本文選題：準(zhǔn)分子激光原位角膜磨鑲術(shù)　切入點(diǎn)：干眼癥　出處：《北京協(xié)和醫(yī)學(xué)院》2013年博士論文

【摘要】：目的 觀(guān)察LASIK術(shù)后角膜中央基底層下上皮神經(jīng)叢的再生,研究其數(shù)量及形態(tài)參數(shù)與干眼指標(biāo)間的關(guān)系,以及神經(jīng)再生及干眼程度與術(shù)后時(shí)間、不同術(shù)式、切削深度等指標(biāo)之間的相關(guān)性,從而幫助我們更全面地了解LASIK術(shù)后干眼癥的病理生理機(jī)制,以期優(yōu)化其治療方案。 方法 隨機(jī)入選2011年10月至2012年9月在北京協(xié)和醫(yī)院眼科行傳統(tǒng)LASIK/飛秒LASIK手術(shù)的近視患者42例(84眼)。根據(jù)患者隨訪(fǎng)時(shí)間分為L(zhǎng)ASIK術(shù)后半年組19例(38眼)和LASIK術(shù)后一年組23例(46眼)。對(duì)患者進(jìn)行的術(shù)后檢查主要包括干眼相關(guān)檢查和角膜共聚焦顯微鏡檢查兩部分,其中前者又可分為淚液三項(xiàng)試驗(yàn)和OSDI問(wèn)卷調(diào)查,后者即采用HRT III共聚焦顯微鏡著重對(duì)基底層下上皮神經(jīng)叢進(jìn)行觀(guān)察,在單眼的角膜中央?yún)^(qū)域內(nèi)任意選擇三點(diǎn)行立體掃描,從中挑選出基底層下上皮神經(jīng)最豐富且最清晰的三幅圖像后使用ACCMetrics軟件對(duì)這些圖像進(jìn)行神經(jīng)數(shù)量及形態(tài)參數(shù)的統(tǒng)計(jì)并取平均值,具體參數(shù)包括神經(jīng)纖維主干及主干上分支的密度(CNFD和CNBD)、神經(jīng)纖維長(zhǎng)度(CNFL)、神經(jīng)總分支節(jié)點(diǎn)的密度(CTBN)、以及神經(jīng)纖維的寬度(CNFW)和彎曲度(CNFT)等。采用獨(dú)立樣本t檢驗(yàn)的方法比較術(shù)后不同隨訪(fǎng)時(shí)間組(半年組、一年組)之間,以及不同種類(lèi)LASIK術(shù)式組(傳統(tǒng)組、飛秒組)之間神經(jīng)參數(shù)與干眼指標(biāo)的差異；此外,根據(jù)實(shí)際情況對(duì)神經(jīng)參數(shù)與干眼指標(biāo),以及兩者分別與切削深度及基質(zhì)層厚度之間的關(guān)系行偏相關(guān)及雙變量相關(guān)性分析。 結(jié)果 1.干眼指標(biāo),LASIK術(shù)后一年組患者的Schirmer試驗(yàn)值和TBUT值均顯著大于半年組(t=-2.340,-5.403,P0.05),熒光素染色分值顯著小于半年組(t=2.634,P0.05),但兩組間的OSDI評(píng)分未見(jiàn)統(tǒng)計(jì)學(xué)顯著性差異(t=1.207,P0.05)。神經(jīng)參數(shù),LASIK術(shù)后一年組患者的CNFD、CNBD、CNFL、CTBN值均顯著大于半年組(t=-3.293,-4.501,-7.091,-4.240, P0.01),但是兩組間的CNFW、CNFT值均未見(jiàn)顯著性差異(t=1.480,0.474,P0.05)。 2. LASIK術(shù)后半年組,CNBD值與熒光素染色評(píng)分值呈負(fù)相關(guān)(r=-0.346,P0.05),其余神經(jīng)參數(shù)與干眼指標(biāo)均無(wú)相關(guān)性(P值均0.05)。LASIK術(shù)后一年組,CNFD值與Schirmer試驗(yàn)值呈正相關(guān)(r=0.321, P0.05), CNBD、CTBN、CNFT值與Schirmer試驗(yàn)值呈負(fù)相關(guān)(r=-0.347,-0.340,-0.325,P0.05),而CNFW值則與OSDI評(píng)分值呈正相關(guān)(r=0.342,P0.05),其余神經(jīng)參數(shù)與干眼指標(biāo)均無(wú)相關(guān)性(P值均0.05)。 3.無(wú)論是LASIK術(shù)后半年組還是一年組,行傳統(tǒng)LASIK手術(shù)的患者其各項(xiàng)干眼主客觀(guān)指標(biāo)和神經(jīng)數(shù)量及形態(tài)參數(shù)與行飛秒LASIK手術(shù)的患者相比不存在任何顯著性差異(P值均0.05)。 4. LASIK術(shù)后半年組,神經(jīng)纖維的數(shù)量及形態(tài)參數(shù)以及干眼指標(biāo)與手術(shù)切削深度及殘留基質(zhì)床厚度均無(wú)相關(guān)性(P值均0.05)。LASIK術(shù)后一年組,TBUT值與手術(shù)切削深度呈負(fù)相關(guān)(r=-0.297,P0.05),而其余神經(jīng)參數(shù)及干眼指標(biāo)與手術(shù)切削深度及殘留基質(zhì)床厚度均無(wú)相關(guān)性(P值均0.05)。 結(jié)論 1. LASIK術(shù)后一年患者的干眼客觀(guān)指標(biāo)較術(shù)后半年患者顯著改善,且其角膜中央基底層下上皮神經(jīng)叢主干及分支的數(shù)量、神經(jīng)纖維的長(zhǎng)度均較術(shù)后半年患者顯著增加。 2. LASIK術(shù)后半年及一年患者角膜中央基底層下上皮神經(jīng)叢的某些神經(jīng)參數(shù)與干眼指標(biāo)存在相關(guān)性,尤以術(shù)后一年者較為明顯。 3.傳統(tǒng)LASIK與飛秒LASIK相比,其對(duì)術(shù)后半年及一年患者的干眼指標(biāo)和神經(jīng)參數(shù)所產(chǎn)生的影響無(wú)顯著差異。 4. LASIK術(shù)后一年患者的TBUT值與手術(shù)切削深度呈負(fù)相關(guān)。
[Abstract]:objective
The regeneration of central corneal basal epithelial nerve plexus under observation after LASIK, and the number and morphological parameters of dry eye index, and dry eye and nerve regeneration degree and postoperative time, different surgical methods, the correlation between the cutting depth and other indicators, so as to help us a more comprehensive understanding of the pathophysiology of dry eye after LASIK, in order to optimize the treatment plan.
Method
From October 2011 to September 2012 were randomly selected in 42 cases in Peking Union Medical College Hospital underwent conventional LASIK/ femtosecond LASIK surgery patients (84 eyes). According to the follow-up time were divided into 19 cases of group six months after LASIK (38 eyes) and LASIK 1 year after surgery group 23 cases (46 eyes). The postoperative patients were examined including the two part dry eye related examination and corneal confocal microscopy, which can be divided into three tear test and OSDI questionnaire, which is used by HRT III confocal microscope focuses on the observation of the basal layer of epithelial plexus, choose three bit stereo scan in the central region of the cornea from monocular. Selected three images under basal epithelial nerve most abundant and most clear statistics using ACCMetrics software for nerve number and morphology parameters of these images and averaged, the specific parameters include the nerve fiber The main trunk and branch density (CNFD and CNBD), nerve fiber length (CNFL), nerve branch node density (CTBN), and the width of nerve fibers (CNFW) and curvature (CNFT). By using the method of independent sample t test to compare the different postoperative follow-up group (six months group. A group of years) between, and different types of LASIK surgery group (traditional group, femtosecond group) between the neural parameters and the differences of dry eye index; in addition, according to the neural parameters and dry eye index analysis for the actual situation, and the relationship between cutting depth and matrix respectively with the thickness of bivariate correlation and partial correlation.
Result
1. dry eye index, after LASIK Schirmer in experimental group and TBUT values were significantly greater than half the group (t=-2.340, -5.403, P0.05), fluorescein staining scores were significantly less than half the group (t=2.634, P0.05), but OSDI score no statistically significant difference between the two groups (t=1.207, P0.05) nerve. CNFD, a group of parameters in patients after LASIK CNBD, CNFL, CTBN were significantly greater than half the group (t=-3.293, -4.501, -7.091, -4.240, P0.01), but the CNFW between the two groups, there were no significant differences in CNFT values (t=1.480,0.474, P0.05).
2. LASIK six months after operation group, the CNBD score was negatively correlated with fluorescein staining (r=-0.346, P0.05), the neural parameters and dry eye were no correlation (P 0.05) group one year after.LASIK, CNFD value was positively correlated with the experimental data of Schirmer (r=0.321, P0.05), CNBD, CTBN. CNFT was negatively correlated with the experimental data of Schirmer (r=-0.347, -0.340, -0.325, P0.05), while the CNFW value was positively correlated with OSDI score (r=0.342, P0.05), the neural parameters and dry eye were no correlation (P 0.05).
3., whether in the half year group or the one year group after LASIK, there was no significant difference in the subjective and objective indexes and nerve number and morphological parameters of dry eye between those who underwent traditional LASIK operation and those who underwent femtosecond LASIK surgery (P = 0.05).
4. LASIK six months after operation group, the number and morphology of nerve fibers and parameters of dry eye index and ablation depth and residual stromal bed thickness had no correlation (P = 0.05) group one year after.LASIK, TBUT was negatively correlated with surgical cutting depth (r=-0.297, P0.05), while the remaining parameters and neural stem eye index and ablation depth and residual stromal bed thickness had no correlation (P = 0.05).
conclusion
After 1. LASIK, the dry eye index of one year after operation was significantly improved compared with that of half a year after operation, and the number of trunk and branch of corneal central basal layer and the length of nerve fiber were significantly higher than those of half a year after operation.
2., half a year and a year after LASIK, there were correlations between some nerve parameters of corneal central basal layer and epithelial nerve plexus and dry eye index, especially in one year after operation.
3. compared with the femtosecond LASIK, there is no significant difference in the effects of LASIK and femtosecond LASIK on the dry eye index and the nerve parameters in the six months and one year after the operation.
4. LASIK after one year, the TBUT value of the patients was negatively correlated with the depth of the surgical cutting.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R779.63

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本文編號(hào)：1689848