Smart术后角膜前表面形态及高阶像差的变化  

Changes of corneal anterior surface morphology and higher-order aberrations after Smart

作　　者：王淑涵 王桂琴 于澳淼 赵少贞[1] 魏瑞华[1] 黄悦 Wang Shuhan;Wang Guiqin;Yu Aomiao;Zhao Shaozhen;Wei Ruihua;Huang Yue(Tianjin Key Laboratory of Retinal Functions and Diseases,Tianjin Branch of National Clinical Research Center for Ocular Diseases,Eye Institute and School of Optometry,Tianjin Medical University Eye Hospital,Tianjin 300384,China)

机构地区：[1]天津医科大学眼科医院,天津医科大学眼视光学院,天津医科大学眼科研究所,国家眼耳鼻喉疾病临床医学研究中心天津市分中心,天津市视网膜功能与疾病重点实验室,300384

出　　处：《中华实验眼科杂志》2021年第6期522-527,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：天津市临床重点学科(专科)建设项目(TJLCZDXKM013)。

摘　　要：目的比较低度和中度近视患者智能脉冲技术辅助的经上皮准分子激光角膜切削术(Smart)术后角膜非球面性及高阶像差的变化。方法采用非随机对照研究设计,纳入2018年11月至2019年3月于天津医科大学眼科医院接受Smart手术的中、低度近视患者54例98眼,其中低度近视组23例41眼,中度近视组31例57眼。分别于术前、术后1个月、术后3个月采用Pentacam眼前节分析系统测量角膜Q值、角膜表面变异指数(ISV)、总高阶像差(HOA)、垂直彗差(Z_(3)^(-1))、水平彗差(Z_(3)^(1))和球差(Z_(4)^(0)),比较低度和中度近视患者角膜前表面形态的改变。采用Pearson相关分析对测量参数的相关性进行分析。结果低度近视组术后1个月角膜Q值、ISV、HOA、Z_(4)^(0)分别为0.445±0.191、26.973±5.611、0.671±0.142和0.384±0.188,较术前的-0.273±0.817、13.784±2.376、0.433±0.687和0.231±0.062均明显增加,中度近视组术后1个月角膜Q值、ISV、HOA、Z_(4)^(0)分别为0.693±0.203、34.038±5.773、0.874±0.216和0.520±0.129,较术前的-0.309±0.104、14.838±3.992、0.409±0.081和0.228±0.089均明显增加,差异均有统计学意义(均P<0.05)。中度近视组手术后不同时间点角膜Q值、ISV、HOA、Z_(4)^(0)均高于低度近视组,差异均有统计学意义(均P<0.05)。术后1个月、3个月,2个组角膜Z_(3)^(-1)、Z_(3)^(1)比较差异均无统计学意义(均P>0.05)。相关性分析结果显示,2个组ΔQ值和ΔISV均与等效球镜度呈负相关(ΔQ值:低度近视组:r=-0.364,P=0.044;中度近视组:r=-0.589,P<0.01;ΔISV:低度近视组:r=-0.298,P=0.039;中度近视组:r=-0.409,P=0.022);中度近视组ΔQ值与ΔZ_(4)^(0)呈正相关(r=0.348,P=0.009),低度近视组ΔQ值与ΔZ_(4)^(0)无显著相关性(r=0.180,P=0.266)。结论Smart术后低度和中度近视眼角膜高阶像差及ISV均较术前增加,角膜Q值均由负变正,但对低度近视眼角膜前表面非球面性的影响较小。Objective To compare the changes of corneal asphericity and higher-order aberrations after smart pulse technology-assisted transepithelial photorefractive keratectomy(Smart)for low and moderate myopia and to investigate the changes in the shape of the front corneal surface in patients with different diopters.Methods A non-randomized controlled study design was used.Ninety-eight eyes of 54 patients with moderate or low myopia who underwent Smart surgery in Tianjin Medical University Eye Hospital from November 2018 to March 2019 were included.The 41 eyes of 23 patients with low myopia were set as the low-myopia group,and 57 eyes of 31 patients with moderate myopia were assigned as the moderate-myopia group.The Pentacam anterior segment analysis system was used to measure Q value,index of surface variance(ISV),corneal higher-order aberration(HOA),corneal vertical coma(Z_(3)^(-1)),corneal horizontal coma(Z_(3)^(1))and spherical aberration(Z_(4)^(0))before surgery,1 month and 3 months after surgery.The anterior surface morphology was compared between the low-myopia and moderate-myopia group.Pearson correlation analysis was used to analyze the correlations between measurement parameters.The study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital(No.2019KY-17).Written informed consent was obtained from each patient before surgery.Results Corneal Q value,ISV,HOA and Z_(4)^(0) were 0.445±0.191,26.973±5.611,0.671±0.142 and 0.384±0.188,respectively,in the low-myopia group at one month after surgery,which were significantly increased than corresponding preoperative values of-0.273±0.817,13.784±2.376,0.433±0.687 and 0.231±0.062(all at P<0.05).Corneal Q value,ISV,HOA and Z_(4)^(0) were 0.693±0.203,34.038±5.773,0.874±0.216 and 0.520±0.129,respectively,in the moderate-myopia group at one month after surgery,which were significantly increased than corresponding preoperative values of-0.309±0.104,14.838±3.992,0.409±0.081 and 0.228±0.089(all at P<0.05).Corneal Q values,ISV,HOA a

关 键 词：经上皮准分子激光角膜切削术 角膜非球面性 高阶像差 Q值 

分 类 号：R779.63[医药卫生—眼科]