角膜屈光手术中眼球旋转和瞳孔中心移位的测量

Measurement of eye cyclotorsion and pupil centroid shift during corneal refractive surgery

目的测量国内近视患者在角膜屈光手术中发生的眼球旋转和瞳孔中心移位。方法选择接受双眼CustomVue^TM个体化角膜屈光手术的近视患者86例172眼,术前应用Wavesan像差测量仪在坐位时进行虹膜识别,术中应用VISX Star S4 IR进行卧位时虹膜定位,记录眼球旋转及瞳孔中心移位。结果虹膜定位成功147眼,其中63例126眼患者双眼均成功定位,其眼球旋转包括：（1）外旋（右眼逆时针旋转,左眼顺时针旋转）60眼;（2）内旋（右眼顺时针旋转,左眼逆时针旋转）4眼;（3）双眼逆时针旋转44眼;（4）双眼顺时针旋转18眼。在成功定位的147眼中,旋转≤1°者38眼,1.1°～2.0°者29眼,2.1°～3.0°者22眼,3.1°～4.0°者21眼,4.1°～5.0°者17眼,5.1°～6.0°者13眼,〉6.1°者7眼;平均旋转度数2.6°±1.9°（0.1°～8.6°）。瞳孔中心移位平均为（0.348±0.144）mm（0.064～0.539mm）,X轴移位为（0.27±0.16）mm（0～0.50mm）,Y轴移位为（0.17±0.12）mm（0～0.48mm）。结论角膜屈光手术中从坐位改变到卧位会发生眼球旋转和瞳孔中心移位。CustomVue^TM系统能够有效进行虹膜定位,测量眼球旋转和瞳孔中心移位。

Objective To measure the eye cyclotorsion and pupil centroid shift of Chinese myopic patients during corneal refractive surgery.Methods One hundred and seventy-two eyes of 86 consecutive myopic patients who had bilateral CustomVue^TM corneal refractive surgery were involved in the study.Wavefront measurement and iris registration were performed in the upright position with Wavescan aberrometer,and another iris registration was performed in the supine position during the operation with VISX Star S4 IR.Results One hundred and forty-seven of 172 eyes were registrant successfully and 63 patients were registrant bilaterally.The rotations were divided into four categories：（1） Excyclotorsion：counterclockwise rotation in the right eye and clockwise in the left eye：60 eyes;（2）Incyclotorsion：clockwise rotation in the right eye and counterclockwise in the left eye：4 eyes;（3） Counterclockwise rotation in both eyes：44 eyes;（4）Clockwise rotation in both eyes：18 eyes.Among the 147 eyes registrant,38 eyes had a rotation ≤1°,29 eyes of 1.1°～2.0°,22 eyes of 2.1°～3.0°,21 eyes of 3.1°～4.0°,17 eyes of 4.1°～5.0°,13 eyes of 5.1°～6.0°,7 eyes above 6.1°.The mean absolute value of rotation angle was 2.6°±1.9°,ranging from 0.1° to 8.6°.The mean pupil centroid shift was （0.348±0.144） mm （0.064～0.539 mm）,with （0.27±0.16） mm （0～0.50 mm） in the X axis and （0.17±0.12） mm （0～0.48 mm） in the Y axis.Conclusion Eyes can have a cyclotorsion and pupil centroid shift when going from the upright to the supine position.CustomVue^TM with iris registration may be a useful tool for the measurement of eye cyclotorsion and pupil centroid shift.