正常人及角膜屈光手術后角膜生物力學特性（ORA）研究
發(fā)布時間：2018-09-18 17:44
【摘要】：目的：本研究旨在借助眼反應分析儀分析正常人群角膜生物力學特性指標的正常值范圍及分布特點以及影響角膜生物力學特性的角膜生物學指標,并對LASIK與SBK、Epi-LASIK手術后早期(術后1周與1-2個月)及術后中長期(術后1年)角膜生物力學改變的情況進行比較性研究。 方法： 第一部分：橫斷面研究,共包括240人480只眼,分別進行眼反應分析儀(Ocular Response Analyzer, Reichert,美國)及Pentacam三維眼前節(jié)分析診斷系統(tǒng)(Oculus GmbH, Wetzlar,德國)測量,采用Pearson線性相關分析及單因素方差分析、獨立樣本的t檢驗等對數(shù)據(jù)進行統(tǒng)計分析。 第二部分：為前瞻性研究,術后早期臨床觀察部分共包括Epi-LASIK 30例30只眼,LASIK 34例34只眼,SBK 22例22只眼,術后隨訪時間為術后1周及1-2個月。另一組行術后中長期觀察,其中Epi-LASIK 20例40只眼,LASIK20例39只眼,術后隨訪1年。分別進行眼反應分析儀及Pentacam三維眼前節(jié)分析診斷系統(tǒng)測量,采用重復測量的方差分析及獨立樣本的t檢驗對數(shù)據(jù)進行統(tǒng)計分析,并應用Pearson線性相關分析對其影響因素進行分析。 結(jié)果： 1.角膜滯后值(Corneal Hysteresis, CH)及角膜阻力因子(Corneal Resistance Factor, CRF)呈正態(tài)分布,平均為(10.38±1.36) mmHg和(10.70±1.59)mmHg。 2.CH及CRF與中央角膜厚度呈正相關(CH:r=0.54, P=0.000;CRF:r=0.61,P=0.000),與年齡、球鏡、柱鏡及等效球鏡度數(shù)無相關。CH與CRF同角膜中央前表面高度呈負相關(CH:r=-0.136*,P=0.002; CRF:r=-0.152*,P=0.001),同角膜前表面Q值呈正相關(CH:r=0.136*, P=0.002; CRF:r=0.132*, P=0.003),球差與CH、CRF間也呈正相關(CH:r=0.184*,P=0.000;CRF:r=0.191*,P=0.000)。 3.CH與CRF同以角膜中央為圓心直徑分別為1、1.5、2、2.5、3、3.5、4、4.5、5、5.5、6mm相隔各0.5mm的同心圓區(qū)域角膜范圍的角膜容積(Cornea Volume, CV)值均呈中度以上的相關關系。 4. Epi-LASIK、LASIK及SBK三種手術后早期各手術方式組間CH與CRF間差異無統(tǒng)計學意義(CH:F= 0.623, P=0.539; CRF:F=0.038, P= 0.963)。 5.手術后1年Epi-LASIK及LASIK兩種手術方式間CH與CRF間差異無統(tǒng)計學意義(CH:t=-0.270,P=0.308:CRF:t=-0.989,P=0.630). 6.切削深度在Epi-LASIK與SBK組中與術后1周及術后1-2個月CH.CRF變化量間均無明顯相關關系,但在LASIK組中與術后1周與1-2個月CH.CRF變化量間均呈明顯正性相關關系。切削深度與術后1年CH、CRF變化量在Epi-LASIK組無明顯相關關系(CH:r=0.086,P=0.604;CRF:r=0.214,P=0.191), LASIK組中與CRF呈中度相關關系(CH:r=0.291,P=0.077;CRF:r=0.499*,P=0.001)。 結(jié)論： 1.角膜滯后值CH及角膜阻力因子CRF呈正態(tài)分布,與中央角膜厚度呈中度以上的正性相關關系,與年齡及屈光度無明顯相關關系,并且同各范圍內(nèi)角膜容積量均呈中度以上的相關關系,CRF較CH表現(xiàn)出更強的相關性。 2.CH與CRF與角膜形態(tài)有較強的相關性,同角膜中央前表面高度呈較弱的負性相關關系,說明角膜中央越凸出,角膜生物力學特性越弱,這與角膜前表面Q值同CH、CRF間的相關關系一致。同時,球差與CH、CRF間呈現(xiàn)了較弱的正向相關關系,即角膜球差越大,生物力學指標越高。 3.Epi-LASIK.LASIK與SBK三種手術后CH與CRF間差異無統(tǒng)計學意義,可見,在一定矯正屈光度數(shù)范圍內(nèi),板層手術與表層手術在對相似人群特征角膜生物力學特性影響上,無論在術后早期還是中長期差異不是十分明顯。 4.術后早期Epi-LASIK生物力學指標變化無明顯差別,LASIK與SBK手術后1-2個月時CH較術后1周明顯提高,CRF也有一定程度的提高。說明術后板層手術角膜生物力學特性恢復較表層手術提前,CH較CRF明顯。 5.切削深度在Epi-LASIK與SBK組中與術后CH.CRF變化量間均無相關,但在LASIK組中與術后CH、CRF變化量間均呈明顯正性相關關系,說明對于切削層面較表淺的Epi-LASIK與SBK切削量對其生物力學特性的作用不及切削層面較深的LASIK明顯,即LASIK手術切削量越多,手術對角膜生物力學特性影響越大,其術后生物力學特性越弱。
[Abstract]:OBJECTIVE: To analyze the normal range and distribution of corneal biomechanical properties and the corneal biomechanical parameters affecting the corneal biomechanical properties in normal people with the aid of an eye response analyzer, and to evaluate the corneal biology after LASIK and SBK, Epi-LASIK at the early stage (1 week and 1-2 months after surgery) and at the middle and long term (1 year after surgery). A comparative study of mechanical changes was conducted.
Method:
Part I: A cross-sectional study involving 240 people and 480 eyes was conducted using Ocular Response Analyzer (Reichert, USA) and Pentacam three-dimensional anterior segment analysis and diagnosis system (Oculus GmbH, Wetzlar, Germany). The data were analyzed by Pearson linear correlation analysis, one-way ANOVA and t test of independent samples. Statistical analysis was carried out.
The second part: For prospective study, the early clinical observation included 30 eyes of Epi-LASIK, 34 eyes of LASIK, 22 eyes of SBK. The follow-up time was 1 week and 1-2 months after operation. The other group was followed up for 1 year, including 40 eyes of 20 cases of Epi-LASIK, 39 eyes of 20 cases of LASIK. The analysis instrument and Pentacam three-dimensional anterior segment analysis and diagnosis system were used to measure the data. The analysis of variance of repeated measurements and t-test of independent samples were used to analyze the data. Pearson linear correlation analysis was used to analyze the influencing factors.
Result:
1. Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF) showed normal distribution, with an average of (10.38 (+ 1.36) mmHg and (10.70 (+ 1.59) mmHg.
2. CH and CRF were positively correlated with central corneal thickness (CH: r = 0.54, P = 0.000; CRF: r = 0.61, P = 0.000), but not with age, spherical, columnar and equivalent spherical lenses. CH and CRF were negatively correlated with anterior central corneal surface height (CH: r = - 0.136 *, P = 0.002; CRF: r = - 0.152 *, P = 0.001), and positively correlated with anterior corneal surface Q (CH: r = 0.136 *, P = 0.002). 32* (P=0.003), spherical aberration is positively correlated with CH and CRF (CH:r=0.184*, P=0.000, CRF:r=0.191*, P=0.000).
3. CH and CRF were moderately correlated with Cornea Volume (CV) values in the concentric circle region 0.5mm apart from the central cornea, with the diameter of 1,1.5,2,2.5,3,3.5,4,4.5,5.5,6 mm respectively.
4. There was no significant difference between CH and CRF among the three early postoperative groups (CH: F = 0.623, P = 0.539; CRF: F = 0.038, P = 0.963).
5. There was no significant difference between CH and CRF between Epi-LASIK and LASIK one year after operation (CH: t = - 0.270, P = 0.308: CRF: t = - 0.989, P = 0.630).
6. There was no significant correlation between the cutting depth in Epi-LASIK and the changes of CH.CRF in SBK group at 1 week and 1-2 months after operation, but there was a significant positive correlation between the cutting depth and the changes of CH.CRF in Epi-LASIK group at 1 week and 1-2 months after operation. CRF: r = 0.214, P = 0.191, and moderately correlated with CRF in LASIK group (CH: r = 0.291, P = 0.077; CRF: r = 0.499 *, P = 0.001).
Conclusion:
1. Corneal hysteresis value CH and corneal resistance factor CRF showed normal distribution, and had a positive correlation with central corneal thickness above moderate, and had no significant correlation with age and diopter, and had a moderate correlation with corneal volume above all ranges. CRF showed stronger correlation than CH.
2. There is a strong correlation between CH and CRF and corneal morphology, and a weak negative correlation between CH and anterior central surface height of cornea, indicating that the more prominent the central cornea, the weaker the corneal biomechanical properties, which is consistent with the correlation between Q value of anterior corneal surface and CH, CRF. At the same time, there is a weak positive correlation between spherical aberration and CH, CRF. The larger the spherical aberration, the higher the biomechanical index.
3. There was no significant difference between CH and CRF after Epi-LASIK. LASIK and SBK. It can be seen that the effect of lamellar surgery and surface surgery on corneal biomechanical characteristics of similar populations in a certain range of corrective diopters was not very significant in the early or middle and long term after surgery.
4. There was no significant difference in the changes of biomechanical parameters of Epi-LASIK in the early postoperative period. CH and CRF were significantly increased at 1-2 months after LASIK and SBK compared with 1 week after SBK, which indicated that the corneal biomechanical characteristics of lamellar surgery were recovered earlier than that of surface surgery, and CH was more obvious than that of CRF.
5. There was no correlation between cutting depth and postoperative CH. CRF in Epi-LASIK and SBK groups, but there was a significant positive correlation between the changes of CH and CRF in LASIK group and postoperative CH and CRF, indicating that the effect of epi-LASIK and SBK cutting depth on its biomechanical properties was less significant than LASIK cutting depth, that is, LASIK surgery. The more the amount of cutting, the greater the effect of surgery on corneal biomechanical properties, and the less biomechanical characteristics.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.63
本文編號：2248651
[Abstract]:OBJECTIVE: To analyze the normal range and distribution of corneal biomechanical properties and the corneal biomechanical parameters affecting the corneal biomechanical properties in normal people with the aid of an eye response analyzer, and to evaluate the corneal biology after LASIK and SBK, Epi-LASIK at the early stage (1 week and 1-2 months after surgery) and at the middle and long term (1 year after surgery). A comparative study of mechanical changes was conducted.
Method:
Part I: A cross-sectional study involving 240 people and 480 eyes was conducted using Ocular Response Analyzer (Reichert, USA) and Pentacam three-dimensional anterior segment analysis and diagnosis system (Oculus GmbH, Wetzlar, Germany). The data were analyzed by Pearson linear correlation analysis, one-way ANOVA and t test of independent samples. Statistical analysis was carried out.
The second part: For prospective study, the early clinical observation included 30 eyes of Epi-LASIK, 34 eyes of LASIK, 22 eyes of SBK. The follow-up time was 1 week and 1-2 months after operation. The other group was followed up for 1 year, including 40 eyes of 20 cases of Epi-LASIK, 39 eyes of 20 cases of LASIK. The analysis instrument and Pentacam three-dimensional anterior segment analysis and diagnosis system were used to measure the data. The analysis of variance of repeated measurements and t-test of independent samples were used to analyze the data. Pearson linear correlation analysis was used to analyze the influencing factors.
Result:
1. Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF) showed normal distribution, with an average of (10.38 (+ 1.36) mmHg and (10.70 (+ 1.59) mmHg.
2. CH and CRF were positively correlated with central corneal thickness (CH: r = 0.54, P = 0.000; CRF: r = 0.61, P = 0.000), but not with age, spherical, columnar and equivalent spherical lenses. CH and CRF were negatively correlated with anterior central corneal surface height (CH: r = - 0.136 *, P = 0.002; CRF: r = - 0.152 *, P = 0.001), and positively correlated with anterior corneal surface Q (CH: r = 0.136 *, P = 0.002). 32* (P=0.003), spherical aberration is positively correlated with CH and CRF (CH:r=0.184*, P=0.000, CRF:r=0.191*, P=0.000).
3. CH and CRF were moderately correlated with Cornea Volume (CV) values in the concentric circle region 0.5mm apart from the central cornea, with the diameter of 1,1.5,2,2.5,3,3.5,4,4.5,5.5,6 mm respectively.
4. There was no significant difference between CH and CRF among the three early postoperative groups (CH: F = 0.623, P = 0.539; CRF: F = 0.038, P = 0.963).
5. There was no significant difference between CH and CRF between Epi-LASIK and LASIK one year after operation (CH: t = - 0.270, P = 0.308: CRF: t = - 0.989, P = 0.630).
6. There was no significant correlation between the cutting depth in Epi-LASIK and the changes of CH.CRF in SBK group at 1 week and 1-2 months after operation, but there was a significant positive correlation between the cutting depth and the changes of CH.CRF in Epi-LASIK group at 1 week and 1-2 months after operation. CRF: r = 0.214, P = 0.191, and moderately correlated with CRF in LASIK group (CH: r = 0.291, P = 0.077; CRF: r = 0.499 *, P = 0.001).
Conclusion:
1. Corneal hysteresis value CH and corneal resistance factor CRF showed normal distribution, and had a positive correlation with central corneal thickness above moderate, and had no significant correlation with age and diopter, and had a moderate correlation with corneal volume above all ranges. CRF showed stronger correlation than CH.
2. There is a strong correlation between CH and CRF and corneal morphology, and a weak negative correlation between CH and anterior central surface height of cornea, indicating that the more prominent the central cornea, the weaker the corneal biomechanical properties, which is consistent with the correlation between Q value of anterior corneal surface and CH, CRF. At the same time, there is a weak positive correlation between spherical aberration and CH, CRF. The larger the spherical aberration, the higher the biomechanical index.
3. There was no significant difference between CH and CRF after Epi-LASIK. LASIK and SBK. It can be seen that the effect of lamellar surgery and surface surgery on corneal biomechanical characteristics of similar populations in a certain range of corrective diopters was not very significant in the early or middle and long term after surgery.
4. There was no significant difference in the changes of biomechanical parameters of Epi-LASIK in the early postoperative period. CH and CRF were significantly increased at 1-2 months after LASIK and SBK compared with 1 week after SBK, which indicated that the corneal biomechanical characteristics of lamellar surgery were recovered earlier than that of surface surgery, and CH was more obvious than that of CRF.
5. There was no correlation between cutting depth and postoperative CH. CRF in Epi-LASIK and SBK groups, but there was a significant positive correlation between the changes of CH and CRF in LASIK group and postoperative CH and CRF, indicating that the effect of epi-LASIK and SBK cutting depth on its biomechanical properties was less significant than LASIK cutting depth, that is, LASIK surgery. The more the amount of cutting, the greater the effect of surgery on corneal biomechanical properties, and the less biomechanical characteristics.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.63
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