高度近视眼睫状沟间距的差异性及其与角膜水平直径的相互关系
고도근시안첩상구간거적차이성급기여각막수평직경적상호관계
Discrepancy of sulcus-to-sulcus diameter and its relationship with white-to-white diameter in high myopic eyes
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2014年 12期 1102-1106 ,共5页

    张静%罗汇慧%吴君舒%余克明

    장정%라회혜%오군서%여극명

    睫状沟间距%角膜水平直径%超声生物显微镜%OrbscanⅡz%IOLMaster%近视 睫狀溝間距%角膜水平直徑%超聲生物顯微鏡%OrbscanⅡz%IOLMaster%近視
    첩상구간거%각막수평직경%초성생물현미경%OrbscanⅡz%IOLMaster%근시
    Sulcus-to-sulcus%White-to-white diameter%Ultrasound biomicroscopy%OrbscanⅡz%IOLMaster%Myopia
    背景 水平睫状沟间距(STS)和角膜水平直径是选择可植入接触镜(ICL)型号大小的重要参考指标,尺寸和型号不合适的ICL可引起术后多种并发症.既往已有较多关于正常眼的相关研究,但高度近视眼的相关测量结果鲜有报道. 目的 探讨高度近视眼不同径线STS的差异性,研究不同测量仪器获得的水平STS与角膜水平直径的差异及其相互关系.方法 于2013年4-6月收集中山大学中山眼科中心拟行ICL植入术的高度近视眼患者26例48眼,平均球镜值为(-12.93±3.87)D,平均散光度为(-1.37±1.02)D.应用超声生物显微镜(UBM)测量受检眼45°、90°、135°、180°4个不同径线的STS,使用OrbscanⅡz角膜地形图和IOLMaster测量受检眼的角膜水平直径,不同径线间STS的总体差异比较采用单因素方差分析,两两比较采用SNK-q检验.采用Bland-Altman一致性检验法分析UBM测得的水平方向STS与OrbscanⅡz或IOLMaster测得的角膜水平直径的一致性. 结果 UBM测得的45°、90°、135°、180°径线方向上STS平均值分别为(12.06±0.50)、(12.27±0.50)、(12.03±0.46)和(11.84±0.47) mm.除45°径线与135°径线的STS之间差异无统计学意义(P=0.817)外,45°与90°、45°与180°、90°与135°、90°与180°、135°与180°径线STS之间的差异均有统计学意义(P=0.036、0.026、0.020、0.000、0.045).OrbscanⅡz测得角膜水平直径为(11.56±0.40) mm,与180°水平径线的STS差异有统计学意义(t=-4.384,P=0.000),Bland-Altman一致性分析显示两者结果一致性欠佳,95％可信区间(CI)为-0.57 ～ 1.12 mm.IOLMaster测得角膜水平直径为(11.98±0.41)mm,与180°水平径线的STS差异有统计学意义(t=2.368,P=0.000),Bland-Altman一致性分析显示两者结果一致性欠佳,95％ CI为-0.96～0.67 mm.IOLMaster比ObrscanⅡz测得的角膜水平直径长,且差异有统计学意义(P=0.020),两种仪器测量Bland-Altman一致性分析显示95％ CI范围虽然较窄,为-0.73 ～-0.13 mm,但是平均差值较大,为-0.43 mm,两者一致性较差.结论 高度近视眼不同径线方向上STS并不完全相等,垂直方向最长,水平方向最短.采用IOLMaster和OrbscanⅡz所测量的角膜水平直径推算UBM测量的STS并不准确.三者在临床上不能相互替代用于计算ICL型号的大小.
    배경 수평첩상구간거(STS)화각막수평직경시선택가식입접촉경(ICL)형호대소적중요삼고지표,척촌화형호불합괄적ICL가인기술후다충병발증.기왕이유교다관우정상안적상관연구,단고도근시안적상관측량결과선유보도. 목적 탐토고도근시안불동경선STS적차이성,연구불동측량의기획득적수평STS여각막수평직경적차이급기상호관계.방법 우2013년4-6월수집중산대학중산안과중심의행ICL식입술적고도근시안환자26례48안,평균구경치위(-12.93±3.87)D,평균산광도위(-1.37±1.02)D.응용초성생물현미경(UBM)측량수검안45°、90°、135°、180°4개불동경선적STS,사용OrbscanⅡz각막지형도화IOLMaster측량수검안적각막수평직경,불동경선간STS적총체차이비교채용단인소방차분석,량량비교채용SNK-q검험.채용Bland-Altman일치성검험법분석UBM측득적수평방향STS여OrbscanⅡz혹IOLMaster측득적각막수평직경적일치성. 결과 UBM측득적45°、90°、135°、180°경선방향상STS평균치분별위(12.06±0.50)、(12.27±0.50)、(12.03±0.46)화(11.84±0.47) mm.제45°경선여135°경선적STS지간차이무통계학의의(P=0.817)외,45°여90°、45°여180°、90°여135°、90°여180°、135°여180°경선STS지간적차이균유통계학의의(P=0.036、0.026、0.020、0.000、0.045).OrbscanⅡz측득각막수평직경위(11.56±0.40) mm,여180°수평경선적STS차이유통계학의의(t=-4.384,P=0.000),Bland-Altman일치성분석현시량자결과일치성흠가,95％가신구간(CI)위-0.57 ～ 1.12 mm.IOLMaster측득각막수평직경위(11.98±0.41)mm,여180°수평경선적STS차이유통계학의의(t=2.368,P=0.000),Bland-Altman일치성분석현시량자결과일치성흠가,95％ CI위-0.96～0.67 mm.IOLMaster비ObrscanⅡz측득적각막수평직경장,차차이유통계학의의(P=0.020),량충의기측량Bland-Altman일치성분석현시95％ CI범위수연교착,위-0.73 ～-0.13 mm,단시평균차치교대,위-0.43 mm,량자일치성교차.결론 고도근시안불동경선방향상STS병불완전상등,수직방향최장,수평방향최단.채용IOLMaster화OrbscanⅡz소측량적각막수평직경추산UBM측량적STS병불준학.삼자재림상상불능상호체대용우계산ICL형호적대소.
    Background Horizontal sulcus-to-sulcus (STS) and white-to-white diameter are important parameters for designing the proper size of collamer implantable contact lens (ICL).Inappropriate size of ICL may induce the complications postoperatively.Several previous studies compare horizontal STS and white-to-white diameter in normal eyes have been reported,but seldom in high myopic eyes.Objective This study was to investigate the discrepancy of STS diameters in 4 axes and analyze the relationship between horizontal STS diameter and white-towhite diameter in high myopia eyes.Methods The STS diameters in 4 axes (45,90,135 and 180 degrees) and the white-to-white diameters were measured in 48 eyes of 26 high myopia patients using the 50 MHz ultrasound biomicroscopy (UBM),the Orbscan-Ⅱ topography system,and the IOL Master,respectively.The mean spherical was (-12.93±3.87) diopters (D) (-8 to-20 D).Statistical evaluation was performed using the one-way ANOVA for comparison of measurement.The agreement of three devices was assessed using the Bland and Altman method.Results The mean STS diameter at 45,90,135 and 180 degrees was (12.06±0.50) mm,(12.27±0.50)mm,(12.03±0.46) mm and (11.84±0.47)mm,respectively.The 90 degree STS was significantly larger than other STS diameters (all at P＜0.05).The 180 degrees STS was significantly shorter than other STS diameters (all at P＜0.05).However,there was no significant difference between 45 degree STS and 135 degree STS (P=0.817).The mean WTW was (11.56±0.40) mm with Orbscan Ⅱ z topography system and (11.98±0.41) mm with IOLMaster.The WTW measured with Orbscan Ⅱ z was significantly shorter than the 180 degrees STS (t =-4.384,P =0.000).The WTW measured with IOLMaster was significantly larger than the 180 degrees STS (t =2.368,P =0.000).Bland-Altman analysis showed not very well agreement for measurements of WTW,STS between Orbscan Ⅱz and UBM,IOLMaster and UBM,Orbscan Ⅱ z and IOLMaster,the width of 95％ confidence interval (CI) were-0.57 to 1.12 mm,-0.96 to 0.67 mm,-0.73 to-0.13 mm,respectively.Conclusions The STS diameters in 4 different axes are not identical with each other in high myopia eyes.The longest STS is in the vertical meridian,the shortest STS is in the horizontal meridian.The WTW diameter measured with both Orbscan Ⅱ z and IOLMaster are not precise for calculating the horizontal STS in high myopia eyes.Three instruments cannot be interchanged for calculating the size of ICL.
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