近视眼患者屈光度与像差的相关性研究

Relationship between diopter and aberration in myopic eyes

目的:探讨近视眼患者屈光度、角膜前表面像差及全眼像差之间的关系。方法:选取2013年4月至2015年8月于重庆明达眼科门诊部接受角膜屈光手术的部分近视患者74例(144眼),对该部分患者的术前临床资料进行回顾性分析。利用综合验光仪确定患者屈光度并计算等效球镜(spherical equivalent,SE);利用Sirius眼前节分析仪和Wave Scan波前像差仪分别确定6 mm瞳孔直径时角膜前表面及全眼的总像差(all order aberration,AOA)、总高阶像差(high order aberration,HOA)、总彗差(coma aberration,Coma)、总三叶草(trefoil aberration,Trefoil)、球差(spherical aberration,Spherical)、垂直彗差(vertical coma,Z_3^(-1))、水平彗差(horizontal coma,Z_3~1)的均方根(root mean square,RMS)值,对获取的数据进行配对样本t检验及Pearson相关性分析,检验标准均为α=0.05。结果:全眼高阶像差部分中HOA、Coma、Trefoil及Spherical均明显小于角膜前表面对应的高阶像差,差异具有统计学意义(P<0.05),而Z_3^(-1)、Z_3~1与其比较差异无统计学意义(P>0.05);根据SE将所有纳入144眼分为SE≤-6.00 D组(89眼)和SE>-6.00 D组(55眼),SE≤-6.00 D组和SE>-6.00 D组屈光度与角膜前表面各像差均无相关性(屈光度与角膜前表面像差AOA、HOA、Coma、Trefoil、Spherical、Z_3^(-1)、Z_3~1相关系数r:SE≤-6.00 D组分别为-0.086、0.074、0.060、0.066、0.054、0.112、-0.069,均P>0.05;SE>-6.00 D组分别为0.522、0.827、0.975、0.497、0.106、0.148、0.226,均P>0.05),而与全眼AOA均呈现明显的正相关(SE≤-6.00 D组r=0.741、SE>-6.00 D组r=0.962,均P<0.01);当SE>-6.00 D时屈光度与全眼Spherical呈正相关(r=0.346,P<0.05)。结论:近视眼患者眼内高阶像差中的HOA、Coma、Trefoil及Spherical对角膜前表面对应的高阶像差有抵消作用,可降低全眼像差,Z_3^(-1)、Z_3~1对角膜前表面对应的高阶像差既有抵消作用又有叠加作用;屈光度对全眼像差的低阶部分及高阶像差中的球差部分影响显著而对角膜像差无明显影响。

Objective：To study the relationship between diopter,anterior corneal aberration and ocular aberration in myopic eyes. Methods ：Totally 74 patients（ 144 eyes） were recruited before corneal refractive surgery. All patients underwent the following exami- nations including mean spherical equivalent（SE）, anterior corneal aberration （sirius, CSO）, total aberration （wavefront analyzer, VISX）. The root mean square （RMS） of all order aberration （AOA）, high order aberration （HOA）, coma aberration （Coma）, trefoil aberration （Trefoil）, spherical aberration （Spherical）, vertical coma （Z3 -1）, horizontal coma （Z3 1） were collected and the anterior corneal and total aberration measurements were performed on eyes with 6 mm pupil diameter. All data were dealt with Paired sample t-test and Pearson correlation analysis and P〈0.05 was considered statistically significant difference. Results ：The HOA, Coma,Trefoil and Spherical were significantly lower in ocular aberration than in the anterior corneal high-order aberration ,with statistically significant differences （P〈0.05）, and there was no significant difference in Z3 -1 and Z3 1 （P〉0.05）. There was no correlation between the diopter and all of the anterior corneal aberrationsboth in the group of SE≤6.00 D（89 eyes） and group of SE〉-6.00 D（55 eyes）. The correlation coefficients （r） between diopter and anterior corneal surface aberrations in the group of SE≤-6.00 D were 0.086,0.074,0.060, 0.066,0.054,0.112, -0.069, P〉0.05 and in the group of SE 〉-6.00 D were 0.522,0.827,0.975,0.497,0.106, 0. 148,0.226, P〉0.05 ; significant correlation between the diopter and ocular aberration AOA was observed both in the groups of SE≤-6.00 D（r=0.741 ） and SE〉-6.00 D（r=0.962）（P〈0.01 ）. There was significant correlation between the diopter and Spherical of the whole eye in the groups of SE〉-6.00 D （r=-0.346,P〈0.05）. Conclusion：The intraocular HOA, Coma, Trefoil and Spherical exert compensation effect on the aberrations of the anterior corneal to reduce the total ocular aberrations. The effect of intraocular Z3-1, Z3 1 on anterior corneal high order aberration show partial compensation and partial superposition among subjects. The diopter exert obvious effect on low-order aberra- tions of the ocular aberration and spherical aberration of higher-order aberrations, but has no effect on anterior corneal aberrations.