翼状胬肉切除联合自体结膜移植术后角膜像差及眼前节参数变化的临床研究

Clinical research of the corneal aberration and anterior segment parameters changes after pterygium surgery

目的使用Sirius三维眼前节分析系统评估翼状胬肉切除联合自体结膜移植手术后角膜像差和角膜前后表面散光度、角膜前后表面高度、角膜非球面性系数(Q值)等眼前节参数的变化。方法收集2017年2月至2018年3月于华厦眼科集团台州五官科医院就诊的翼状胬肉患者对50例(63只眼)的病例资料进行研究。其中,男性29例(38只眼),女性21例(25只眼);平均年龄(53.32±9.14)岁。全部患者施行翼状胬肉切除联合自体结膜移植手术。分别在术前和术后6个月,使用Sirius三维眼前节分析系统记录角膜散光度、角膜屈光力、Q值、角膜像差(包括总像差、高阶像差、彗差、球差、三叶草像差)以及角膜前后表面的高度,采用均数±标准差(x珋±s)进行描述,并采用配对t检验比较术前与术后的变化。结果患者术前角膜前后表面的散光度分别为(3.96±2.7) D和(0.40±0.15) D,术后6个月角膜前后表面的散光度分别为(1.45±1.1) D和(0.19±0.1) D,术后6个月角膜前后表面的散光度较术前均降低,其差异有统计学意义(t=6.83,9.25; P<0.05)。患者术前角膜前后表面的平均屈光力分别为(42.67±2.11) D和(-6.48±0.21) D,术后6个月角膜前后表面的平均屈光力分别为(44.70±1.90) D和(-6.60±0.20) D,术后6个月角膜前后表面的平均屈光力较术前均升高,其差异有统计学意义(t=5.36,3.28; P<0.05)。患者术前角膜前后表面的Q值分别为(-0.40±0.65)和(-0.42±0.2),术后6个月角膜前后表面的Q值分别为(-0.38±0.8)和(-0.41±0.16),术后6个月角膜前后表面的Q值与术前比较,其差异无统计学意义(t=0.15,0.68; P>0.05)。患者术前总像差为(6.29±3.18)μm,高阶像差为(2.4±1.18)μm,慧差为(0.006±0.46)μm,三叶草像差为(-0.15±0.32)μm;术后6个月总像差为(4.13±2.28)μm,高阶像差为(1.24±0.57)μm,慧差为(-0.015±0.28)μm,三叶草像差为(-0.07±0.61)μm。除球差外,术后6个月的角膜总像差、高阶像差、慧差均下降,其差异有统计学意义(t=5.96,12.15,2.02; P<0.05);三叶草像差较术前下降,但差异无统计学意义(t=-0.92; P>0.05)。患者在4 mm区域,术前角膜前后表面的高度分别为(-3.52±25.92)μm和(3.42±56.05)μm,术后6个月角膜前后表面的高度分别为(-3.46±10.37)μm和(-8.96±32.01)μm,与术前相比,术后6个月在4 mm区域角膜前后表面高度的差异无统计学意义(t=1.45,1.72; P>0.05)。患者在8 mm区域,术前角膜前后表面的高度分别为(-44.84±46.59)μm和(-157.07±117.85)μm,术后6个月角膜前后表面的高度分别为(-68.14±25.14)μm和(-198.40±66.50)μm,术后6个月在8 mm区域角膜前后表面高度分别较术前降低,其差异有统计学意义(t=6.38,12.93; P<0.05)。结论翼状胬肉会影响角膜表面,引起角膜像差和角膜高度的变化,手术切除翼状胬肉可以改善患者的视觉质量。翼状胬肉患者计划行屈光手术或晶状体手术,应该先进行翼状胬肉切除手术。

Objective To assess the changes in corneal higher order aberrations and changes in the elevation of the front and back corneal surfaces using the Sirius anterior segment analysis system. Methods From February 2017 to March 2018,50 patients(63 eyes) with pterygium were studied in Taizhou E&ENT Hospital,Huaxia Eye Hospital Group. Among them,there were 29 males(38 eyes) and 21 females(25 eyes),with an average age of(53. 32 ± 9. 14) years. All patients underwent pterygium excision combined with autologous conjunctival transplantation. The corneal astigmatism,corneal refractive power,asphericityvalue, corneal aberration(including total aberration, higher order aberration, coma, spherical aberration, clover aberration) and corneal anterior and posterior surface height were recorded by Sirius three-dimensional anterior segment analysis system before and 6 months after surgery,respectively. The data of the patients were expressed by mean standard deviation(x珋± s). Before and after surgery were compared by paired t-test. Results The astigmatism of anterior and posterior corneal surfaces were(3. 96 ± 2. 7) D and(0. 40 ± 0. 15) D respectively. The astigmatism of anterior and posterior corneal surfaces were(1. 45 ± 1. 1) D and(0. 19 ± 0. 1) D respectively,6 months after surgery. The astigmatism of anterior and posterior corneal surfaces was lower than that of preoperative corneal surfaces,and the difference was statistically significant(t = 6. 83,9. 25; P < 0. 05). The average refractive power of the anterior and posterior corneal surfaces were(42. 67 ± 2. 11) D and(-6. 48 ± 0. 21) D,respectively. The average refractive power of the anterior and posterior corneal surfaces were(44. 70 ± 1. 90) D and(-6. 60 ± 0. 20) D,respectively,at 6 months after surgery. The average refractive power of the anterior and posterior corneal surfaces was higher than that of the preoperative corneal surfaces. The refractive power of anterior and posterior corneal surfaces were both rised 6 months after surgery,their differences were statistically significant(t = 5. 36,3. 28; P < 0. 05). The asphericity values of anterior and posterior corneal surfaces were(-0. 40 ± 0. 65) and(-0. 42 ± 0. 2). The asphericity values of anterior and posterior corneal surfaces were(-0. 38 ± 0. 8) and(-0. 41 ± 0. 16) respectively at 6 months after surgery. There was no significant difference in the asphericity values between anterior and posterior corneal surfaces at 6 months after surgery(t = 0. 15,0.68; P > 0. 05). The preoperative total aberration,higher order aberration,coma aberration and clover aberration were(6.29 ± 3. 18) microns,(2. 4 ± 1. 18) microns,(0. 006 ± 0. 46) microns and(-0. 15 ± 0. 32) microns,respectively. The total aberration,higher order aberration,coma aberration and clover aberration were(4. 13 ± 2. 28) microns,(1. 24 ± 0.57) microns,(-0. 015 ± 0. 28) microns and(-0. 07 ± 0. 61) microns respectively at 6 months after surgery. Except spherical aberration,the total corneal aberration,higher order aberration and coma aberration decreased 6 months after surgery,and the differences were statistically significant(t = 5. 96,12. 15,2. 02; P < 0. 05). The aberration of clover decreased compared with that before surgery,but the difference was not statistically significant(t =-0. 92,P > 0. 05).The anterior and posterior corneal surface heights were(-3. 52 ± 25. 92) microns and(3. 42 ± 56. 05) microns in 4 mm area before surgery,respectively. The anterior and posterior corneal surface heights were(-3. 46 ± 10. 37) microns and(-8. 96 ± 32. 01) microns in 6 months after surgery. The differences of anterior and posterior corneal surface heights in 4 mm area between preoperatively and 6 months after surgery were not statistically significant(t = 1. 45,1. 72; P > 0. 05).The anterior and posterior corneal surface heights were(-44. 84 ± 46. 59) microns and(-157. 07 ± 117. 85) microns in the 8 mm area before surgery,respectively. The anterior and posterior corneal surface heights were(-68. 14 ± 25. 14)microns and(-198. 40 ± 66. 50) microns in the 6 months after surgery,respectively. The anterior and posterior corneal surface heights in the 8 mm area were higher than those before surgery. The difference was significant(t = 6. 38,12. 93; P< 0. 05). Conclusion Pterygium affects the corneal surface and induces heights changes and aberrations that is why it should be removed to improve the visual performance of the patients. We should consider pterygial excision before any refractive surgery or lens surgery planned for those patients. aberrations that is why it should be removed to improve the visual performance of the patients. We should consider pterygial excision before any refractive surgery or lens surgery planned for those patients.