高能量加速型角膜胶原交联术对圆锥角膜眼表的影响  

Effect of high-energy accelerated corneal collagen cross-linking on the ocular surface of keratoconus

作　　者：夏艳云 钟定娟 王华[1] 李孟婷 李前 陈蛟[1] 何书喜[1] XIA Yanyun;ZHONG Dingjuan;WANG Hua;LI Mengting;LI Qian;CHEN Jiao;HE Shuxi(Department of Ophthalmology,Hunan Provincial People's Hospital,The First Affiliated Hospital of Hunan Normal University,Changsha 410005,Hunan,China)

机构地区：[1]湖南师范大学附属第一医院/湖南省人民医院眼视光中心,湖南长沙410005

出　　处：《山东大学耳鼻喉眼学报》2021年第6期42-51,共10页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：湖南省创新性省份建设项目(2020SK2118)。

摘　　要：目的探讨圆锥角膜患者角膜胶原交联术前后眼表的变化规律。方法选取诊断为圆锥角膜符合纳入、排除标准,且知情同意后接受行高能量加速型角膜交联术的患者42例(60眼)。以眼为单位,根据Kmax分3个组(轻度圆锥角膜组、中度圆锥角膜组、重度圆锥角膜组);根据K2与K1差值即散光分为3个组,A组(0≤K2-K1≤2.5D),B组(2.5D<K2-K1≤5D),C组(K2-K1>5D),追踪观察并且记录患者角膜交联术前、术后1mo、3mo角膜最大曲率(Kmax)、K1和K2、角膜厚度与散光、泪膜破裂时间、泪河高度等相关参数的变化规律及特点。采用SPSS 26.0软件对数据进行统计学分析,对比术前及术后不同时间点各参数是否有差异,检验水准为α=0.05,P<0.05为差异有统计学意义。结果 (1)根据Kmax分组,术前基线角膜厚度、K1、K2均具有统计学意义(P<0.001),年龄、散光、泪河高度、泪膜破裂时间均无统计学意义(P=0.35、0.22、0.63、0.57),3个组手术前后不同时间点的角膜厚度、Kmax、泪河高度、K1、K2总体比较差异均具有统计学意义(F;=52.72、5.22、3.30、5.06、5.25,均P<0.05;F;=9.25、38.28,P<0.05,2.48,P>0.05,13.37,P<0.05,6.28,P>0.05), 3个组手术前后不同时间点的泪膜破裂时间总体比较差异无统计学意义(F;=1.001,P=0.38;F;=0.953,P=0.40);(2)根据散光分组,术前基线Kmax、K1、K2均具有统计学意义(P=0.001、0.02、<0.001),年龄、角膜厚度、泪河高度、泪膜破裂时间均无统计学意义(P=0.13、0.43、0.96、0.11),3个组手术前后不同时间点的角膜厚度、Kmax、泪河高度、K1、 K2总体比较差异均具有统计学意义(F;=45.91、6.61、4.06、5.19、8.4,均P<0.05;F;=0.53、0.6、0.75、1.19,P>0.05,7.63,P<0.05);3个组手术前后不同时间点的泪膜破裂时间总体比较差异无统计学意义(F;=1.103,P=0.34;F;=1.121,P=0.34);(3)将眼表泪液参数泪河高度及泪膜破裂时间的值与角膜形态参数Kmax、K1、K2、散光的值进行术前、术�Objective To study the changes in ocular surface before and after corneal collagen cross-linking in patients with keratoconus.Methods A retrospective study was conducted on 42 patients(60 eyes)diagnosed with keratoconus at the Ophthalmology Center of Hunan Provincial People's Hospital from November 2020 to May 2021 who met the inclusion and exclusion criteria and received high-energy accelerated corneal collagen cross-linking after providing informed consent.Based on corneal maximum curvature(Kmax),the patients were divided into the following three groups:mild,moderate,and severe.Further,the patients were divided into three groups according to the difference between flat keratometry(K1)and steep keratometry(K2),namely astigmatism:group A(0≤K2-K1≤2.5D),group B(2.5D<K2-K1≤5D),and group C(K2-K1>5D).The changes and characteristics of Kmax,K1,K2,corneal thickness,astigmatism,tear breakup time,tear meniscus height at 1 and 3 months before and after corneal collagen,and cross-linking were recorded.SPSS 26.0 software was used for statistical analysis to determine any difference in parameters at different time points before and after surgery.The test level was considered asα=0.05,and P<0.05 was considered statistically significant.Results For the Kmax group,preoperative baseline corneal thickness,K1,K2 showed statistical significance(P<0.001),whereas age,astigmatism,tear meniscus height,and tear breakup time did not(P=0.35、0.22、0.63、0.57).Significant differences were noted in corneal thickness,Kmax,tear meniscus height,K1,and K2 at different time points before and after surgery among the three groups(F_(time)=52.72,5.22,3.30,5.06,5.25,respectively,P<0.05;F_(group)=9.25,38.28,P<0.05,2.48,P>0.05,13.37,P<0.05,6.28,P>0.05).There were no significant differences in tear breakup time at different time points before and after surgery among the three groups(F_(time)=1.001,P=0.38;F_(group)=0.953,P=0.40).For the astigmatism group,preoperative baseline Kmax,K1,K2 were statistically significant(P=0.001、0.02、<0.001),wh

关 键 词：高能量加速型角膜交联术 圆锥角膜 眼表 泪膜破裂时间 泪河高度 

分 类 号：R772.2[医药卫生—眼科]