本文選題：近視 + 遠視��； 參考：《天津醫(yī)科大學》2015年博士論文

【摘要】：目的:比較Holladay IOL Consultant Surgical Outcomes Assessment Program(HICSOAP)及American Society of Cataract and Refractive Surgery IOL Power Calculator(ASCRS-IPC)中不同計算方法對角膜屈光術后IOL度數計算準確性。方法:前瞻回顧性系列病例研究。對既往有角膜屈光手術史并于2011年1月至2013年1月接受白內障超聲乳化吸除聯合IOL植入術,且術后3個月以上的患眼共120眼(按既往角膜屈光手術方式分為三組:A組(近視LASIK/PRK組):有臨床病史資料的17眼(9例)——A1組,無臨床病史資料的62眼(33例)——A2組;B組(遠視LASIK/PRK組):有部分臨床病史資料的8眼(4例)——B1組,無臨床病史資料的15眼(9例)——B2組;C組(RK組):均無臨床病史資料,共18眼(9例)),分別采用HICSOAP及ASCRS-IPC軟件中不同IOL度數計算方法計算IOL度數,根據目標術后屈光度、已植入的IOL度數及術后實際屈光度回推計算最優(yōu)IOL度數,比較不同IOL度數計算方法的預測準確性。比較同一樣本用Holladay II-LK、Holladay II-PK、Holladay II-AK三種計算方法的IOL度數預測準確性,借此評估Len Star,Pentacam,Atlas測量角膜屈光術后角膜曲率的準確性,并與Holladay II-Flat K及Holladay II-His K方法進行橫向比較。采用Graph Pad Prism統(tǒng)計學軟件(version 5.0)對所有數據進行統(tǒng)計學分析。結果:1.HICSOAP及ASCRS-IPC兩種計算軟件中不同計算方法引起的屈光度誤差及IOL度數誤差(絕對值)比較1.1近視LASIK/PRK組A1組(有臨床病史資料,17眼)應用HICSOAP及ASCRS-IPC兩種計算軟件中13種IOL度數計算方法經組內比較,引起的屈光度誤差(F=2.790,P=0.0017)及IOL度數誤差(F=2.790,P=0.0017)的絕對值均有統(tǒng)計學差異。Holladay II-PK、Holladay II-Flat K、Holladay II-LK、ASCRS-AWH、Modified-Masket、ASCRS-Min、Holladay II-AK、Holladay II-His K、Wang-Koch-Maloney這9種計算方法引起的IOL度數計算誤差及屈光誤差最小(組內比較,之間均無統(tǒng)計學差異,F=0.8201,P=0.5865),其次為ASCRS-ANH、Shammas-no history、Haigis-L及ASCRS-Max方法,組間兩兩比較差異均有統(tǒng)計學意義(P0.05),后4種計算方法組內比較無統(tǒng)計學差異(F=0.6449,P=0.5905)。A2組(無臨床病史資料,62眼)應用的10種IOL度數計算方法中,Holladay II-Flat K引起的屈光誤差及IOL度數誤差最小,與Holladay II-PK比較差異有統(tǒng)計學意義(t=1.989,P=0.0256);ASCRS-Max引起的屈光誤差及IOL度數誤差最大,與Haigis-L比較差異有統(tǒng)計學意義(t=3.491,P=0.0004);引起的屈光誤差及IOL度數誤差位居第二的是Holladay II-PK、Holladay II-LK、ASCRS-Min及Wang-Koch-Maloney方法(組內比較差異無統(tǒng)計學意義F=0.2551,P=0.8577);位居第三的是ASCRS-ANH、Holladay II-AK、Shammas-no history及Haigis-L方法(組內比較差異無統(tǒng)計學意義F=0.8777,P=0.4532)Wang-Koch-Maloney引起的屈光誤差及IOL度數誤差小于ASCRS-ANH,差異有統(tǒng)計學意義(t=1.957,P=0.0275)。1.2遠視LASIK/PRK組(B組)B1組(有臨床病史資料)中6種IOL度數計算方法(Holladay II-PK,Holladay II-Flat K,Holladay II-LK,Holladay II-AK,Modified-Masket及Haigis-L)引起的屈光度誤差及IOL度數誤差絕對值,經重復測量方差分析,均無統(tǒng)計學差異(F=0.7482,P=0.5930)。B2組(無臨床病史資料)中5種IOL度數計算方法(Holladay II-PK,Holladay II-Flat K,Holladay II-LK,Holladay II-AK及Haigis-L)引起的屈光度誤差及IOL度數誤差絕對值,經重復測量方差分析,均無統(tǒng)計學差異(F=1.658,P=0.1727)。1.3近視RK組(C組)C組中5種IOL度數計算方法(Holladay II-LK,Holladay II-AK,Holladay II-PK,Holladay II-Flat K及Atlas1-4)引起的屈光度誤差及IOL度數誤差絕對值,經重復測量方差分析,均無統(tǒng)計學差異(F=0.6736,P=0.6139)。2.HICSOAP及ASCRS-IPC兩種計算軟件中不同計算方法引起的屈光度誤差趨勢(算數值及中間值)在近視LASIK/PRK組中(包括A1和A2),HICSOAP計算軟件中除了Holladay II-His K(使用臨床病史資料,A1組中)引起的屈光誤差算數值有輕度近視偏移傾向外,其余4種計算方法Holladay II-PK、Holladay II-Flat K、Holladay II-LK及Holladay II-AK引起的屈光誤差算數值均有輕度遠視偏移傾向。而ASCRS-IPC計算軟件中8種計算方法引起的屈光誤差算數值均有輕度近視偏移傾向。在遠視LASIK/PRK組中(包括B1、B2),HICSOAP計算軟件中4種計算方法Holladay II-PK,Holladay II-Flat K,Holladay II-LK and Holladay II-AK引起的屈光誤差算數值均有輕度近視偏移傾向。ASCRS-IPC計算軟件中Haigis-L計算方法引起的屈光誤差算數值亦有輕度近視偏移傾向,而Modified-Masket(使用部分臨床病史資料,B1組中)計算方法引起的屈光誤差算數值則有輕度遠視偏移傾向。在近視RK組(C組)中,應用HICSOAP及ASCRS-IPC兩種計算軟件中5種IOL度數計算方法導致的屈光誤差算數值,除了Holladay II-PK計算方法有輕度遠視偏移傾向外,其余4種計算方法(Holladay II-LK、Holladay II-AK、Holladay II-Flat K及Atlas1-4)均有輕度近視偏移傾向。3.不同儀器測量角膜K值比較及對Holladay II公式計算誤差影響3.1近視LASIK/PRK組在近視LASIK/PRK組,尤其是A2組中,Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR三者間的差異有顯著統(tǒng)計學意義(F=8.763,P=0.0003)。Pentacam EKR最小,與Lenstar AKR、Atlas(0~3mm)AKR相比,差異有統(tǒng)計學意義(t=1.964,P=0.0271;t=3.308,P=0.0008);Atlas(0~3mm)AKR最大,與Lenstar AKR相比,差異有統(tǒng)計學意義(t=2.873,P=0.0028)。Pentacam EKR、Lenstar AKR、Atlas(0~3mm)AKR三種測量結果被選作Flat K(最低角膜曲率值)的百分比依次為53.23%(33次)、27.42%(17次)、19.35%(12次),前兩者比較差異有統(tǒng)計學意義(Fisher's exact test,P0.01),后兩者比較差異無統(tǒng)計學意義(Fisher's exact test,P0.05)。A2組中,Holladay II公式應用不同K值計算IOL度數,結果顯示,Holladay II-Flat K引起的屈光誤差及IOL度數誤差最小,與Holladay II-PK、Holladay II-LK、Holladay II-AK比較,差異均有統(tǒng)計學意義(t=1.989,P=0.0256;t=2.307,P=0.0122;t=2.533,P=0.0070),雖然后三種計算方法比較差異無統(tǒng)計學意義(F=1.036,P=0.3569),但Pentacam EKR被選為Flat K的百分比最高(53.23%,33次)。3.2遠視LASIK/PRK組遠視LASIK/PRK組角膜曲率測量值從數值看,從小至大均依次為Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR。但經重復測量方差分析,B1組內及B2組內Atlas(0~3mm)AKR、Lenstar AKR、Pentacam EKR三者間的差異均無統(tǒng)計學意義(F1=1.183,P1=0.3353;F2=0.4654,P2=0.6327)。在Holladay II計算公式中,Holladay II-PK、Holladay II-LK、Holladay II-AK引起的屈光誤差及IOL度數誤差亦無統(tǒng)計學意義(P0.05)。3.3近視RK組近視RK組中,Pentacam EKR、Lenstar AKR、Atlas(1~4mm)AKR三者間的差異有統(tǒng)計學意義(F=7.978,P=0.0025),Pentacam EKR最大,與Lenstar AKR、Atlas(1~4mm)AKR相比差異均有統(tǒng)計學意義(t1=2.813,P10.05;t2=3.563,P20.05);后兩者相比,差異無統(tǒng)計學意義(t=1.050,P0.05)。在Holladay II計算公式中,Holladay II-PK、Holladay II-LK、Holladay II-AK導致的屈光誤差及IOL度數誤差絕對值卻無統(tǒng)計學差異(F=0.6736,P=0.6139)。結論:1.在HICSOAP軟件及ASCRS-IPC軟件中,應用臨床病史資料的計算方法如Holladay II-His K、ASCRS-AWH、Modified-Masket,在IOL度數預測準確性上,較無臨床病史資料的計算方法如Holladay II-PK、Holladay II-Flat K、Holladay II-LK、ASCRS-Min、Holladay II-AK、Wang-Koch-Maloney并未顯示突出優(yōu)勢。2.對于缺乏臨床病史資料的近視LASIK/PRK術后IOL度數計算而言,HICSOAP軟件中的Holladay IIFlat K方法IOL度數預測準確性最佳。在Holladay II計算公式中,Pentacam EKR被選作Flat K的頻次最高,與該公式契合度最好。3.如果沒有HICSOAP軟件,ASCRS-IPC軟件中的ASCRS-Min及Wang-Koch-Maloney方法同樣顯示較好的IOL度數預測準確性。4.受樣本量限制,對于遠視LASIK/PRK術后及近視RK術后IOL度數計算而言,HICSOAP及ASCRS-IPC兩種計算軟件中所有計算方法IOL度數預測準確性均未顯示統(tǒng)計學差異。5.根據不同角膜屈光手術方式,HICSOAP及ASCRS-IPC軟件中不同IOL度數計算方法引起的屈光度誤差有遠視或近視偏移傾向。
[Abstract]:Objective: To compare the accuracy of Holladay IOL Consultant Surgical Outcomes Assessment Program (HICSOAP) and American Society of Cataract. Method: a prospective retrospective series of case studies. Cataract phacoemulsification and IOL implantation were performed from January 2011 to January 2013, and 120 eyes with 3 months after surgery were divided into three groups: group A (group LASIK/PRK): 17 eyes (9 cases) with clinical history data (9 cases) - 62 eyes (33 cases) without clinical history data (33 cases) - A2 Group B (group LASIK/PRK): 8 eyes (4 cases) with some clinical history data - B1 group, 15 eyes (9 cases) without clinical history data (9 cases), group C (group RK): no clinical history data, 18 eyes (9 cases)), respectively, using HICSOAP and ASCRS-IPC software to calculate IOL degrees by different IOL degrees calculation method, according to the refractive index after the target operation, already planted The optimal IOL degree of the IOL degrees and the actual refraction after the operation were calculated, and the accuracy of the different IOL degrees calculation method was compared. The accuracy of the IOL degrees of the three methods of Holladay II-LK, Holladay II-PK, Holladay II-AK was compared with the same sample, and the Len Star was evaluated. The accuracy of the rate is compared with the Holladay II-Flat K and the Holladay II-His K method. All data are statistically analyzed with Graph Pad Prism statistics software (version 5). Results: the refractive error caused by different calculation methods in 1.HICSOAP and ASCRS-IPC two computing software and the degree error (absolute value) are compared 1.. 1 A1 group of LASIK/PRK group of myopia (clinical history data, 17 eyes) applied 13 IOL degrees calculation method in two computing software of HICSOAP and ASCRS-IPC. The absolute values of the refractive error (F=2.790, P=0.0017) and IOL degree error (F=2.790, P=0.0017) were statistically difference.Holladay II-PK. LK, ASCRS-AWH, Modified-Masket, ASCRS-Min, Holladay II-AK, Holladay II-His K, Wang-Koch-Maloney, which cause the IOL degree calculation error and the minimization of the refractive error. The difference was statistically significant (P0.05), and there was no statistical difference (F=0.6449, P=0.5905) in group.A2 (no clinical history data, 62 eyes) in the 10 IOL degrees calculation method, Holladay II-Flat K caused by the minimum of refractive error and IOL degree error, and Holladay II-PK was statistically significant difference (t=1.) 989, P=0.0256); the error of the refractive error and the degree of IOL degree caused by ASCRS-Max is the largest, and there is a significant difference between the Haigis-L and the Haigis-L (t=3.491, P=0.0004). The error caused by the refractive error and the degree of IOL degree error are Holladay II-PK, Holladay II-LK, ASCRS-Min and the method (there is no statistically significant difference within the group. 0.8577); the third one was ASCRS-ANH, Holladay II-AK, Shammas-no history and Haigis-L method (the difference of F=0.8777, P=0.4532) in the group was not statistically significant and the IOL degree error was less than ASCRS-ANH. The 6 IOL degrees calculation methods (Holladay II-PK, Holladay II-Flat K, Holladay II-LK, Holladay II-AK, Modified-Masket and Haigis-L) are the absolute values of the refractive error and the degree error, and there are no statistical differences in the 5 degrees of statistical difference (no clinical history data). The calculation methods (Holladay II-PK, Holladay II-Flat K, Holladay II-LK, Holladay II-AK and Haigis-L) are the absolute values of the refractive error and IOL degree error. There are no statistical differences after the repeated measurement of variance analysis. The diopter error and the absolute value of the IOL degree error caused by II-PK, Holladay II-Flat K and Atlas1-4 have no statistical difference (F=0.6736, P=0.6139).2.HICSOAP and ASCRS-IPC two kinds of computing software, the refractive error tendency (numerical value and intermediate value) in the myopia LASIK/PRK group (package) In addition to A1 and A2), in the HICSOAP computing software, the refractive error caused by the Holladay II-His K (using the clinical history data, the A1 group) has a slight deviation from the mild myopia, and the other 4 methods are Holladay II-PK, Holladay II-Flat K, and the calculated values of the refractive error are slight hyperopia deviation. There are slight myopia deviation in the calculation of the refractive error caused by 8 methods in the ASCRS-IPC computing software. In the hyperopia LASIK/PRK group (including B1, B2), the 4 calculation methods of the HICSOAP computing software are Holladay II-PK, Holladay II-Flat K, and Holladay II-LK. In the.ASCRS-IPC computing software of offset tendency, the numerical value of refractive error caused by Haigis-L calculation method also has the tendency of slight nearsightedness, while Modified-Masket (using partial clinical history data, B1 group) the calculation method of refractive error caused by the calculation method has mild hyperopia deviation. In the RK group of myopia (C group), HICSOAP and ASCRS-IPC are applied. In the two computing software, the refractive error calculated by 5 IOL degrees calculation method is calculated. In addition to the Holladay II-PK calculation method, there is a slight hyperopia deviation and the other 4 kinds of calculation methods (Holladay II-LK, Holladay II-AK, Holladay II-Flat K and Atlas1-4) have a slight deviation of myopia. Laday II formula calculation error affects 3.1 myopia LASIK/PRK group in group LASIK/PRK, especially in group A2, Atlas (0~3mm) AKR, Lenstar AKR, Pentacam EKR, there are significant differences between the three. P=0.0008); Atlas (0~3mm) AKR was the largest, compared with Lenstar AKR, the difference was statistically significant (t=2.873, P=0.0028).Pentacam EKR, Lenstar AKR. The percentages of the three measurements were 53.23% (33 times), 27.42% (17) and 19.35% (12 times). Her's exact test, P0.01), there is no significant difference in the latter two (Fisher's exact test, P0.05).A2 group, Holladay II formula is used to calculate the degree of different K values. The results show that the error of refraction and the degree error is the smallest. T=1.989, P=0.0256; t=2.307, P=0.0122; t=2.533, P=0.0070), although there was no statistical difference between the last three methods (F=1.036, P=0.3569), but Pentacam EKR was selected as the percentage of Flat K (53.23%, 33). Tlas (0~3mm) AKR, Lenstar AKR, Pentacam EKR., but by repeated measurements of variance analysis, B1 group and B2 group Atlas (0~3mm) AKR. The error and IOL degree error also had no statistical significance (P0.05).3.3 myopia RK group myopia RK group, Pentacam EKR, Lenstar AKR, Atlas (1~4mm) AKR three differences were statistically significant. There was no statistical difference (t=1.050, P0.05). In the Holladay II formula, the absolute values of the refractive error and IOL degree error caused by Holladay II-PK, Holladay II-LK and Holladay II-AK were not statistically different (F=0.6736,). Such as Holladay II-His K, ASCRS-AWH, Modified-Masket, in the accuracy of the prediction of IOL degree, there are no clinical history data such as Holladay II-PK, Holladay II-Flat K, Holladay, etc. In the number calculation, the Holladay IIFlat K method in the HICSOAP software is the best for the IOL degree prediction. In the Holladay II formula, Pentacam EKR is selected as the highest frequency of Flat K. The accuracy of the degree prediction was limited by the sample size. For the IOL degree calculation after the hyperopic LASIK/PRK operation and the myopia RK operation, the accuracy of all the calculation methods of IOL degrees in all the two computing software of HICSOAP and ASCRS-IPC did not show statistical difference.5. based on different corneal refractive surgery methods, HICSOAP and ASCRS-IPC software of different IOL degree. The diopter errors caused by the number calculation method tend to be hyperopic or myopic.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R779.6

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本文編號：1857777