先天性晶状体脱位患者角膜曲率与像差特征

Characteristics of Corneal Curvature and Aberrations in Patients with Congenital Ectopia Lentis

目的:探讨先天性晶状体脱位(CEL)患者角膜曲率、散光和像差的特征,为术前人工晶状体(IOL)的选择提供参考。方法:病例对照研究。收集2018年7月至2021年7月就诊于中山大学中山眼科中心的双眼CEL患者55例(55眼)作为CEL组,同时纳入年龄、性别匹配的健康门诊体检者54例(54眼)作为对照组。采用Pentacam测量2组角膜前、后表面及总角膜曲率、散光及像差。采用Mann-WhitneyU检验、Kruskal-WallisH检验等对组间角膜参数的差异进行统计分析。采用卡方检验及Fisher确切概率法分析2组及各亚组间的散光类型分布。CEL组角膜参数与年龄之间的相关性采用Spearman相关分析。结果:CEL组角膜前、后表面曲率及总角膜曲率小于对照组,差异均有统计学意义(U=-5.62、-6.25、-5.66,P<0.001)。CEL组角膜前表面散光、总角膜散光高于对照组,差异有统计学意义(U=2.20,P=0.028;U=3.06,P=0.002);2组间的角膜后表面散光差异无统计学意义;2组间散光类型分布差异有统计学意义(P=0.001、0.028、0.001)。CEL组总角膜像差、高阶像差及低阶像差高于对照组(U=3.95,P<0.001;U=2.24,P=0.025;U=3.87,P<0.001),而球差低于对照组(U=-3.70,P<0.001),差异均有统计学意义。角膜前表面水平彗差与年龄呈负相关(r=-0.31,P=0.032)。结论:与健康者相比,CEL患者角膜曲率更小,角膜散光程度更高,角膜像差更大,角膜球差更小。CEL术前选择IOL时应参考总角膜散光情况,建议选择零球差或者球面IOL。

Objective:To investigate the characteristics of corneal curvature,astigmatism and aberrations in patients with congenital ectopia lentis(CEL)to provide reference for the selection of intraocular lens(IOL)before operation.Methods:In this case control study,55 eyes of 55 patients with bilateral CEL(CEL group)and 54 eyes of 54 healthy outpatient controls(control group)were enrolled from July 2018 to July 2021 at Zhongshan Ophthalmic Center,Sun Yat-Sen University.The characteristics of corneal curvature,astigmatism and aberrations were measured by a rotating Scheimplfulg camera(Pentacam HR).All parameters were compared using Mann-Whitney U test,Kruskal-Wallis H test,Chi-square test and Fisher's exact test.A correlation between age and comeal parameters in CEL group was evaluated by Spearman correlation analysis.Results:The anterior,posterior and total corneal curvature in CEL group were significantly lower than those in control group(U=-5.62,-6.25,-5.66,P<0.001).The anterior and total corneal astigmatism were significantly larger in the CEL group(U=2.20,P=0.028;U=3.06,P=0.002),while the difference in posterior corneal astigmatism between the two groups were not statistically significant.The distribution of astigmatism types was statistical differences between the two groups(P=0.001,0.028,0.001).The total corneal aberrations,high-order aberrations and low-order aberrations were increased in CEL group(U=3.95,P<0.001;U=2.24,P=0.025;U=3.87,P<0.001),whereas the spherical aberration decreased(U=-3.70,P<0.001).A significant negative correlation was found between age and anterior corneal horizontal coma(r=-0.31,P=0.032).Conclusions:Compared with the control group,the CEL group had lower corneal curvature,higher corneal astigmatism,greater corneal aberrations and smaller corneal spherical aberrations.The total corneal astigmatism should be taken into consideration when choosing IOL before surgery.It is recommended to choose IOL with zero spherical aberration or spherical IOL for CEL patient.