨訪研究者(64人)基線年齡、性別(男/女)、SER、AL、角膜頂點(diǎn)屈光力分別為：9.6±1.7歲、23/41、-2.88±0.96D、24.53±0.61mm、43.47±1.03D,與脫落者(24人)比較各基線數(shù)據(jù)統(tǒng)計(jì)值均無顯著差異。64人SER由-2.88±0.96D降至戴鏡3月-0.20±0.85D,以后各時間點(diǎn)無顯著差異(p≥0.453)：2年AL延長0.37±0.27mm,18月、24月AL比基線顯著增長(p0.05);CAPC戴鏡3月后2.86±1.01D,以后各時間點(diǎn)無顯著差異(p≥0.229);CPRMS戴鏡3月10.84±5.28D·mm,以后各時間點(diǎn)無顯著差異(p0.999)。戴鏡3月角膜頂點(diǎn)屈光力由43.47±1.03D降至40.61±1.23D,環(huán)平均屈光力中央到周邊逐漸增大,直徑5.8m環(huán)達(dá)最大值42.80±1.O1D,其中2.8-7.2m環(huán)平均屈光力顯著大于角膜頂點(diǎn)屈光力(p0.05)。暗瞳直徑與AL增長量無顯著相關(guān)性(p=0.169);基線SER與AL增長量顯著正相關(guān)(p=0.042,r=0.298)；CPRMS與眼軸增長量顯著負(fù)相關(guān)(p0.001,r=0.624)；CAPC與眼軸增長量顯著負(fù)相關(guān)(p0.001,r=0.592)。CAPC與CPRMS緊密正相關(guān)(p0.001,r=0.916)。結(jié)論配戴OK鏡后角膜環(huán)平均屈光力中央減小,周邊顯著大于中央。角膜屈光力相對近視漂移和角膜頂點(diǎn)屈光力變化均與眼軸增長量顯著負(fù)相關(guān),角膜頂點(diǎn)屈光力變化與角膜屈光力相對近視漂移緊密正相關(guān)。
[Abstract]:Part 1 the effect of corneal plastic lens on the refractive power of corneal diameter and the correlation with the growth of ocular axis in order to investigate the characteristics of the refractive power distribution and the correlation between the changes of corneal diopter and the axial growth of the cornea after the OK lens, 32 9-14 year old children of 9-14 years old. The best corrected visual acuity is more than 2. 0/20; equivalent spherical refractive index (SER) -1.00--4.50D; CIS astigmatism less than -1.50D; central corneal refractive power 41.5-44.5D; no distant and near apparent strabismus; previously unused contact lens or other myopia control therapy; inactive ocular inflammation and ocular surface disease affecting tear film. Before wearing glasses, after wearing glasses, March, June, December, 18 months, and 24 months of follow-up evaluation Naked eye vision, slit lamp fluorescent staining, eye axis length (AL), corneal topography and so on. Corneal topography was centered on the vertex of cornea. The cornea sagittal refraction (N1 to N4, T1 to T4, I1 to I4) was recorded at the three diameter lines of the nasal side, temporal and lower, and the maximum value of three lines of refraction relative to the corneal vertex refractive power (Apex) was added to the corneal topography. MaxN, maxT and maxI. calculated the standard deviation in the calculation group of Apex, maxN, maxT and maxI respectively, retested the repeatability and variation coefficient, and examined the repeatability of the measured values. According to the three grouping methods, the researchers were divided into two groups (group 1, group 2), respectively, and the mean of repeated measurements of variance analysis (ANOVA) were respectively compared. Compared to three groups of group 1 and group 2 AL growth.Pearson correlation test, maxN, maxT, maxI and AL growth correlated.P0.05 as significant differences. Results 27 children completed 2 year follow-up studies, 14 male 13 women, SER, AL, and corneal vertex refractive power were 10.4 + 1.2, -2.57 + 0.90 D, 24.50 + 0.60 mm, 43.46 + 1.02; There was no significant difference in baseline data between group two subgroups and group two. There were no significant differences in Apex, maxN, maxT and maxI (P > 0.93).Apex, maxN, maxT, and maxI, respectively, 0.06D, 0.27D, and 0.16%, respectively, 0.05%, 0.22%, 0.16%, respectively. The refractive power of 4mm was significantly higher than that of the corneal apex (P0.05) during the.24 month follow-up period (p0.001). The three grouping methods had significant influence on the extension of AL (nasal p=0.001, temporal p=0.011, and lower p=0.001), and the AL extension of the three line group 2 was less 54%-69%.maxN than that in the group 1. 05). Conclusion the measured values of Apex, maxN, maxT and maxI were more repeatable after wearing the OK mirror. The corneal refractive power around the cornea was significantly greater than that of the central refraction after wearing the mirror. The maximum change of the relative refractive power of the diameter line cornea was negatively correlated with the growth of the ocular axis. It was negatively correlated with the 2 year AL lengthening (P0.05). The second part of the corneal plastic lens diagonal. The influence of membrane diopter relative to the drift of myopia and the correlation with the growth of ocular axis to investigate the distribution of the mean refraction of the corneal ring after wearing OK mirror. The effect of corneal refractive power relative myopia drift (CPRMS) on the eye axis growth. Methods 88 7-12 year old children were examined with OK mirror, the best corrected visual acuity was more than 20/20; SER-1.00 to -4 .50D: conformed astigmatism less than -1.50D; central corneal refractive power of 41.5 to 44.5D; no distant and near apparent strabismus; previously unused contact lenses or other myopia control therapies; inactive ocular inflammation and ocular surface diseases affecting tear film. Before wearing glasses, after wearing glasses, March, June, December, 18 months and 24 months of follow-up evaluation of visual acuity, slit lamp Fluorescence staining, AL, corneal topography and other.Pentacam anterior segment analysis system measured the average refractive power and corneal vertex refractive power (Apex) of the center of the cornea, diameter 0.5-7.2m (each ring diameter interval 0.1mm) and corneal vertex refraction (single factor ANOVA, Bonferroni test) after wearing the lens. Corneal vertex refraction. MATLAB and spline interpolation were used to calculate the relative myopic drift (CPRMS) of corneal refractive power (CPRMS). The follow-up time points SER, AL, corneal vertex refraction, AL growth, corneal vertex refraction (CAPC) and CPRMS (repeated measurements of ANOVA, Bonferroni test) were compared. Single factor ANOVA, Bonferroni test) control age, gender effect, partial correlation analysis of dark pupil diameter, baseline SER, CPRMS, CAPC and 2 years of axial lengthening correlation.Pearson correlation test CAPC and CPRMS related.P0.05 apparent difference. Results completed 2 year follow-up researchers (64 people) baseline age, sex (male / female), SER, SER. AL, the refractive power of the corneal apex was 9.6 + 1.7 years, 23/41, -2.88 + 0.96D, 24.53 + 0.61mm, 43.47 + 1.03D. There was no significant difference in the statistical values of the baseline data from the shedding persons (24 people). The.64 SER from -2.88 + 0.96D decreased to the March -0.20 + 0.85D, and there was no significant difference at all time points (0.453). L was significantly higher than baseline (P0.05); CAPC wearing mirror was 2.86 + 1.01D after March, and there was no significant difference at all time points (P > 0.229), CPRMS wearing mirror was 10.84 + 5.28D. Mm in March, and there was no significant difference at all time points (p0.999). In March, the corneal vertex refractive power dropped from 43.47 + 1.03D to 40.61 + 1.23D, and the center of the ring mean refractive power increased gradually to the periphery and diameter 5.8m. The maximum ring reach was 42.80 + 1.O1D, and the average refractive power of the 2.8-7.2m ring was significantly greater than the corneal vertex refraction (P0.05). There was no significant correlation between the dark pupil diameter and the AL growth (p=0.169); the baseline SER was positively correlated with the AL growth (p=0.042, r=0.298); CPRMS was negatively correlated with the growth of the eye axis (p0.001, r=0.624), and the growth of the eye axis was significant The negative correlation (p0.001, r=0.592).CAPC was closely related to CPRMS (p0.001, r=0.916). Conclusion the mean refraction center of the corneal ring was reduced and the periphery was significantly greater than that of the central area. The relative myopia drift and the change of corneal vertex refractive power were all negatively correlated with the eye axis growth Liang Xian, the change of corneal vertex refraction and corneal refractive power. The relative myopia drift is closely related.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R778.11

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 江臻穎;孫夷;樸明子;瞿小妹;;兒童屈光參數(shù)數(shù)據(jù)庫平臺建設(shè)研究[J];醫(yī)學(xué)信息學(xué)雜志;2012年01期

2 劉英萍,徐連庸;屈光學(xué)知識問答[J];中國眼鏡科技雜志;1995年04期

3 施明光,趙月娟;屈光學(xué)若干基本概念[J];中華眼科雜志;2001年02期

4 汪芳潤;尹忠貴;楊晨皓;;兒童視力與屈光特點(diǎn)及相關(guān)問題討論(上)[J];中國眼耳鼻喉科雜志;2006年06期

5 宋艷;蔣晨;;900眼漢族大學(xué)生屈光結(jié)構(gòu)的生物學(xué)測量分析[J];新疆醫(yī)學(xué);2009年03期

6 李前;何書喜;;周邊屈光對近視的影響[J];國際眼科雜志;2013年09期

7 馬群,黃震,韓蘇寧,宋艷萍,李麗,劉孟麗;正視眼角膜表面形態(tài)和屈光力分析[J];中國臨床解剖學(xué)雜志;1997年02期

8 徐文文;王利華;馬魯新;楊曉冉;;近視兒童屈光成分光學(xué)相干生物測量的研究[J];山東大學(xué)學(xué)報(醫(yī)學(xué)版);2007年05期

9 湯建祺,齊備;視光答疑(續(xù)三)[J];中國眼鏡科技雜志;1998年01期

10 張寧;陶晗;張春麗;陳奇妙;龐瑛;唐業(yè)衛(wèi);;232例1～2歲正常群體兒童屈光分析[J];中國婦幼保健;2011年05期

相關(guān)會議論文 前1條

1 王瑞卿;周翔天;趙海嵐;;正常豚鼠眼各屈光參數(shù)與屈光力的相關(guān)性研究[A];2005年浙江省眼科學(xué)術(shù)會議論文集[C];2005年

相關(guān)重要報紙文章 前2條

1 馬曉瓊;散光也應(yīng)進(jìn)行矯正[N];中國醫(yī)藥報;2001年

2 馬帥;視力突然變好未必是好兆[N];衛(wèi)生與生活報;2008年

相關(guān)博士學(xué)位論文 前4條

1 鐘元園;角膜塑形鏡對兒童角膜周邊屈光力及眼軸增長的影響[D];復(fù)旦大學(xué);2014年

2 徐文文;遠(yuǎn)視兒童屈光演變的縱向觀察[D];山東大學(xué);2015年

3 陳露;上海市少年兒童屈光發(fā)育現(xiàn)狀及進(jìn)展的縱向調(diào)查研究[D];復(fù)旦大學(xué);2012年

4 李景泓;眼—鏡屈光參數(shù)測試系統(tǒng)工程的研究[D];中北大學(xué);2014年

相關(guān)碩士學(xué)位論文 前8條

1 潘勇;嬰幼兒屈光監(jiān)測[D];蘇州大學(xué);2015年

2 趙丹妮;5～13歲兒童屈光不正狀態(tài)和屈光要素的相關(guān)性研究[D];重慶醫(yī)科大學(xué);2012年

3 張霞;穿透性角膜移植術(shù)屈光控制的臨床與實(shí)驗(yàn)研究[D];第二軍醫(yī)大學(xué);2005年

4 高磊;調(diào)節(jié)對兒童屈光構(gòu)成因素的影響[D];青島大學(xué);2000年

5 宋艷;900眼漢族大學(xué)生屈光結(jié)構(gòu)的生物學(xué)測量結(jié)果分析[D];新疆醫(yī)科大學(xué);2007年

6 曾穎;不同光譜的光照環(huán)境對恒河猴屈光發(fā)育的影響[D];昆明醫(yī)科大學(xué);2012年

7 何艷茹;IOL Master與A超測量老年性白內(nèi)障患者屈光結(jié)果的對比研究[D];新疆醫(yī)科大學(xué);2013年

8 王婷芝;鞏膜環(huán)扎外加壓術(shù)后的屈光和眼壓研究[D];鄭州大學(xué);2007年

，

本文編號：2015745