近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化

Dynamic changes in the angle Kappa,pupil size,and center position among dominant and nondominant eyes in myopic patients

目的探讨行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化。方法选取2018年12月至2020年8月在延边大学附属医院眼科行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者117例(234眼)为研究对象。采用ALLEGRO Topolyzer角膜地形图仪(德国Wavelight公司)测量并记录患者60 s内暗光与亮光状态下的瞳孔大小和瞳孔中心位置的变化。采用德国WaveLight EX500鹰视准分子激光机(500 kHz)的波前像差优化的切削程序进行准分子激光切削并记录患者仰卧位时P-Dist(瞳孔中心与角膜共轴反光点之间的偏移量)。优势眼和非优势眼之间各项参数比较采用配对资料t检验。结果117例患者中,右优势眼82例,左优势眼35例。优势眼的前房深度较非优势眼略深,差异有统计学意义(P<0.05)。暗光条件下,优势眼的瞳孔中心相对角膜共轴反光点的水平位移为(-0.07±0.14)mm,非优势眼为(0.01±0.13)mm,两组间水平位移相比差异有统计学意义(P<0.05)。从暗光到亮光条件下,随着瞳孔收缩,优势眼的瞳孔中心移位量为(0.08±0.13)mm,非优势眼为(0.04±0.12)mm,两组间差异有统计学意义(P=0.034)。从暗光到亮光条件下,优势眼瞳孔直径变化量为(3.44±0.50)mm,非优势眼为(3.17±0.49)mm,差异有统计学意义(P=0.047)。所有患眼P-Dist为(0.209±0.101)mm。优势眼P-Dist为(0.195±0.085)mm,非优势眼为(0.215±0.103)mm,两组间差异有统计学意义(P=0.041)。结论优势眼的P-Dist小于非优势眼。在暗光条件下,优势眼的瞳孔中心略向颞侧移动。手术时有必要对优势眼和非优势眼的Kappa角进行个体化调整。

Objective To investigate the dynamic changes in the angle Kappa,pupil size,and center position of dominant and nondominant eyes in myopic patients undergoing femtosecond laser combined with excimer laser in situ keratomileusis(FS-LASIK).Methods Totally 117 myopic patients(234 eyes)who underwent FS-LASIK in the Affiliated Hospital of Yanbian University from December 2018 to August 2020 were enrolled in the study.The WaveLightALLEGRO Topolyzer(WaveLight GmbH,Germany)was used to measure and record the changes in pupil size and center position of all eyes under photopic and mesopic conditions within 60 s.The wavefront aberration optimized cutting procedure of the WaveLight Eagle Vision EX500 excimer laser(500 kHz)was used for excimer laser cutting.The P-Dist(the offset between the pupil center and the coaxially sighted corneal light reflex)in supine position was recorded.Paired t-test was used to compare the parameters between dominant and nondominant eyes.Results Among the 117 patients,82 had the right dominant eye and 35 had the left dominant eye.The anterior chamber of dominant eyes was slightly deeper than that of nondominant eyes(P<0.05).Under mesopic conditions,the horizontal P-Dist was(-0.07±0.14)mm in dominant eyes and(0.01±0.13)mm in nondominant eyes,and the difference was statistically significant between the two groups(P<0.05).From mesopic to photopic conditions,the shift of pupil center was(0.08±0.13)mm in dominant eyes and(0.04±0.12)mm in nondominant eyes as pupils contracted,and the difference was statistically significant between the two groups(P=0.034);the pupil diameter change was(3.44±0.50)mm in dominant eyes and(3.17±0.49)mm in nondominant eyes,and the difference was statistically significant between the two groups(P=0.047).P-Dist of all eyes was(0.209±0.101)mm.P-Dist was(0.195±0.085)mm in dominant eyes and(0.215±0.103)mm in nondominant eyes,and the difference was statistically significant between the two groups(P=0.041).Conclusion P-Dist of dominant eyes is smaller than that of nondominant eyes,and the pupil center of dominant eyes slightly shifts to the temporal side under mesopic conditions.It is recommended to adjust the angle Kappa of dominant and nondominant eyes during surgery.