白内障人群角膜散光流行病学调查及量化分析

The distribution and the pattern of corneal astigmatism in cataract surgery candidates

目的描述并量化白内障患者角膜散光分布及随年龄增长而变化的趋势。方法连续收集2013年1月~2017年6月来本院的白内障患者。用德国ZEISS公司的IOL MASTER测定角膜散光度数及轴向。用Spearman相关系数来评估双变量的相关性。并引用向量法(J0、J45)和线性回归模型评估角膜散光随年龄的变化趋势。结果这项研究共纳入1 907人(3 154眼),平均年龄72.24岁(16~98岁)。其中,角膜散光≥1.00 D约占43.17%。角膜散光的程度与年龄呈显著相关(ρ=-0.115,P=0.000),性别和散光度数之间的没有显著相关(ρ=0.443,P=0.658),散光度数不存在眼别之间的差异(ρ=0.005,P=0.778)。通过线性回归模型发现随着年龄的增长角膜散光向逆归趋势偏移;年龄每增长1岁,J0在右眼增加-0.014 D(P=0.000)、左眼增加-0.017 D(P=0.000)。Spearman相关分析显示J45和年龄之间相关性无统计学意义(ρ=-0.03,P=0.09),统计分析表明角膜散光轴位与年龄增长显著相关。结论在我们研究人群中角膜散光≥1.00 D的患者所占比例接近一半,这些患者植入矫正散光的人工晶体或可提高视觉质量。特别是年轻患者的逆归散光更应积极纠正,同时我们也应该更加关注散光轴位随年龄变化的趋势,以便改进手术方式或生产出更完善的人工晶体。

Objective To describe and quantify the pattern of corneal astigmatism in cataract surgery candidates and to provide information for cataract surgeons and intraocular lens（IOL） manufacturers for improving the quality of the postoperative vision. Methods The datasets of cataract surgery candidates acquired between January 2013 to June 2017, were collected and analyzed retrospectively. Keratometry values were optically measured by partial coherence interferometry（IOLMaster） before cataract extraction. Spearman rank correlation coefficients were used to estimate bivariate correlations. The power vector method, J0 and J45 values, and linear regression models were used to assess the association between age and Astigmatism（j0, j45 and axis degree）. Results The study evaluated the keratometry values in 3154 eyes（1 907 patients） with a median age of 72.24 years（range 16 to 98 years）. The corneal astigmatism was 1.00 diopter（D） or higher in 43.17% of eyes. The magnitude of corneal astigmatism was positively correlated with age（ρ=-0.115, P=0.000）. There was no significant correlation between the gender and the degree of astigmatism（ρ=0.443, P=0.658）, and there was no difference between the right eye and the left eye（ρ=0.005, P=0.778）. A trend toward increasing against-the-rule astigmatism with age was found by linearregression models; the per-year increase in age was associated with a J0 decrease of 0.014 D in right eyes and 0.017 D in left eyes（both P=0.000）. No association was found between age and J45. There was no significant correlation between the gender and the degree of astigmatism（ρ=-0.03, P=0.09）. And there was no difference between the right eye and the left eye, greater correlation was found between axis and age. Conclusion Most eyes having corneal astigmatism of 1.00 D or greater could be covered by the range of the cylindrical power of the toric IOLs available on the market. Against-the-rule corneal astigmatismof relatively younger cataract surgery candidates should be managedmore aggressively.We also pay more attention to the change trend of axi along with the age, in order to improve the operation method and lens（IOL） manufacturing.