年龄相关性白内障患者14万例角膜前表面散光的分布特征

Distribution of the anterior corneal astigmatism in over 140000 patients with age-related cataract

目的分析中国18家医院的14万例年龄相关性白内障患者角膜前表面散光的分布特征。方法回顾性系列病例研究。连续性收集2015年7月至2018年10月于中国18家爱尔眼科医院就诊的40岁以上年龄相关性白内障患者143889例(143889只右眼)的眼部生物学参数资料。角膜前表面散光度数和轴向、前房深度、角膜屈光力、眼轴长度等眼球参数采用IOLMaster 500测量,获取3次测量结果的平均值。各医院将资料整理分析后提交给武汉爱尔眼科医院进行总体分析。非正态分布数据以M(P25~P75)表示;采用Mann-Whitney检验、Kruskal-Wallis检验、χ^(²)检验等分析角膜前表面散光度数和轴向在不同性别、年龄、前房深度、角膜屈光力、眼轴长度中的分布差异。结果143889例患者中女性84319例,男性59570例;年龄为72(65~78)岁;角膜散光度数为0.84(0.51~1.33)D,散光度数≥0.75 D者80895例(56.22%),散光度数≥1.00 D者57304例(39.83%)。女性角膜散光度数为0.87(0.53~1.37)D,男性为0.82(0.50~1.29)D(U=-14.891);女性顺规散光比例为33.26%(28046/84319),逆规散光比例为49.08%(41385/84319);男性顺规散光比例为34.26%(20408/59570),逆规散光比例为46.91%(27945/59570)(χ^(²)=70.913),差异均有统计学意义(均P<0.05)。随年龄增加,角膜散光度数先由0.94(0.57~1.48)D减少至0.75(0.46~1.18)D,后又增大至1.19(0.74~1.79)D,差异有统计学意义(H=1263.438,P<0.05),变化的转折在61~70岁。随着年龄的增大,顺规散光比例减小[由77.50%(396/511)减少至12.50%(3/24)],逆规散光比例增大[由11.15%(57/511)增大至79.07%(34/43)],斜向散光比例变化不大[17.02%(16/94)至19.92%(245/1230)],分布差异有统计学意义(χ^(²)=10174.496,P<0.05)。前房越浅,角膜散光度数越大,由0.82(0.51~1.31)D增大至1.05(0.61~1.56)D;逆规散光比例越大,由47.32%(60207/127227)增大至51.69%(184/356),差异均有统计学意义(H=409.961,χ²=120.995;均P<0.05)。平均角膜屈光力越大,角膜散光度数越大,由0.80(0.49~1.33)D增大至0.95(0.58~1.53)D;逆规散光比例越小,由52.84%(4963/9392)减小至39.97%(9023/22577),差异均有统计学意义(H=808.562,χ^(²)=752.147;均P<0.05)。不同眼轴长度相比,当眼轴长度>25.00 mm时,角膜散光度数最大,为1.04(0.62~1.65)D;逆规散光比例最大,为49.00%(10964/22376),差异均有统计学意义(H=2071.198,χ^(²)=131.130;均P<0.05)。结论年龄相关性白内障患者角膜前表面散光轴向以逆规散光为主。随着年龄的增大,角膜散光度数有先减小后增加的趋势。65岁为顺规散光向逆规散光变化的转折点。前房越浅,角膜前表面散光度数以及逆规散光比例越大。当眼轴长度>25.00 mm时,角膜前表面散光度数和逆规散光比例最大。

Objective To analyze the distribution characteristics of the anterior corneal astigmatism in 140000 cataract patients from 18 hospitals in China.Methods Retrospective study.A total of 143889 patients(143889 right eyes)over the age of 40 years with age-related catarac were admitted to 18 Aier eye hospitals in China from July 2015 to October 2018.The average values of the three measurements of the magnitude of anterior corneal astigmatism,the meridian of corneal astigmatism,anterior chamber depth,corneal refractive power,and axial length measured by IOLMaster 500 were obtained.The data acquisition method of each sub-center was to collect and analyze the electronic case data in accordance with the inclusion and exclusion criteria,and to provide them for the sponsor Wuhan Aier Eye Hospital.Non-normal distribution data are presented as M(P25,P75).Mann-Whitney test,Kruskal-Wallis test,Chi-square test were used to analyze the distribution differences of the magnitude of corneal astigmatism and the meridian of corneal astigmatism in gender,age,anterior chamber depth,corneal refractive power and axial length.Results Among the 143889 patients,84319 were females and 59570 were males,the median age was 72(65,78)years old,the median corneal astigmatism was 0.84(0.51,1.33)D;the corneal astigmatism was≥0.75 D in 80895 patients(56.22%)and was≥1.00 D in 57304 patients(39.83%).The median corneal astigmatism was 0.87(0.53,1.37)D in women and 0.82(0.50,1.29)D in men;with statistical difference(U=-14.891;P<0.05).The proportion of with-the-rule(WTR)astigmatism was 33.26%(28046/84319)for women and 34.26%(20408/59570)for men;The proportion of against-the-rule(ATR)astigmatism was 49.08%(41385/84319)for women and 46.91%(27945/59570)for men,with statistical difference(χ^(²)=70.913;P<0.05).With the increase of age,the magnitude of corneal astigmatism first decreased from 0.94(0.57,1.48)D to 0.75(0.46,1.18)D,and then increased to 1.19(0.74,1.79)D,with statistical difference(H=1263.438;P<0.05),and the change was at 61 to 70 years old.With the increase of age,the proportion of WTR astigmatism decreased from 77.50%(396/511)to 12.50%(3/24),the proportion of ATR astigmatism increased from 11.15%(57/511)to 79.07%(34/43),and the proportion of oblique astigmatism changed little from 17.02%(16/94)to 19.92%(245/1230),the distribution difference was significant(χ^(²)=10174.496;P<0.05).As the anterior chamber became shallow,the magnitude of corneal astigmatism significantly increased from 0.82(0.51,1.31)D to 1.05(0.61,1.56)D,and the proportion of ATR astigmatism increased from 47.32%(60207/127227)to 51.69%(184/356)(H=409.961,χ^(²)=120.995,both P<0.05).With the corneal refractive power rising,the magnitude of corneal astigmatism increased from 0.80(0.49,1.33)D to 0.95(0.58,1.53)D,the proportion of ATR astigmatism decreased from 52.84%(4963/9392)to 39.97%(9023/22577);the difference was significant(H=808.562,χ^(²)=752.147,both P<0.05).When the axial length was>25.00 mm,the magnitude of corneal astigmatism was highest[1.04(0.62,1.65)D],and the proportion of ATR astigmatism was also highest[49.00%(10964/22376)];the difference was significant(H=2071.198,χ^(²)=131.130,all P<0.05).Conclusions The meridian of corneal astigmatism in middle-aged and elderly cataract patients is mainly ATR astigmatism.With the increasing of age,the magnitude of corneal astigmatism decreases first and then increases.The turning point from the proportion of WTR astigmatism to the proportion of ATR astigmatism is 65 years old.The shallower the anterior chamber is,the more the magnitude of corneal astigmatism and the proportion of ATR astigmatism increase.When the axial length is>25.00 mm,both the magnitude of corneal astigmatism and the proportion of ATR astigmatism reach the peak.