2085例年龄相关性白内障患者白内障摘除术前角膜散光情况的调查

Corneal astigmatism among 2 085 age-related cataract patients before surgery

目的 调查湖北地区年龄相关性白内障患者白内障摘除术前角膜散光的分布和特征.方法 回顾性研究.收集2012年1月至2016年7月于武汉大学中南医院眼科诊断为年龄相关性白内障并拟行白内障摘除术的患者2085例（3 586只眼）,其中女性1 215例,男性870例,平均年龄（73.1±9.4）岁.按年龄分为5个组：50- 59岁组、60- 69岁组、70- 79岁组、80- 89岁组、≥90岁组.采用IOL Master测量术前角膜最小曲率（K1）和最大曲率（K2）并计算角膜曲率及角膜散光度数.角膜散光度数、分布和类型用描述性统计进行分析,Kolmogorov-Smirnov检验用来检验正态分布,t检验和Kruskal-Wallis检验分别用来比较各组正态分布和非正态分布的定量资料,年龄和角膜散光的相关性采用Spearman检验.结果 纳入分析的2 085例患者（3 586只眼）平均角膜曲率44.33 D（95％CI：44.28- 44.39 D）,角膜散光度数0.05- 6.74 D,平均1.06 D.角膜散光度数的数据不符合正态分布,0.25- 1.25 D,共2 371只眼（66.1％）,〈0.25 D者150只眼（4.2％）,〉1.25 D者1 065只眼（29.7％）.角膜散光度数随年龄增大而增加（χ^2=64.511,P〈0.01）.男性角膜散光度数为1.03 D（95％CI：1.00- 1.07）D,女性角膜散光度数1.08 D（95％CI：1.04- 1.11 D）,差异有统计学意义（χ^2=4.304,P=0.038）.女性平均角膜曲率44.69 D（95％CI：44.62- 44.75 D）,男性平均角膜曲率43.84 D（95％CI：43.76 -43.92D）,女性角膜曲率比男性更陡峭,差异有统计学意义（t=-16.230,P〈0.01）.角膜散光是顺规散光、逆规散光和斜规散光的分别有1 040（29.0％）、1 902（53.0％）和644（18.0％）只眼.随年龄增大逆规散光有增加趋势.结论 湖北地区年龄相关性白内障患者角膜散光度数大部分为0.25- 1.25 D.角膜散光度数随年龄增大而增加,以逆规散光为主,50岁及以上男性的角膜散光度数较女性低.女性的角膜曲率比男性更为陡峭.

Objective To investigate the characteristics and distribution of corneal astigmatism before surgery among age-related cataract patients in the Hubei area.Methods Retrospective study.From January 1,2012 to July 31,2016,IOL Master measurements of all qualified cataract surgery candidates were retrospectively collected.Descriptive statistical analysis was used to assess the degree,distribution and type of corneal astigmatism.Kolmogorov-Smirnov （K-S） test was used to evaluate the normal distribution of variables.One-way analysis of variance and Kruskal-Wallis test were applied for the comparison of variance for normally and non-normally distributed quantitative data among different age groups.Spearman＇s rank test was used to assess the relationship between age and corneal astigmatism.Results The mean age of the 2 085 patients （3 586 eyes） involved was （73.1±9.43） years old,with more women （58.3%） than men.The mean value of corneal curvature was 44.33 D （95%CI：44.28-44.39）,and the mean corneal astigmatism was 1.06 D （range,0.05 D to 6.74 D）.K-S test indicated the distribution of corneal curvature was normal （P=0.18）,while corneal astigmatism did not obey the normal distribution （P〈0.01）.Corneal astigmatism was between 0.25 D and 1.25 D in 67.7% of the eyes,〉1.25 D in 29.7%,and〈0.25 D in 4.2%.Corneal astigmatism degree increased with the age increase （P〈0.01）.There was no statistical difference in corneal astigmatism between women and men （P=0.075）.However,women had steeper corneal curvatures than men with statistical difference （P〈0.01）.Corneal astigmatism with the rule was observed in 29.0% of the eyes,while astigmatism against the rule was found in 53.0%.And astigmatism against the rule increased with age.Conclusion Corneal astigmatism mostly distributes between 0.25 D and 1.25 D in age-related cataract patients who lived in Hubei.Corneal astigmatism degree increased with age,and the dominant type was astigmatism against the rule.There was no difference in astigmatism between men and women patients aged 50 years and above,but in 70-to 79-year-old patients,women had a higher astigmatism degree than men.The corneal curvature of women was steeper than men in general and in each age group.