应用无力矩双连续缝合法治疗圆锥角膜的临床观察

Clinical observation of no-torque double running pattern for keratoconus

目的观察无力矩双连续缝合法治疗圆锥角膜的疗效。方法 2010年12月至2014年6月在济南市眼科医院诊断为圆锥角膜伴后弹力层破裂、行光学性穿透性角膜移植术治疗的38例患者(38只眼)纳入改良组,缝合方式为改良的无力矩双连续缝合。2008年12月至2010年11月在济南市眼科医院诊断为急性圆锥角膜(均伴后弹力层破裂,病变区角膜水肿明显)、行光学性穿透性角膜移植术治疗的12例患者(12只眼)纳入对照组,缝合方式为传统的扭力矩双连续缝合。比较两组患者术前视力、术后各时间点最佳矫正视力(BCVA)和散光度的差异。改良组和对照组患者年龄、术前视力、术后各时间点BCVA、散光度数采用两样本t检验;术后各时间段两组的散光变化差异比较采用单因素方差分析。P<0.05为差异有统计学意义。结果改良组和对照组患者术前视力差异无统计学意义(t=0.393,P>0.05),两组具有可比性。改良组患者术后第2周、术后1年BCVA分别为(4.79±0.15)D和(4.84±0.12)D,均高于对照组患者,差异均有统计学意义(t=5.270和2.244,P均<0.05)。术后2周、2个月、6个月角膜地形图检查显示,改良组散光均小于对照组,差异有统计学意义(t=-9.986、-10.625和-3.284,P均<0.05);术后1年,改良组散光仍小于对照组,但差异无统计学意义(t=-1.349,P>0.05)。改良组患者术后各时间段角膜地形图散光变化差异有统计学意义(F=35.024,P<0.05),其中术后2个月、6个月均高于术后2周,但术后1年与术后2周散光变化差异无统计学意义(P>0.05)。对照组患者术后各时间段角膜地形图散光变化差异有统计学意义(F=2.675,P<0.05)。结论无力矩双缝合法术后散光更小,能够获得更好的术后视力。

Objective To observe the result of no-torque double running pattern in treatment of keratoconus. Methods Thirty-eight patients（ 38 eyes） who were diagnosed as keratoconus with corneal descemet membrane rupture and did optical penetrating corneal transplantation using an improved no-torque double running suture pattern in Jinan City eye hospital from December 2010 to June 2014（ improved group）. Twelve patients（ 12 eyes） who were diagnosed as acute keratoconus with corneal descemet membrane rupture and corneal edema, and did optical penetrating corneal transplantation using a traditional torque double running pattern in Jinan City Eye Hospital from December 2008 to November 2010（ controlled group）. The difference of preoperative visual acuity,the best corrected visual acuity（ BCVA） and the degree of astigmatism at various time points after operation were compared in the two groups. The two-sample t test was used to analyse the difference in two groups in age,preoperative visions and BCVA,and astigmatic degree. Astigmatic degree variance between the two groups was compared by single effect analysis of variance. A P 〈 0. 05 was considered statisticallysignificant. Results There was no significant difference in preoperative visual acuity in the two groups（ t = 0. 393,P 〉 0. 05）. BCVA in improved group was（ 4. 84 ± 0. 12） D and（ 4. 84 ± 0. 12） D at the time points of 2 weeks and 1 year after operation,which was higher than those in control group（ t =5. 270 and 2. 244,P 〈 0. 05）. The corneal topographer showed that astigmatism in improved group was significantly lower than that of the control group at the time points of 2 weeks,2 months and 6 months after the operation（ t =- 9. 986、- 10. 625 and- 3. 284,P 〈 0. 05）,respectively. The astigmatism in improved group was still smaller than that of the control group at 1 year after operation,but it was not statistically significant（ t =- 1. 349,P 〉 0. 05）. The variation on astigmatism in corneal topographyin in improved group had significant differences at each time point after the operation（ F = 35. 024,P 〈0. 05）,the astigmatism of the patients at the time points of 2 months and 6 months after operation was both higher than 2 weeks postoperatively,but no significant difference in astigmatism was observed between 1 year and 2 weeks after the operation（ P 〉 0. 05）. The variation on astigmatism in corneal topographyin in control group had significant differences at each time point after the operation（ F =2. 675,P 〈 0. 05）. Conclusions There was smaller postoperative astigmatism and better postoperative visual acuity for patients treated with no-torque double running suture pattern.