中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
7期
635-640
,共6页
角膜厚度%准分子激光角膜原位磨镶术%角膜内皮显微镜%眼前节光学相干断层扫描%OrbsanⅡ%超声角膜测厚仪
角膜厚度%準分子激光角膜原位磨鑲術%角膜內皮顯微鏡%眼前節光學相榦斷層掃描%OrbsanⅡ%超聲角膜測厚儀
각막후도%준분자격광각막원위마양술%각막내피현미경%안전절광학상간단층소묘%OrbsanⅡ%초성각막측후의
Corneal thickness%Laser-assisted in-situ keratomileusis%Specular microscope%Anterior segment optical coherence tomography%Orbscan Ⅱ%Ultrasound pachymetry
背景 准确的角膜厚度测量对准分子激光角膜屈光手术的术前设计及术后随访非常重要,对屈光欠矫及屈光回退的患者能否行二次激光加强手术更是不可或缺的重要检查. 目的 比较OrbscanⅡ眼前节分析仪(OrbscanⅡ)、非接触角膜内皮显微镜、眼前节光学相干断层扫描仪(AS-OCT)和A型超声角膜测厚仪对准分子激光角膜原位磨镶术(LASIK)术后角膜中央和旁中央厚度测量结果的差异. 方法 收集2011年3-6月在河南省眼科研究所&河南省立眼科医院接受LASIK手术的患者64例64眼(均纳入右眼),受检者术前平均等效球镜屈光度为(-4.75±2.38)D,平均水平角膜直径为(11.36±0.32)mm,采用OrbscanⅡ、非接触角膜内皮显微镜、AS-OCT和A型超声角膜测厚仪(超声法)分别测量受检眼的中央角膜厚度(CCT),同时采用OrbscanⅡ、非接触角膜内皮显微镜、AS-OCT 3种非接触角膜厚度测量法测量距角膜中心3 mm区角膜上方(12:00)、下方(6:00)、鼻上方(2:00)和颞上方(10:00)的旁中央角膜厚度,比较不同角膜测厚仪测量结果的差异,评价检测仪器间测量结果的一致性. 结果 CCT测量结果显示,AS-OCT、A型超声角膜测厚仪、非接触角膜内皮显微镜和OrbsanⅡ的测量值分别为(467.12±31.10)、(466.67±30.99)、(441.84±33.65) μm和(422.51±44.09)μm,总体比较差异有统计学意义(F=23.730,P=0.000);A型超声角膜测厚仪测得的CCT值明显高于OrbsanⅡ和非接触角膜内皮显微镜的结果,差异均有统计学意义(q=6.940、6.720,均P=0.000);与OrbscanⅡ测量方法比较,非接触角膜内皮显微镜和AS-OCT测量的CCT值明显较高,差异均有统计学意义(q=-5.540、6.940,均P=0.000),而AS-OCT测量的CCT值明显高于非接触角膜内皮显微镜的测量值,差异有统计学意义(q=6.800,P=0.000).Bland-Ahman一致性分析结果显示,A型超声角膜测厚仪与AS-OCT测量值的最大绝对差值为25.3 μm,二者的一致性最好.旁中央角膜厚度测量结果显示,OrbsanⅡ测量的角膜厚度值最大,其次为AS-OCT,非接触角膜内皮显微镜测得值最小,3种测厚仪在12:00、2:00、10:00、6:00子午线测得的旁中央角膜厚度值的总体比较差异均有统计学意义(F=5.020、22.950、67.890、18.850,P＜0.01).结论 在分析LASIK术后眼角膜厚度测量值时应考虑到不同检测仪器测量结果的差异,Orbscan Ⅱ对CCT的测量值偏薄,而对旁中央角膜厚度测量值偏厚,非接触角膜内皮显微镜对CCT和旁中央角膜厚度的测量值均偏薄,而AS-OCT与A型超声角膜测厚仪测得的CCT值非常接近,两种仪器可相互替代使用.
揹景 準確的角膜厚度測量對準分子激光角膜屈光手術的術前設計及術後隨訪非常重要,對屈光欠矯及屈光迴退的患者能否行二次激光加彊手術更是不可或缺的重要檢查. 目的 比較OrbscanⅡ眼前節分析儀(OrbscanⅡ)、非接觸角膜內皮顯微鏡、眼前節光學相榦斷層掃描儀(AS-OCT)和A型超聲角膜測厚儀對準分子激光角膜原位磨鑲術(LASIK)術後角膜中央和徬中央厚度測量結果的差異. 方法 收集2011年3-6月在河南省眼科研究所&河南省立眼科醫院接受LASIK手術的患者64例64眼(均納入右眼),受檢者術前平均等效毬鏡屈光度為(-4.75±2.38)D,平均水平角膜直徑為(11.36±0.32)mm,採用OrbscanⅡ、非接觸角膜內皮顯微鏡、AS-OCT和A型超聲角膜測厚儀(超聲法)分彆測量受檢眼的中央角膜厚度(CCT),同時採用OrbscanⅡ、非接觸角膜內皮顯微鏡、AS-OCT 3種非接觸角膜厚度測量法測量距角膜中心3 mm區角膜上方(12:00)、下方(6:00)、鼻上方(2:00)和顳上方(10:00)的徬中央角膜厚度,比較不同角膜測厚儀測量結果的差異,評價檢測儀器間測量結果的一緻性. 結果 CCT測量結果顯示,AS-OCT、A型超聲角膜測厚儀、非接觸角膜內皮顯微鏡和OrbsanⅡ的測量值分彆為(467.12±31.10)、(466.67±30.99)、(441.84±33.65) μm和(422.51±44.09)μm,總體比較差異有統計學意義(F=23.730,P=0.000);A型超聲角膜測厚儀測得的CCT值明顯高于OrbsanⅡ和非接觸角膜內皮顯微鏡的結果,差異均有統計學意義(q=6.940、6.720,均P=0.000);與OrbscanⅡ測量方法比較,非接觸角膜內皮顯微鏡和AS-OCT測量的CCT值明顯較高,差異均有統計學意義(q=-5.540、6.940,均P=0.000),而AS-OCT測量的CCT值明顯高于非接觸角膜內皮顯微鏡的測量值,差異有統計學意義(q=6.800,P=0.000).Bland-Ahman一緻性分析結果顯示,A型超聲角膜測厚儀與AS-OCT測量值的最大絕對差值為25.3 μm,二者的一緻性最好.徬中央角膜厚度測量結果顯示,OrbsanⅡ測量的角膜厚度值最大,其次為AS-OCT,非接觸角膜內皮顯微鏡測得值最小,3種測厚儀在12:00、2:00、10:00、6:00子午線測得的徬中央角膜厚度值的總體比較差異均有統計學意義(F=5.020、22.950、67.890、18.850,P＜0.01).結論 在分析LASIK術後眼角膜厚度測量值時應攷慮到不同檢測儀器測量結果的差異,Orbscan Ⅱ對CCT的測量值偏薄,而對徬中央角膜厚度測量值偏厚,非接觸角膜內皮顯微鏡對CCT和徬中央角膜厚度的測量值均偏薄,而AS-OCT與A型超聲角膜測厚儀測得的CCT值非常接近,兩種儀器可相互替代使用.
배경 준학적각막후도측량대준분자격광각막굴광수술적술전설계급술후수방비상중요,대굴광흠교급굴광회퇴적환자능부행이차격광가강수술경시불가혹결적중요검사. 목적 비교OrbscanⅡ안전절분석의(OrbscanⅡ)、비접촉각막내피현미경、안전절광학상간단층소묘의(AS-OCT)화A형초성각막측후의대준분자격광각막원위마양술(LASIK)술후각막중앙화방중앙후도측량결과적차이. 방법 수집2011년3-6월재하남성안과연구소&하남성립안과의원접수LASIK수술적환자64례64안(균납입우안),수검자술전평균등효구경굴광도위(-4.75±2.38)D,평균수평각막직경위(11.36±0.32)mm,채용OrbscanⅡ、비접촉각막내피현미경、AS-OCT화A형초성각막측후의(초성법)분별측량수검안적중앙각막후도(CCT),동시채용OrbscanⅡ、비접촉각막내피현미경、AS-OCT 3충비접촉각막후도측량법측량거각막중심3 mm구각막상방(12:00)、하방(6:00)、비상방(2:00)화섭상방(10:00)적방중앙각막후도,비교불동각막측후의측량결과적차이,평개검측의기간측량결과적일치성. 결과 CCT측량결과현시,AS-OCT、A형초성각막측후의、비접촉각막내피현미경화OrbsanⅡ적측량치분별위(467.12±31.10)、(466.67±30.99)、(441.84±33.65) μm화(422.51±44.09)μm,총체비교차이유통계학의의(F=23.730,P=0.000);A형초성각막측후의측득적CCT치명현고우OrbsanⅡ화비접촉각막내피현미경적결과,차이균유통계학의의(q=6.940、6.720,균P=0.000);여OrbscanⅡ측량방법비교,비접촉각막내피현미경화AS-OCT측량적CCT치명현교고,차이균유통계학의의(q=-5.540、6.940,균P=0.000),이AS-OCT측량적CCT치명현고우비접촉각막내피현미경적측량치,차이유통계학의의(q=6.800,P=0.000).Bland-Ahman일치성분석결과현시,A형초성각막측후의여AS-OCT측량치적최대절대차치위25.3 μm,이자적일치성최호.방중앙각막후도측량결과현시,OrbsanⅡ측량적각막후도치최대,기차위AS-OCT,비접촉각막내피현미경측득치최소,3충측후의재12:00、2:00、10:00、6:00자오선측득적방중앙각막후도치적총체비교차이균유통계학의의(F=5.020、22.950、67.890、18.850,P＜0.01).결론 재분석LASIK술후안각막후도측량치시응고필도불동검측의기측량결과적차이,Orbscan Ⅱ대CCT적측량치편박,이대방중앙각막후도측량치편후,비접촉각막내피현미경대CCT화방중앙각막후도적측량치균편박,이AS-OCT여A형초성각막측후의측득적CCT치비상접근,량충의기가상호체대사용.
Background Accurate measurement of corneal thickness is very important during the pre-and post-operative management of corneal surgical procedures,especially laser-assisted in-situ keratomileusis (LASIK),which is the most popular approach to the correction of refractive errors currently.This may be particularly important for the patients who have undergone previous laser refractive surgery with suboptimal outcomes and are being considered for an enhancement procedure.Objective This study was to compare the measuring outcomes of corneal thickness by slit-scanning pachymetry,non-contact specular microscope,anterior segment optical coherence tomography (AS-OCT)and ultrasound pachymetry,with a focus on central and midperipheral (from the central 3.0 mm) region of cornea in post-LASIK eyes.Methods Sixty-four right eyes of 64 patients who received LASIK were collected in Henan Eye Institute,Henan Eye Hospital from March to June 2011 with the equivalent spherical diopter of (-4.75±2.38)D and horizontal corneal diameter of (11.36±0.32)mm.Central corneal thickness was measured on each eye by using non-contact specular microscope (Topcon SP-3000P),slit-scanning pachymetry (Orbscan Ⅱ),AS-OCT and A-type ultrasound pachymetry,respectively,and the paracentral corneal thickness including 12:00,2:00,6:00 and 10:00 meridian was measured using Orbscan Ⅱ,non-contact specular microscope and AS-OCT.The measuring values and the agreement from different instruments were compared and evaluated.Results The mean central corneal thickness was (467.12±31.10)tμm for AS-OCT,(466.67±30.99)μm for ultrasound pachymetry,(441.84 ± 33.65) μm for specular microscopy and (422.51 ± 44.09) μm for Orbsan Ⅱ,respectively,showing a significant difference among the four methods (F =23.730,P =0.000).The central thickness value of the A-type ultrasound pachymetry was significantly higher than that of Orbsan Ⅱ or non-contact specular microscope (q =6.940,6.720,both at P =0.000).Compared with Orbscan Ⅱ,the measuring values of non-contact specular microscope and AS-OCT were significantly higher (q =-5.54,6.940,both at P =0.000),and the measuring value of AS-OCT was significantly higher that of non-contact specular microscope (q =6.800,P =0.000).The lowest difference value (25.3 μm)and the best agreement was found between the ultrasound pachymetry and AS-OCT.The paracentral corneal thickness values in 12:00,2:00,10:00,6:00 meridians were highest for Orbsan Ⅱ and the next for AS-OCT,and non-contact specular microscope had the lowest values,with significantly differences among them (F =5.020,22.950,67.890,18.850,all at P ＜ 0.01).Conclusions The corneal thickness values vary with the different instruments.Orbsan Ⅱ underestimates the central corneal thickness and overestimates the midperipheral corneal thickness,and non-contact specular microscope underestimates both the central and midperipheral corneal thickness.The measuring outcome from AS-OCT has a good agreement with ultrasound pachymetry and therefore they can be used interchangeably.
