中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2013年
5期
266-270
,共5页
邓世靖%张丰菊%郭宁%侯文博%孙旭光
鄧世靖%張豐菊%郭寧%侯文博%孫旭光
산세정%장봉국%곽저%후문박%손욱광
显微镜检查,共焦%角膜磨镶术,前弹力层下%角膜接触镜%基底下神经纤维,角膜
顯微鏡檢查,共焦%角膜磨鑲術,前彈力層下%角膜接觸鏡%基底下神經纖維,角膜
현미경검사,공초%각막마양술,전탄력층하%각막접촉경%기저하신경섬유,각막
Microscopy,confocal%Keratomileusis,sub-Bowman%Contact lenses%Subbasal nerve fibers,corneal
目的 利用活体共聚焦显微镜(IVCM)观察配戴角膜接触镜对前弹力层下激光角膜磨镶术(SBK)后角膜基底下神经纤维(CSNFs)修复的影响,探讨IVCM在评价屈光手术神经损伤修复中的价值.方法 前瞻性队列研究.选择2010年5月至2011年6月在北京同仁眼科中心行SBK术患者43例(86眼),年龄18～35岁,屈光度-2.75～-10.00 D,部分患者术前均配戴过软性角膜接触镜.将患者分为4组:组Ⅰ,戴镜时间≤5年,共10例；组Ⅱ,戴镜时间＞5～10年,共6例；组Ⅲ,戴镜时间大于＞10年,共4例；组Ⅳ(对照组),无角膜接触镜配戴史,共23例.分别于术前,术后1、3、6个月采用IVCM观察CSNFs的密度、数量级弯曲度,并通过评分评价CSNFs再生速度.数据采用独立样本t检验、单因素方差分析和x2检验进行统计分析.结果 术前不同戴镜时间患者角膜中央CSNFs密度、数量及弯曲度比较差异无统计学意义(F=1.042、1.947、0.821,P＞0.05),但配戴时间大于10年的患者神经密度和数量较低,弯曲度较高.术后6个月角膜中央再生CSNFs密度、数量明显低于术前,弯曲度高于术前(t=6.150、-4.141、9.709,P＜0.01).术后6个月不同戴镜时间组角膜中央再生CSNFs密度、数量及弯曲度差异无统计学意义(F=1.472、0.318、0.353,P＞0.05),但随戴镜时间延长,数量和密度下降,弯曲度增高；不同戴镜时间对SBK术后CSNFs再生速度的影响差异无统计学意义(x2=4.273、8.806、5.364,P＞0.05),但配戴角膜接触镜大于10年患者术后3和6个月再生CSNFs进入角膜中央3 mm区域的比例低于其他各组.结论 配戴角膜接触镜时间对SBK术前后CSNFs无显著影响,但长时间配戴可延缓术后CSNFs的修复.IVCM可客观、定量评价SBK术后角膜神经的损伤与修复.
目的 利用活體共聚焦顯微鏡(IVCM)觀察配戴角膜接觸鏡對前彈力層下激光角膜磨鑲術(SBK)後角膜基底下神經纖維(CSNFs)脩複的影響,探討IVCM在評價屈光手術神經損傷脩複中的價值.方法 前瞻性隊列研究.選擇2010年5月至2011年6月在北京同仁眼科中心行SBK術患者43例(86眼),年齡18～35歲,屈光度-2.75～-10.00 D,部分患者術前均配戴過軟性角膜接觸鏡.將患者分為4組:組Ⅰ,戴鏡時間≤5年,共10例；組Ⅱ,戴鏡時間＞5～10年,共6例；組Ⅲ,戴鏡時間大于＞10年,共4例；組Ⅳ(對照組),無角膜接觸鏡配戴史,共23例.分彆于術前,術後1、3、6箇月採用IVCM觀察CSNFs的密度、數量級彎麯度,併通過評分評價CSNFs再生速度.數據採用獨立樣本t檢驗、單因素方差分析和x2檢驗進行統計分析.結果 術前不同戴鏡時間患者角膜中央CSNFs密度、數量及彎麯度比較差異無統計學意義(F=1.042、1.947、0.821,P＞0.05),但配戴時間大于10年的患者神經密度和數量較低,彎麯度較高.術後6箇月角膜中央再生CSNFs密度、數量明顯低于術前,彎麯度高于術前(t=6.150、-4.141、9.709,P＜0.01).術後6箇月不同戴鏡時間組角膜中央再生CSNFs密度、數量及彎麯度差異無統計學意義(F=1.472、0.318、0.353,P＞0.05),但隨戴鏡時間延長,數量和密度下降,彎麯度增高；不同戴鏡時間對SBK術後CSNFs再生速度的影響差異無統計學意義(x2=4.273、8.806、5.364,P＞0.05),但配戴角膜接觸鏡大于10年患者術後3和6箇月再生CSNFs進入角膜中央3 mm區域的比例低于其他各組.結論 配戴角膜接觸鏡時間對SBK術前後CSNFs無顯著影響,但長時間配戴可延緩術後CSNFs的脩複.IVCM可客觀、定量評價SBK術後角膜神經的損傷與脩複.
목적 이용활체공취초현미경(IVCM)관찰배대각막접촉경대전탄력층하격광각막마양술(SBK)후각막기저하신경섬유(CSNFs)수복적영향,탐토IVCM재평개굴광수술신경손상수복중적개치.방법 전첨성대렬연구.선택2010년5월지2011년6월재북경동인안과중심행SBK술환자43례(86안),년령18～35세,굴광도-2.75～-10.00 D,부분환자술전균배대과연성각막접촉경.장환자분위4조:조Ⅰ,대경시간≤5년,공10례；조Ⅱ,대경시간＞5～10년,공6례；조Ⅲ,대경시간대우＞10년,공4례；조Ⅳ(대조조),무각막접촉경배대사,공23례.분별우술전,술후1、3、6개월채용IVCM관찰CSNFs적밀도、수량급만곡도,병통과평분평개CSNFs재생속도.수거채용독립양본t검험、단인소방차분석화x2검험진행통계분석.결과 술전불동대경시간환자각막중앙CSNFs밀도、수량급만곡도비교차이무통계학의의(F=1.042、1.947、0.821,P＞0.05),단배대시간대우10년적환자신경밀도화수량교저,만곡도교고.술후6개월각막중앙재생CSNFs밀도、수량명현저우술전,만곡도고우술전(t=6.150、-4.141、9.709,P＜0.01).술후6개월불동대경시간조각막중앙재생CSNFs밀도、수량급만곡도차이무통계학의의(F=1.472、0.318、0.353,P＞0.05),단수대경시간연장,수량화밀도하강,만곡도증고；불동대경시간대SBK술후CSNFs재생속도적영향차이무통계학의의(x2=4.273、8.806、5.364,P＞0.05),단배대각막접촉경대우10년환자술후3화6개월재생CSNFs진입각막중앙3 mm구역적비례저우기타각조.결론 배대각막접촉경시간대SBK술전후CSNFs무현저영향,단장시간배대가연완술후CSNFs적수복.IVCM가객관、정량평개SBK술후각막신경적손상여수복.
Objective To analyze the effect of contact lens (CL) wear on corneal reinnervation after sub-Bowman keratomileusis (SBK) corneal subbasal nerve fibers (CSNFs) by in vivo confocal microscopy (IVCM) and to evaluate the clinical applications of IVCM on corneal reinnervation.Methods It was a prospective cohort study.Forty-three patients (86 eyes) were selected from May 2010 to June 2011 in Beijing Tongren Eye Center.The age was 18-35 years old,refractive errorwas-2.75--10.00 D.They were divided into 4 groups:group I,time of soft CL wearing ≤5 years (20 eyes); group Ⅱ,5 years＜time of soft CL wearing≤10 years (12 eyes); Group Ⅲ,time of soft CL wearing ＞10 years (8 eyes); group Ⅳ,without history of CL wearing (46 eyes).The density,number,tortuosity and regenerated velocity of CSNFs of different group were evaluated by IVCM before and 1,3,6 months after SBK.Data were analyzed with independent t test,one-factor analysis of variance and chi-square test.Results There were no significant difference of density,number and tortuosity of central CSNFs among different groups preoperative (F=1.042,1.947,0.821,P＞0.05),but the density and number of central CSNFs decrcased and the tortuosity increased in group of CL wearing ＞10 years.The density and number of central CSNFs were significant lower,and the tortuosity was significant higher than that of pre-operation (t=6.150,-4.141,9.709,P＜0.01).The density,number and tortuosity of central CSNFs among different groups were not significant different (F=1.472,0.318,0.353,P＞0.05),but the longer CL wearing,the lower density and number of central CSNFs and the higher tortuosity were.The velocity of CSNFs regeneration among different groups were not significant different (x2=4.273,8.806,5.364,P＞0.05),but the percentage of regenerated CSNFs deriving into the central 3 mm in group Ⅲ was lower than other groups at 3 and 6 month after surgery.Conclusion The time of CL wearing has no significant effect on CSNFs reinnervation before and after SBK.But long time wearing would delay the reinnervation of CSNFs.IVCM was useful to quantitative evaluate the corneal reinnervation pre-SBK and post-SBK.
