近视患者前弹力层下激光角膜磨削术后Kappa角及角膜形态变化  

Changes of angle Kappa and corneal morphology changes in myopic patients after Sub-Bowman-Keratomileusis

作　　者：丁翌 张之佩 闵晓珊[1] 夏晓波[1] 胡生发[1] DING Yi;ZHANG Zhipei;MIN Xiaoshan;XIA Xiaobo;HU Shengfa(Department of Ophthalmology,Xiangya Hospital,Central South University,Changsha 410008;Department of Ophthalmology,First People’s Hospital of Changde City,Changde Hunan 415003,China)

机构地区：[1]中南大学湘雅医院眼科,长沙410008 [2]常德市第一人民医院眼科,湖南常德415003

出　　处：《中南大学学报（医学版）》2021年第2期162-168,共7页Journal of Central South University ：Medical Science

摘　　要：目的:研究近视患者Kappa角与屈光度的分布情况及前弹力层下激光角膜磨削术(Sub-BowmanKeratomileusis,SBK)后患者Kappa角与角膜形态的变化规律,分析手术对角膜形态及双眼视近功能的影响。方法:回顾性分析2015年8月至2016年8月在中南大学湘雅医院行SBK治疗的134例(268只眼)近视患者的临床资料。患者在术前、术后1个月、术后6个月均采用OrbscanⅡz角膜地形图行Kappa角、角膜中央3 mm区曲率、角膜后表面Diff值检测。根据术前Kappa角的大小分为大K组(Kappa角≥5°,71只眼)和小K组(Kappa角<5°,197只眼)。对影响术后6个月Kappa角变化的因素进行相关性分析。结果:大K组Kappa角为(5.67±0.65)°,等效球镜度为(-4.84±2.32)D,术后Kappa角较术前减小(均P<0.01),且随着时间的推移减小的幅度增大;小K组Kappa角为(3.51±1.08)°,等效球镜度为(-5.78±2.63)D,术后Kappa角较术前增大,术后6个月与术前相比差异具有统计学意义(P<0.05),且随着时间的推移增大的幅度减小。2组术后角膜后表面Diff值均变大(均P<0.001),术后1个月至6个月Diff值呈减小趋势。2组术后1个月角膜中央3 mm区曲率均明显变小(均P<0.001),术后1个月至术后6个月,大K组曲率趋于稳定,小K组曲率呈增大趋势。2组患者术后6个月Kappa角的变化与角膜中央3 mm区曲率及角膜后表面Diff值的变化均无明显相关性(均P>0.05),而均与角膜切削厚度呈正相关(r大K组=0.398,r小K组=0.218,均P<0.05),与术前屈光度呈负相关(r大K组=-0.283,r小K组=-0.233,均P<0.05)。结论:大Kappa角多出现在中低度近视患者中,术后Kappa角明显减小,而小Kappa角多出现在中高度近视患者中,术后Kappa角增大。近视患者经SBK后视近时双眼调节与集合功能重新调整以达到平衡,视近功能可能获得一定程度的改善。Objective:To investigate angle Kappa and diopter distribution in myopic patients and the changes of angle Kappa and corneal morphology after Sub-Bowman-Keratomileusis(SBK),and to analyze the effects of the surgery on corneal morphologic changes and the patients’ near fixation characteristics.Methods:The clinical data of 134 myopic patients(268 eyes) undergoing SBK from August2015 to August 2016 were retrospectively analyzed.Angle Kappa,corneal curvature in the central corneal region of 3 mm,and post-corneal Diff value were measured by Orbscan Ⅱz Corneal Topography System before operation,1 month and 6 months after operation.According to the values of angle Kappa before SBK,the patients were divided into 2 groups:the large K group(angle Kappa≥5°,71 eyes) and the small K group(angle Kappa<5°,197 eyes).Correlation analysis of the factors influencing angle Kappa at 6 months after operation was performed.Results:In the large K group,angle Kappa was(5.67±0.65)°,spherical equivalent was(-4.84±2.32) D,and angle Kappa was decreased after operation(both P<0.05) with the increased decreasing range over time.In the small K group,angle Kappa was(3.51±1.08)°,spherical equivalent was(-5.78±2.63) D,angle Kappa was increased after operation with decreased increasing range over time,and the difference was statistically significant between 6 months after operation and before operation(P<0.05).The post-corneal Diff value of the 2 groups was increased after operation(all P<0.001),and was decreased from 1 month to 6 months after surgery.The corneal curvature in the central corneal region of 3 mm of the 2 groups 1 month after operation was decreased significantly(both P<0.001).From 1 month to 6 months after operation,the corneal curvature of the large K group tended to be stable,while the corneal curvature of the small K group tended to increase.There was no significant correlation between the changes of angle Kappa 6 months after operation and the changes of the corneal central curvature or the post-corneal Diff value(bo

关 键 词：近视 KAPPA角 前弹力层下激光角膜磨削术 角膜曲率 角膜后表面Diff值 

分 类 号：R779.63[医药卫生—眼科]