准分子激光术中不同体位Kappa角变化分析

Analysis of changes of Kappa angle in patient with myopia of different position during Laser Assisted in-situ keratomi leusis （LASIK）

目的探究近视患者坐位、仰卧位时kappa角的大小，坐位与仰卧位时kappa角变化关系。方法临床病例对照研究。对2011年7～12月在解放军总医院激光近视治疗中心符合行激光近视手术的患者215（395只眼），按近视程度分为低度、中度、高度三组。术前行Oculus Pentacam眼前节分析系统检查，获得坐位时kappa角在角膜的水平和垂直偏移量，术中患者仰卧位在角膜瓣制作完成掀瓣前开启鹰视酷眼激光仪x和y轴跟踪调节程序，获得患者卧位时kappa角水平和垂直方向的偏移量，进行低度、中度、高度分组统计。结果（1）坐位正kappa角223只眼（56．4％），仰卧位正kappa角343只眼（86．8％）：（2）kappa角与屈光度的关系采用单因素方差分析，低度、中度、高度三组患者的kappa角水平偏移量差异无统计学意义（P〉0．05），垂直偏移量差异有统计学意义（P〈0．05）。（3）坐位与仰卧位kappa角关系采用配对t检验，水平、垂直偏移量差异有显著性且均有统计学意义（P〈0．05）。（4）kappa角坐位与仰卧位垂直偏移量与近视度数差异有统计学意义（R坐位=-0．109，R仰卧位=-0．172P〈0．05）。结论坐位与仰卧位kappa角水平、垂直偏移量具有相关性。近视度数越大kappa角垂直偏移量越大。在行屈光手术时应考虑到体位变化对kappa角的影响。

Objective To investigate the change of Kappa ting and supine position during laser assisted in-situ keratomi angle in patient with myopia of sit-leusis （LASIK）. Method A total of 215 patients with myopic included 395 eyes who underwent LASIK were divided into low, middle and high myopia groups according to different diopters. The horizontal and vertical offsets of kappa angle in sitting position of preoperative analytical system examination were measured by Oculus Pen-tacam. During the operation the X and Y axis tracking modulation of ALLEGRETTO Wavelight Ex-cimer Laster System were opened for getting horizontal and vertical offsets of kappa angle in supine position. All data were analyzed respectively. Results Kappa angle of 223 eyes （56.4%） were posi-tive values in sitting position, and 343 eyes （86.8%） were positive values in supine position. The re-lationship between kappa angle and diopter was analyzed with one-factor analysis of variance. The differences of horizontal offsets of kappa angle in different position of three groups were no statisti-cally significant （P 〉0.05）, but the differences of vertical offsets of kappa angle of the three groups were statistically significant （P 〈0.05）. There were significant differences in horizontal and vertical kappa angle between sitting and supine position by paired T test （P 〈0.05）, and there were positive correlations. The offsets of kappa angle in sitting and supine positions had a significantly negative re-lation with the degree of myopia （sitting position R=-0.109, supine position R=-0.172; P 〈0.05）.Conclusions There is correlation in horizontal and vertical offsets of kappa angle in sitting and su- pine positions. With the increase of the myopic degree vertical offset of kappa angle is increased. Clinicians should take into account different postures when refractive surgery need be performed.