不同年龄段马凡综合征晶状体不全脱位患者角膜特征及意义

Corneal characteristics in Marfan syndrome patients of different ages with lens subluxation and their significance

目的比较不同年龄段马凡综合征晶状体不全脱位患者的角膜特征并探讨其临床意义。方法马凡综合征组45例84眼和对照组84例84眼列入研究,前者按年龄分为两组:儿童组(5~14岁)49眼和非儿童组(>14岁)35眼。使用Pentacam测量角膜曲率、角膜散光和中央角膜厚度。结果与对照组相比,马凡综合征组患者角膜变平、散光增大,两组间差异均具有统计学意义(均为P=0.000)。马凡综合征患者角膜前表面曲率儿童组为(40.02±1.42)D,非儿童组为(41.03±1.57)D;角膜后表面曲率儿童组为(-5.71±0.23)D,非儿童组为(-5.89±0.31)D;总角膜散光儿童组为(-1.71±0.84)D,非儿童组为(-1.34±0.78)D,两组相比差异均具有统计学意义(均为P<0.05)。角膜前表面散光儿童组高于非儿童组(P=0.017),而后表面散光两组间差异无统计学意义(P=0.377)。儿童组总角膜散光和角膜前表面散光以顺规散光(69.39%)为主,而非儿童组顺规散光和斜向散光的比例相当。两组角膜后表面都以逆规散光为主(儿童组占85.71%,非儿童组占77.14%)。以角膜前表面散光估计总角膜散光时约有一半的患者会高估约0.32 D。结论马凡综合征晶状体不全脱位患者角膜变平、散光增大。儿童组角膜更扁平,总角膜散光和角膜前表面散光值较高,以顺规散光为主。马凡综合征患者的角膜后表面散光值较稳定,以逆规散光为主。忽视角膜后表面散光,以角膜前表面散光值估计总角膜散光时易高估。

Objective To compare the corneal characteristics in Marfan syndrome （MFS） patients of different ages with lens subluxation and explore their clinical significance.Methods Together 84 eyes of 45 MFS patients （MFS group） and 84 eyes of 84 control subjects （control group） were recruited in this study,and the patients in the MFS group were subdivided into two groups by age：5-14 year-old group with 49 eyes and 〉14 year-old group with 35 eyes.The biometric characteristics,including corneal curvature （i.e.Km）,central corneal thickness,and corneal astigmatism,were measured by Pentacam.Results Compared with the control group,MFS patients had decreased Km and increased corneal astigmatism,approaching significant difference （both P=0.000）.There were significant differences in anterior corneal curvature [（40.02±1.42）D vs.（41.03±1.57）D],posterior corneal curvature [（-5.71±0.23）D vs.（-5.89±0.31）D],and total corneal astigmatism [（-1.71±0.84）D vs.（-1.34±0.78）D] between 5-14 year-old group and 〉14 year-old group （all P〈0.05）.The anterior corneal astigmatism was significantly higher in 5-14 year-old group than that in 〉14 year-old group（P=0.017）,whereas the posterior corneal astigmatism had no significant difference between the two groups（P=0.377）.In 5-14 year-old group,the astigmatic type of total cornea and anterior corneal surface was dominated by with-the-rule astigmatism （69.39%）,whereas the proportion of with-the-rule and oblique astigmatism was approximately equal 〉14 year-old group.The astigmatic type of posterior corneal surface in 5-14 year-old group （accounting for 85.71%） and 〉14 year-old group （accounting for 77.14%） was dominated by against-the-rule astigmatism.The total corneal astigmatism was overestimated by a mean of 0.32 D when only taking the magnitude of anterior corneal astigmatism into consideration.Conclusion A flattened cornea and increased corneal astigmatism are the corneal characteristics for MFS patients with lens subluxation especially for the children patients.The magnitude of posterior corneal astigmatism remains unchanged and is primarily against-the-rule astigmatism.And the total corneal astigmatism can be easily overestimated if posterior corneal astigmatism is not taken into consideration.