论著

湖南地区汉族人群糖尿病视网膜病变危险因素的相关性

Correlation of risk factors of diabetic retinopathy in Han population in Hunan

:509-516
 
目的:分析湖南地区汉族人群中2型糖尿病患者的人口学特征及生化指标,寻找糖尿病视网膜病变的高危因素。方法:釆用病例对照研究,统计湖南地区正常人群、2型糖尿病但无视网膜病变患者、2型糖尿病视网膜病变患者的人口学特征及生化指标的相关数据,进行成组t检验及logistic回归分析,探讨分析糖尿病视网膜病发生的易感因素。所有研究对象均为汉族。结果:对照组[非糖尿病(non-diabetes mellitus,NDM)组]和2型糖尿病未合并视网膜病变[(non-diabetic retinopathy,NDR)]组之间性别分布、年龄分布、BMI、舒张压、HbA1c、总胆固醇、高密度脂蛋白(high-density lipoprotein,HDL)、尿酸及总胆红素差异无统计学意义(均P>0.05)。NDM组中腹围、收缩压、空腹血糖、三酰甘油、肌酐和低密度脂蛋白(low-density lipoprotein,LDL)值均低于NDR组,差异有统计学意义(均P<0.05)。NDM组中BMI、腹围、收缩压、舒张压、空腹血糖、HbA1c、总胆固醇、三酰甘油、肌酐和LDL值均低于2型糖尿病合并视网膜病变组(diabetic retinopathy,DR)组,差异有统计学意义(均P<0.05)。NDR组收缩压、舒张压、HbA1c、总胆固醇、三酰甘油和肌酐值均低于DR组,差异有统计学意义(均P<0.05)。结论:收缩压超过150 mmHg,舒张压超过90mmHg,糖化血红蛋白超过9%,血清肌酐超过100 μmol/L,三酰甘油超过3 mmol/L均为糖尿病患者发生视网膜病变的高危易感因素。
Objective: To analyze the demographic characteristics and biochemical indexes of type 2 diabetic patients in Han population in Hunan, and to find the high-risk factors of diabetic retinopathy. Methods: The data of demographic characteristics and biochemical indexes of normal population, type 2 diabetic patients but without retinopathy and type 2 diabetic retinopathy in Hunan were analyzed. Group t test and logistic regression analysis were used to analyze the susceptibility factors of diabetic retinopathy. All the subjects were Han population. Results: There were no significant differences in gender distribution, age distribution, BMI, diastolic blood pressure, HbA1c,total cholesterol, high-density lipoprotein, uric acid and total bilirubin between the control group [non-diabetes mellitus (NDM) group] and the type 2 diabetic without retinopathy group [non-diabetic retinopathy (NDR)group] (all P>0.05). The abdominal circumference, systolic blood pressure, fasting blood glucose, triglyceride,creatinine and low-density lipoprotein in NDM group were all lower than those in NDR group, and the differences were statistically significant (all P<0.05). BMI, abdominal circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, total cholesterol, triglyceride, creatinine and LDL in NDM group were all lower than those in type 2 diabetic retinopathy (DR) group, and the differences were statistically significant (all P<0.05). The comparison between the NDR group and the DR group showed that the values of systolic blood pressure,diastolic blood pressure, HbA1c, total cholesterol, triglyceride and creatinine in the NDR group were all lower than those in the DR group, and the differences were statistically significant (all P<0.05). Conclusion: SBP ≥150 mmHg,DBP ≥90 mmHg, HbA1c ≥9%, serum creatinine ≥100 μmol/L, triglyceride ≥3 mmol/L are the high-risk factors of diabetic retinopathy.
论著

原发性开角型青光眼患者5年视野缺损进展情况及相关因素

Progression and influencing factors of 5-year visual field damage in patients with primary open-angle glaucoma

:426-432
 
目的:了解原发性开角型青光眼(primary open angle glaucoma,POAG)患者视野缺损的进展情况,探讨其发生进展的相关危险因素。方法:回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首次视野检查的平均偏差或平均缺损进行分期。将历次随访视野检查的平均偏差或平均缺损与时间进行线性回归分析,取其斜率(dB/年)。根据平均偏差或平均缺损的斜率将患者分为进展组与无进展组。分析患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度损害位置、平均随诊间隔时间、基线视野分期等因素与青光眼视野缺损进展的关系。结果:共纳入128例患者(252只眼),其中129眼使用Octopus视野计检查随访,基线视野缺损值为(10.91±5.76) dB;123眼使用Humphrey视野计,基线视野偏差值为(–10.62±6.89) dB。视野缺损早、中、晚期的比例分别为26.19%、36.51%和37.30%。进展组31只眼(12.30%),无进展组221只眼(87.70%)。上下方RNFL都存在重度损害的患者,其视野缺损更易进展(P<0.001)。平均随诊间隔时间≤4个月的患眼,发生进展的比例高于平均随诊间隔时间>4个月的患眼(P=0.058)。基线视野分期、年龄、性别、总随访时间与视野缺损进展未见显著相关性。结论:青光眼患者的视功能损害出现恶化是普遍存在的。上下方RNFL均存在重度损害、随诊间隔时间短与视野缺损进展相关。视神经结构的改变与功能损害具有相关性,结构改变的方位对功能损害进展有提示功能。规律随诊对病情监测有重要意义,对于可能快速进展的患者,应缩短随诊间隔时间。
Objective: To investigate the progression of visual field defect in primary open angle glaucoma (POAG), and to explore the related risk factors for its progression. Methods: A retrospective analysis was performed on patients with POAG who had at least 4 visual field examinations in the Department of Ophthalmology, Peking University Third Hospital from January 2014 to July 2018. The visual field was staged according to the mean deviation or mean defect of the first visual field examination. Linear regression analyses of mean deviation or mean defect were performed against time, and corresponding regression slopes (in decibels per year) were calculated. Patients were divided into progressive and non-progressive groups according to the mean deviation slope or mean defect slope. The relationship between retinal nerve fiber layer (RNFL) thickness lesion location, mean follow-up interval, baseline visual field staging, and the progression of visual field defect in glaucoma were analyzed. Results: A total of 128 patients (252 eyes) were included. Among them, 129 eyes were followed up with an Octopus perimeter, and the average mean defect value of the baseline visual field was 10.91±5.76 dB; while the other 123 eyes were followed up with a Humphrey perimeter, and the average mean deviation value of the baseline visual field was –10.62±6.89 dB. The proportion of early, middle and late visual field defects was 26.19%, 36.51% and 37.30%. There were 31 eyes (12.30%) in the progressive group and 221 eyes (87.70%) in the non-progressive group. Patients with severe damage to both the upper and lower RNFLs had more visual field defects (P<0.001). Patients with an average follow-up interval ≤4 months had a higher rate of progression than those with an average follow-up interval >4 months (P=0.058).There were no significant differences in baseline visual field stage, age, gender, and total follow-up time between the progression and progression-free groups. Conclusion: Deterioration of visual function impairment is common in glaucoma patients. The progression of visual field defects is associated with severe impairments which are present both in the upper and lower RNFLs, and short follow-up intervals. Optic nerve structure changes are related to functional impairment, and the location of structural changes is suggestive of functional impairment progression.Regular follow-up visits are of great significance for disease monitoring. For patients who may progress rapidly, the follow-up interval should be shortened.
综述

视网膜静脉阻塞继发黄斑水肿的抗VEGF治疗方案的研究进展

Research progress in anti-vascular endothelial growth factor treatment regimens for macular edema secondary to retinal vein occlusion

:371-379
 
抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗视网膜静脉阻塞(retinal vein occlusion,RVO)继发黄斑水肿(macular edema,ME)的有效性及安全性已得到广泛证实。但抗VEGF治疗方案尚无统一标准。现行的治疗方案主要包括固定治疗方案、按需(pro re nata,PRN)治疗方案、稳定性标准驱使的按需(stabilization criteria-driven PRN)治疗方案、治疗与延长(treat and extend,T&E)方案。近年来不少研究综合比较了各个治疗方案在改善视功能、量化评估疾病活动性、调整随访频率等多个维度的表现,为临床医生提供选择抗VEGF治疗方案的参考依据。本文旨在回顾并总结近年来对抗VEGF药物治疗RVO继发ME的研究,阐述抗VEGF治疗方案的研究进展。
The efficacy and safety of anti-vascular endothelial growth factor (VEGF) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) have been widely confirmed. However, there is no unified standard for anti-VEGF treatment regimens. Current treatment regimens mainly include fixed treatment regimen, pro re nata (PRN) treatment regimen, stabilization criteria-driven PRN treatment regimen, and treat and extend (T&E) regimen. In recent years, many studies have compared different treatment regimens in composite dimensions,including improving visual function, assessing disease activity quantitatively and adjusting the follow-up frequency,to provide clinicians with a reference of choosing anti-VEGF treatment regimens. The purpose of this article is to review and summarize recent researches on anti-VEGF drugs in the treatment of ME secondary to RVO, and to clarify the research progress in the anti-VEGF treatment regimens.
论著

不同类型黄斑裂孔患病的相关因素

Related factors of various types of macular hole diseases

:333-336
 
目的:观察并分析不同类型黄斑裂孔的患病相关影响因素。方法:回顾性分析2012年1月 至2018年12月在兰州大学第二医院住院治疗的1 150例(1 202只眼)全层黄斑裂孔患者的年龄、性别、民族、最佳矫正视力、黄斑裂孔类型以及是否继发孔源性视网膜脱离等临床资料。结果:黄斑裂孔患病人数随年龄增长呈趋势性分布,60~69岁年龄段患病人数最多;男女患病差异有统计学意义(P<0.05),眼别差异无统计学意义(P>0.05);特发性黄斑裂孔继发孔源性视网膜脱离的占比明显低于其他类型;特发性黄斑裂孔的入院最佳矫正视力较高,与高度近视黄斑裂孔相比,差异有统计学意义(P<0.05)。结论:黄斑裂孔多发于老年人,女性多见,高度近视黄斑裂孔容易继发孔源性视网膜脱离,可考虑尽早安排手术治疗;外伤性黄斑裂孔好发于中青年男性,常见于眼球钝挫伤,若未引发视网膜脱离等并发症,应适当观察而不急于手术。每1例黄斑裂孔都可能有其特殊性,需要认真分析病情综合判断,酌情选择观察或手术。
Objective: To observe and analyze the disease related factors of different types of macular hole. Methods: Clinical data including age, sex, ethnicity, best corrected visual acuity, macular hole type and whether accompanied by rhegmatogenous retinal detachment were retrospectively analyzed in 1 150 patients (1 202 eyes) hospitalized in our hospital from January 2012 to December 2018. Results: The number of patients with macular hole increased with age. There was statistically significant difference between male and female patients (P<0.05), and no statistically significant difference between eyes (P>0.05). The rate of rhegmatogenous retinal detachment caused by idiopathic macular hole was significantly lower than other types. The optimal corrected visual acuity of idiopathic macular hole was higher in admission, which was statistically different from that of high myopia macular hole and ametropia macular hole (P<0.05). Conclusion: Macular hole is more common in the elderly and more common in women. High myopia and ametropia macular hole are easily associated with rhegmatogenous retinal detachment, so surgical treatment should be arranged as soon as possible. Traumatic macular hole often occurs in young and middle-aged men and is often seen in blunt contusion of the eyeball. Each case of macular hole may have its particularity, which requires careful analysis of the condition, comprehensive analysis, and appropriate choice of observation or surgery.
论著

角膜移植日间手术患者的延续护理需求调查及其影响因素

Investigation and analysis of transitional care needs among patients with keratoplasty in day ward and its influencing factors

:393-400
 
目的:探究角膜移植日间手术患者的延续护理需求现状及其影响因素。方法:采用便利抽样法抽取行角膜移植日间手术的173例患者,采用课题组自行设计的一般资料调查表、角膜移植日间手术患者延续护理需求调查问卷进行调查。采用独立样本t检验、单因素方差分析、多元线性回归进行统计分析。结果:角膜移植日间术后患者延续护理需求得分为88.13±15.55,其中,对疾病相关知识的需求得分最高,为4.39±0.66,对心理护理的需求得分最低,为2.72±1.18;在延续护理实施方式方面,74.6%患者倾向于电话随访,只有5.8%倾向于上门服务;在影响因素方面,婚姻状况、视力、家庭月收入、文化程度是延续护理需求的影响因素。结论:角膜移植日间术后患者的延续护理需求较高,应根据患者延续护理需求及影响因素进行个性化指导,以提高角膜移植手术的成功率和减少并发症的发生。
Objective: To explore transition care needs among patients with keratoplasty in day ward and analyze the influencing factors. Methods: Using convenience sampling method, 173 patients undergoing keratoplasty in day ward were selected, and they were investigated by using a self-designed general information questionnaire and a questionnaire of transitional care needs of patients with keratoplasty in day ward. T-test, one-way analysis of variance (ANOVA), multiple linear regression were used to analyze the data. Results: The total score of transitional care needs among patients with keratoplasty in day ward was 88.13±15.55. The demand for disease related knowledge was the highest (4.39±0.66), the demand for mental nursing was the lowest (2.72±1.18). In terms of the way of implementation, 74.6% patients preferred telephone follow-up and only 5.8% preferred door-to-door service. Single-factor analysis showed that marital status, vision, monthly income, educational level were the factors influencing the demand for transitional care (P<0.05). Conclusion: Patients with keratoplasty in day ward have a high demand for transitional care. In order to improve the success rate of keratoplasty and reduce the incidence of complications, personalized guidance should be given according to patients’ transitional care needs and influencing factors.
技术交流

影响角膜异物剔除术预后的因素分析

Analysis of influencing factors of prognosis of corneal foreign body removal

:348-352
 
角膜异物是眼科急诊中常见病之一,不及时处置或处置不当会导致角膜不同程度的损伤,严重者可引起角膜感染、角膜穿孔等并发症,严重损害视功能。因此安全、高效地剔除角膜异物至关重要。本文从角膜异物的特点、伤后首诊时间、角膜合并感染以及角膜异物的剔除方法等方面对角膜异物剔除术预后的影响进行回顾总结,旨在为医护人员行角膜异物剔除时提供有用参考。
Corneal foreign body is one of common diseases in ophthalmic emergency. Improper handling can cause different degree of corneal injuries, even corneal infection, perforation and endophthalmitis. Therefore, it is essential to eliminate corneal foreign bodies safely and effectively. This article mainly summarizes the influence of the characteristics of the corneal foreign bodies, the first diagnosis time after injury, corneal co-infection and the methods of weeding out the corneal foreign bodies upon the clinical prognosis of corneal foreign body removal, aiming to provide useful reference for medical practitioners in removing corneal foreign bodies.
论著

医联体糖尿病患者眼科随访的健康信念及其影响因素

Health belief and influencing factors of ophthalmic follow-up in patients with diabetes in medical alliance

:307-316
 
目的:测量医联体糖尿病患者眼科随访依从性及相关的健康信念,分析其影响因素。方法:采用便利抽样的方法,使用中文版糖尿病眼科随访依从性问卷对在广州医科大学附属第二医院所辖医联体内的334例糖尿病患者进行调查。结果:仅24.3%的受访者在过去的1年中接受过眼科散瞳检查,受访者眼科随访健康信念的总体评分为3.09±0.64,其中感知的益处和威胁维度评分最高,行为线索维度评分最低。糖尿病类型、就医倾向、合并其他糖尿病并发症、医联体相关知识和家庭类型是糖尿病患者眼科随访健康信念的主要影响因素。结论:医联体糖尿病患者眼科随访健康信念处于一般水平,缺乏行为线索支持,提示在糖尿病眼部并发症筛查和防治过程中,医联体应发挥下筛上转的功能,通过对障碍因素的干预,提高辖区糖尿病患者接受眼科随访的依从性。
Objective: To measure the adherence to ophthalmology follow-up and the related health belief of patients with diabetes in medical alliance, and analyze the influencing factors. Methods: Totally 334 community-dwelling patients with diabetes mellitus were recruited in a medical alliance in Guangzhou by convenient sampling method. They were investigated by the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C). Results: Dilated fundus examination within the last year were only reported by 24.3% of respondents. The mean score of the CADEES-C was 3.09±0.64, with the highest score in perceived benefit and threat dimensions and the lowest score in behavioral cue dimension. The factors that mainly influence the adherence to ophthalmology follow-up and their related health beliefs of patients with diabetes are types of diabetes, propensity to seek treatment, other complications of diabetes, knowledge of medical alliance and family pattern. Conclusion: The adherence to ophthalmology follow-up and the related health belief of patients with diabetes are at low level with the deficiency of behavioral cues. It is suggested that medical alliance should play a critical role to improve the status quo by developing more screening and referrals.
“筑梦·铸人”专题

中国温州学龄儿童近视进展的危险因素

Risk factors for myopia progression in school-age children in Wenzhou, China

:85-92
 
目的:观察学龄儿童的近视进展情况,分析近视进展的危险因素。方法:于2014年纳入温州2所小学二、三年级近视儿童,每年随访1次,直至小学毕业。检查内容包括非睫状肌麻痹主觉验光、双眼视功能检查(隐斜、调节性集合/调节、正负相对调节、正负融像性聚散)和问卷调查。采用无序多分类logistic回归分析近视进展速度的危险因素。结果:共纳入152名近视儿童[年龄7~9岁,95名(62.5%)男性],初始屈光度为-1.30±0.95屈光度(diopter,D),年近视进展量为-0.68±0.35 D。回归分析表明:与慢速组相比(年近视进展量>-0.50 D),中速组(-1.00 D<年近视进展量≤-0.50 D)与快速组(年近视进展量≤-1.00 D)中初始屈光度≤-1.00 D的儿童占比更大(中速组:OR=3.51,P=0.003;快速组:OR=3.29,P=0.044),快速组中女性占比更大(OR=4.52,P=0.012),基线双眼视功能参数在不同组间差异均无统计学意义(均P>0.05)。结论:学龄儿童近视进展速度与性别、初始屈光度相关,与基线双眼视功能无关。女孩、初始近视程度大(7~9岁时,屈光度≤-1.00 D)的儿童近视进展快。
Objective: To investigate myopia progression and analyze the risk factors associated with myopia progression in a cohort of primary schoolchildren. Methods: The study was conducted in two primary schools in Wenzhou. Schoolchildren from grades 2 and 3 were examined in 2014 and were followed up annually until primary school graduation at grade 6. Children who were myopic at baseline were included in this study. The examination included non-cycloplegic subjective refraction, questionnaire survey, and binocular visual function parameters such as phoria, accommodative convergence/accommodation, positive relative accommodation, negative relative accommodation, and fusional convergence range. Multinomial logistic regression analysis was conducted to investigate the risk factors associated with various myopia progression speeds. Results: A total of 152 myopic schoolchildren [baseline age range 7–9 years; 95 male (62.5%)] were included in this study. The average refractive error (spherical equivalent refraction, SER) at baseline was -1.30±0.95 D, and the average annual myopia progression was -0.68±0.35 D. Multinomial logistic regression analysis showed that compared to the slow myopia progression group (annual myopia progression >-0.50 D), the moderate myopia progression group (-1.00 D < annual myopia progression ≤-0.50 D) and the fast myopia progression group (annual myopia progression ≤-1.00 D) were associated with having SER values ≤-1.00 D at baseline (moderate: OR=3.51, P=0.003; fast: OR=3.29, P=0.044); the fast myopia progression group was also associated with female sex (OR=4.52, P=0.012); baseline binocular visual function parameters were not related to various myopia progression speeds (P>0.05 for all). Conclusion: Sex and baseline refractive error were associated with various myopia progression among primary schoolchildren. No correlation between baseline binocular visual functions and myopia progression was found in this study. Myopia progressed faster in girls and children who had greater myopia (SER values ≤?1.00 D at age 7–9 years) at baseline.
论著

有晶体眼人工晶状体植入术后视疲劳症状及影响因素

Outcomes of asthenopia after implantable collamer lens implantation and its related factors

:620-626
 
目的:评估屈光不正患者有晶体眼后房型人工晶体(implantable collamer lens,ICL)植入术后视疲劳症状及调节集合功能、眼表、像差的变化,并探讨其对视疲劳症状的影响。方法:前瞻性病例观察分析。连续收集在沧州市中心医院行ICL手术并完成3个月随访的患者,测定术前、术后1周、1个月、3个月时的视疲劳评分、调节幅度(amplitude of accommodation,AA)、正相对调节和负相对调节(positive/negative relative accommodation,PRA/NRA)、调节灵敏度(accommodative facility,AF)、调节性集合(accommodative convergence,AC)与调节(accommodation,A)比率(AC/A),Schirmer实验、非侵入性泪膜破裂时间(noninvasive breakup time,NBUT)及高阶像差(higher order aberration,HOA),进行统计学分析。结果:ICL术后第1周视疲劳症状较术前明显加重,随时间推移逐渐减轻,术后1个月仍高于术前,术后3个月时恢复。AA术后1周时较术前降低,术后1个月、3个月时明显高于术前;AF术后1周时较术前下降,术后1个月比术前水平稍好,3个月时明显高于术前;PRA、NRA无明显变化;AC/A术后1周时较术前下降,术后1个月回复到术前水平,术后3个月较术前提高。术后1周、1个月及3个月的NBUT值均较术前明显下降,术后1周时最低;Schiermer值术后1周时轻度下降,术后1个月、3个月时基本恢复。术后的总HOA均较术前有所增加,但各个时间点之间无明显变化。相关性分析显示ICL术后AF越差、NBUT越低,视疲劳症状越重。结论:ICL术后视疲劳症状一过性加重,AF和NBUT是影响视疲劳变化的重要因素。
Objective: To evaluate the changes of visual fatigue symptoms, accommodative functions, ocular surface conditions, and high-order aberrations (HOA) after implantation of implantable collamer lens (ICL), and to explore their effects on asthenopia. Methods: It was a prospective observational case series. Patients with ametropia who underwent ICL surgeries and completed 3-month follow-up in our hospital were enrolled.Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA),accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, non-invasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months after surgeries, then statistically analyzed. Results: Symptoms of asthenopia were significantly worse at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. Among regulatory indicators, AA decreased 1 week postoperatively, but was significantly higher at 1 and 3 months after surgeries; AF was lower 1 week after surgery than baseline, slightly better at 1 month postoperatively, and significantly higher at 3 months postoperatively; PRA and NRA had no significant change; AC/A decreased 1 week after surgeries, returned to the baseline at 1 month postoperatively, and increased 3 months postoperatively. Tears and meibomian gland function index: NBUT values at 1 week, 1 month and 3 months after surgeries were significantly decreased compared with those before surgeries, and NBUT at 1 week postoperatively was the lowest; Schiermer values had a slight decrease at 1 week after surgeries, and basically recovered at 1 and 3 months after surgeries. HOA after surgeries were increased compared with those before surgeries, but there was no significant change between each time point. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms. Conclusion: The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.
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LASIK手术前后角膜滞后量与角膜阻力因子变化量及其相关因素的多元线性回归分析

Change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis and multiple linear regression analysis of the correlative factors

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[摘 要] 目的:研究准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)前后角膜滞后量(corneal hysteresis,CH)和角膜阻力因子(corneal resistance factor,CRF)变化量,对其相关因素进行多元线性回归分析。方法:前瞻性研究。纳入行LASIK手术的近视眼及近视散光患者70眼(38例),术前与术后6个月各项参数分别由眼反应分析仪(ocular response analyzer,ORA)、非接触眼压仪、超声角膜测厚仪及Pentacam眼前节分析仪测量。分析LASIK手术前后△CH,△CRF与术前、手术设计等参数的相关性,并对相关参数进行多元线性回归分析。结果:手术前后CH分别为(10.05±1.36),(8.15±0.90) mmHg(1 mmHg=0.133 kPa),CRF分别为(9.91±1.38),(6.92±0.88) mmHg,差异均有统计学意义(P<0.01);△CH与△CRF分别为(1.90±1.15),(2.99±1.23) mmHg。△CH与术前CH,CRF,眼压(intraocular pressure,IOP),预计切削深度(ablative depth,AD)以及AD/CCT呈正相关;△CRF与术前CH,CRF,IOP,AD,AD/CCT,术前等值球镜(spherical equivalent,SE)以及预计 基质床厚度(residual stromal bed’s thickness,RSBT)有相关性。采用多元线性回归对LASIK手术前后△CH,△CRF与术前、手术设计等各相关参数进行分析,回归方程为:△CH=?6.182+0.658CH术前+8.421AD/CCT (R2=0.639,P<0.01),△CRF=?0.007+0.725CRF术前?0.014RSBT (R2=0.689,P<0.01)。结论:LASIK术前后CH与预计AD和角膜厚度比值密切相关,CRF变化量与预计角膜RSBT密切相关,在设计手术时应慎重考虑预计AD与预计RSBT。
Abstract Objective: To discuss the change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis (LASIK), and to analyze their related factors by multivariate linear regression. Methods: In this prospective study, 70 eyes (38 patients) with myopia and myopic astigmatism undergoing LASIK were included. Related factors were measured preoperatively and at 6 months postoperatively by ocular response analyzer, noncontact tonometer (NCT), ultrasonic pachymeter, and Pentacam system. The correlation was analyzed between △CH, △CRF and preoperative and operative design’s parameters, and correlative factors analyze. △CH and △CRF were analyzed by the multiple linear regression. Results: CH before and after LASIK were (10.05±1.36) and (8.15±0.90) mmHg, and CRF before andafter LASIK were (9.91±1.38) and (6.92±0.88) mmHg. There was significant difference between preoperative and postoperative CH and CRF (P<0.01). △CH and △CRF were (1.90±1.15) and (2.99±1.23) mmHg. Preoperative CH, CRF, intraocular pressure (IOP), ablative depth (AD) and AD/CCT were positive correlated with △CH. Preoperative CH, CRF, IOP, AD, AD/CCT, preoperative spherical equivalent (SE) and predicted residual stromal bed’s thickness (RSBT) were correlated with △CRF. The regression equation of △CH and △CRF and influencing factors were △CH =?6.182 + 0.658CHpreoperative + 8.421AD/CCT (R2=0.639, P<0.01), △CRF =?0.007 + 0.725CRFpreoperative ? 0.014RSBT (R2=0.689, P<0.01). Conclusion: The change of CH before and after LASIK is correlative with AD/CCT. The change of CRF before and after LASIK is correlative with predicted residual stromal bed’s thickness. Ablative depth and predicted residual stromal bed’s thickness should be considered carefully during the surgical design.
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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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