不同危险度的患者行SBK术后角膜后表面的变化  

Evaluation of the posterior corneal surface changes with Randleman Ectasia Risk Factor Score System of different risk category by Pentacam3 rotating scheimpflug camera before and after SBK

作　　者：姜严明[1] 黄一飞[1] 蒋晶晶[1] 杜改萍[1] 王丽强[1] 葛梅[1] 

机构地区：[1]中国人民解放军总医院眼科,北京100853

出　　处：《中国实用眼科杂志》2012年第11期1300-1303,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的根据Randleman角膜扩张风险评分系统，将术眼分为低、中、高度危险眼三组，利用Pentacam眼前节分析系统，分析评价这三组在本中心施行前弹力层屈光性角膜成形术（SBK）的患者，观察三组间术前、术后角膜后表面相关参数的变化，暨三组之间发生潜在角膜扩张的危险性。方法统计于本中心行SBK手术，残留角膜基质床厚度均≥300μm，显然验光等效球镜〈-10D，2年内均无近视度数增加的159名患者，共300只眼。根据Randleman角膜扩张风险评分系统，将术眼分为低、中、高度危险三组，各100只眼。利用Pentacam眼前节分析系统观察角膜后表面的参数变化至术后一年，并分析这三组之间术前、术后角膜后表面相关参数的变化。结果三组手术患者在年龄上有显著的统计学差异（P〈0．01），在角膜厚度及角膜地形图评分上有统计学意义（P〈0．05），显然验光等效球镜值、残留角膜基质床厚度各组间差异无统计学意义。利用Pentacam眼前节分析系统观察至术后一年，不同危险度的三组之间角膜后表面高度、Rm值、Km值、Q值无论单因素术前术后比较，或是组间比较均差异无统计学意义（P〉0．05）。结论虽然根据Randleman角膜扩张风险评分标准被定性为中度或高度风险眼，但保留足够的残留角膜基质床厚度（≥300μm），严格控制手术可矫正的显然验光等效球镜最大值（〈-10D），可有效防止术后角膜后表面前移的变化，从而防止角膜扩张的发生，而年龄在显然验光等效球镜值稳定已2年以上的情况下，并不是最重要的决定性因素。Randleman制定的LASIK术后角膜扩张风险评分标准似乎并不适用于SBK手术。Objective To evaluate the posterior corneal surface changes of three groups of different risk category which were defined by the Randleman Ectasia Risk Factor Score System with Pentacam3 rotating scheimpflug camera before and after SBK. Methods Data were collected retrospectively on 300 eyes in three groups each with 100 eyes of low risk, moderate risk and high risk pre SBK. Then, the data were entered into Randleman＇s risk factor score system. The operations were taken by one surgeon at the Department of Ophthalmology, Chinese PLA General Hospital. Data about the posterior corneal surfaces were collected for one year after the SBK also by one research- er. Results Of the 300 eyes, 100 were classified as low risk, 100 as moderate risk and 100 as high risk. On average, the most points were scored in the age. Parameter of the posterior corneal surface （elevation, Rm, Km, and the Q value） was not significantly different between each group. Conclusions Randleman＇s ectasia risk factor scale is not appropriate for the prediction of the comeal ectasia before SBK surgery. When the RSB ≥300μm, MRSE〈10D, other factors, especially age seems not to be the most significant proportion of patients at risk of ectasia.

关 键 词：Randleman角膜扩张风险评分系统 SBK Pentacam眼前节分析系统 

分 类 号：R778.1[医药卫生—眼科]