高级检索
中华实验眼科杂志
期刊首页
过刊列表
高级检索
稿件发表
• 临床研究 •
ENGLISH ABSTRACT
角膜地形图与调制传递函数测量SMILE矫治近视术后有效光学区的比较
侯杰
雷玉琳
饶丰
张静
王雁
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20201120-00785
Comparison of the effective optical zone after small incision lenticule extraction measured by corneal topography and modulation transfer function in myopia
Hou Jie
Lei Yulin
Rao Feng
Zhang Jing
Wang Yan
Authors Info & Affiliations
Hou Jie
Jinan Mingshui Eye Hospital, Jinan 250200, China
Lei Yulin
Jinan Mingshui Eye Hospital, Jinan 250200, China
Rao Feng
Changzhou Institute of Technology, School of Photoeletric Engineering, Changzhou 213002, China
Zhang Jing
Jinan Mingshui Eye Hospital, Jinan 250200, China
Wang Yan
Tianjin Eye Hospital, Tianjin Institute of Ophthalmology, Tianjin Key Lab of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Affiliated Eye Hospital, Tianjin 300020, China
·
DOI： 10.3760/cma.j.cn115989-20201120-00785
557
86
0
0
4
0
PDF下载
APP内阅读
摘要

目的使用角膜地形图和调制传递函数(MTF)测量飞秒激光小切口基质透镜取出术(SMILE)矫治近视术后有效光学区(EOZ)的大小并分析其相关因素。

方法采用回顾性系列病例观察研究，选取2015年12月至2017年7月于济南明水眼科医院行SMILE手术的近视患者62例62眼。使用角膜地形图曲率差异图取值方法及MTF方法分别测量并计算SMILE术后6个月EOZ的大小。采用克隆巴赫系数和组内相关系数(ICC)评估测量数据的可重复性，采用Bland-Altman法进行一致性检验，采用Pearson相关分析法分析EOZ变化与其他参数之间的关系。

结果使用角膜切向曲率差异图测量的EOZ平均值的克隆巴赫系数和ICC均>0.9，重复性较好。2种方法测量的EOZ差值平均为(0.20±0.35)μm，具有较好的一致性，95%一致性界限为-0.49～0.89 μm。SMILE术后6个月，使用切向曲率差异图测得的EOZ为(5.32±0.25)mm，较预计光学区缩小了(1.18±0.25)mm；MTF法计算的EOZ为(5.07±0.32)mm，较角膜地形图获取的值小(0.20±0.35)mm，差异有统计学意义( t＝-4.487， P<0.01)。角膜地形图EOZ与屈光度呈负相关( r＝-0.364， P＝0.004)，与角膜曲率变化值及Q值变化量均呈显著正相关( r＝0.367、0.514，均 P<0.01)。

结论使用角膜地形图切向曲率差异图测量的EOZ数据重复性好，与MTF法的计算值具有良好的一致性；SMILE术后EOZ显著缩小。

近视;光学区;飞秒激光;小切口基质透镜取出术;角膜地形图;调制传递函数
ABSTRACT

ObjectiveTo measure the effective optical zone (EOZ) after small incision lenticule extraction (SMILE) by using corneal topographic map and modulation transfer function (MTF), and to analyze the related factors affecting the EOZ.

MethodsA retrospective observational case series study was performed.Sixty-two myopic patients (62 eyes) who underwent SMILE between December 2015 and July 2017 in Jinan Mingshui Eye Hospital were enrolled.The EOZ was measured by using tangential corneal curvature topographic map and MTF pre- and 6-month post-operatively.The repeatability of data was determined by intraclass correlation coefficient (ICC) and Cronbach Alpha coefficients; the agreement of data was identified by using Bland-Altman plot; the correlations between EOZ and surgical parameters were analyzed by utilizing Pearson correlation coefficient.This study protocol was approved by the Ethics Committee of Jinan Mingshui Eye Hospital(No.2015[013]). Written informed consent was obtained from each patient before surgery.

ResultsThe ICC and Cronbach Alpha coefficients of EOZ measured by corneal topographic map were greater than 0.9, which showed high intraobserver repeatability.The Bland-Altman plots displayed relatively good agreement between the two methods.The 95% limits of agreement was -0.49 to 0.89 μm.Six months after SMILE, the EOZ measured by tangential corneal curvature gradient topographic map was (5.32±0.25)mm, which was (1.18±0.25)mm smaller than predicted optical zone, and the EOZ measured by MTF method was (5.07±0.32)mm, which was (0.20±0.35)mm smaller than corneal tomographic EOZ, and the difference was significant ( t=-4.487, P<0.01). A negative correlation was found between the EOZ and attempted refractive correction ( r=-0.364, P=0.004). The positive correlations were found between the EOZ and ΔKm or ΔQ 6 months after SMILE ( r=0.367, 0.514; both at P<0.01).

ConclusionsThe EOZ measured by tangential corneal curvature topographic map after SMILE is of high repeatability and is consistent with the result calculated by MTF method.The EOZ is significantly reduced after SMILE.

Myopia;Optical zone;Femtosecond laser;Small incision lenticule extraction;Corneal topography;Modulation transfer function
Wang Yan, Email: mocdef.aabnis.piv3417naygnaw
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

侯杰,雷玉琳,饶丰,等. 角膜地形图与调制传递函数测量SMILE矫治近视术后有效光学区的比较[J]. 中华实验眼科杂志,2021,39(02)：126-132.

DOI:10.3760/cma.j.cn115989-20201120-00785

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

角膜屈光手术后视觉质量降低的主要原因包括较小的激光切削区及手术源性像差的引入 [ 1 ]。飞秒激光小切口基质透镜取出术(small incision lenticule extraction，SMILE)的临床开展使角膜屈光手术走向了微创时代，使手术风险降低的同时，患者术后视觉质量也得到进一步提升，但是仍有极少部分患者未达到术后预期效果，出现夜间视力下降、光晕、眩光等症状 [ 2 , 3 , 4 ]。光学区作为激光切削前后提供功能性视觉的角膜表面区域，其大小直接影响着术后的视觉效果 [ 5 , 6 ]。如何获得较好的有效光学区(effective optical zone，EOZ)是手术质量提升的关键因素。以往通常使用角膜地形图或光线追迹原理的方法对传统准分子激光角膜原位磨镶术(laser in situ keratomileusis，LASIK)或表层手术后EOZ进行定义，但不同方法使用的设备、采集的阈值以及使用的参照点不同 [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]，因此无法进行比较。目前尚缺乏使用不同方法测量SMILE术后EOZ的研究。本研究分别使用角膜地形图和调制传递函数(modulation transfer function，MTF)对SMILE术后EOZ进行测量，以探讨其变化特征并对2种方法进行比较。
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Racine L , Wang L , Koch DD . Size of corneal topographic effective optical zone：comparison of standard and customized myopic laser in situ keratomileusis[J]．Am J Ophthalmol， 2006，142(2):227-232. DOI： 10.1016/j.ajo.2006.03.023 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Piñero DP , Teus MA . Clinical outcomes of small-incision lenticule extraction and femtosecond laser-assisted wavefront-guided laser in situ keratomileusis[J]．J Cataract Refract Surg， 2016，42(7):1078-1093. DOI： 10.1016/j.jcrs.2016.05.004 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Kamiya K , Shimizu K , Igarashi A ，et al. Effect of femtosecond laser setting on visual performance after small-incision lenticule extraction for myopia[J]．Br J Ophthalmol， 2015，99(10):1381-1387. DOI： 10.1136/bjophthalmol-2015-306717 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Jabbur NS , Kraff C ；Visx Wavefront Study Group. Wavefront-guided laser in situ keratomileusis using the WaveScan system for correction of low to moderate myopia with astigmatism：6-month results in 277 eyes[J]．J Cataract Refract Surg， 2005，31(8):1493-1501. DOI： 10.1016/j.jcrs.2004.12.050 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Freedman KA , Brown SM , Mathews SM ，et al. Pupil size and the ablation zone in laser refractive surgery：considerations based on geometric optics[J]．J Cataract Refract Surg， 2003，29(10):1924-1931. DOI： 10.1016/s0886-3350(03)00214-1 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Endl MJ , Martinez CE , Klyce SD ，et al. Effect of larger ablation zone and transition zone on corneal optical aberrations after photorefractive keratectomy[J]．Arch Ophthalmol， 2001，119(8):1159-1164. DOI： 10.1001/archopht.119.8.1159 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Boxer Wachler BS , Huynh VN , El-Shiaty AF ，et al. Evaluation of corneal functional optical zone after laser in situ keratomileusis[J]．J Cataract Refract Surg， 2002，28(6):948-953. DOI： 10.1016/s0886-3350(02)01322-6 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Nepomuceno RL , Boxer Wachler BS , Scruggs R ．Functional optical zone after myopic LASIK as a function of ablation diameter[J]．J Cataract Refract Surg， 2005，31(2):379-384. DOI： 10.1016/j.jcrs.2004.04.073 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Tabernero J , Klyce SD , Sarver EJ ，et al. Functional optical zone of the cornea[J]．Invest Ophthalmol Vis Sci， 2007，48(3):1053-1060. DOI： 10.1167/iovs.06-0867 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Partal AE , Manche EE . Diameters of topographic optical zone and programmed ablation zone for laser in situ keratomileusis for myopia[J]．J Refract Surg， 2003，19(5):528-533.
返回引文位置Google Scholar
百度学术
万方数据
[11]
Racine L , Wang L , Koch DD . Size of corneal topographic effective optical zone：comparison of standard and customized myopic laser in situ keratomileusis[J]．Am J Ophthalmol， 2006，142(2):227-232. DOI： 10.1016/j.ajo.2006.03.023 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Qian Y , Huang J , Zhou X ，et al. Corneal power distribution and functional optical zone following small incision lenticule extraction for myopia[J]．J Refract Surg， 2015，31(8):532-538. DOI： 10.3928/1081597X-20150727-03 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Holladay JT , Janes JA . Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis[J]．J Cataract Refract Surg， 2002，28(6):942-947. DOI： 10.1016/s0886-3350(02)01324-x .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Camellin M , Arba Mosquera S ．Aspheric optical zones：the effective optical zone with the SCHWIND AMARIS[J]．J Refract Surg， 2011，27(2):135-146. DOI： 10.3928/1081597X-20100428-03 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Bühren J , Kühne C , Kohnen T ．Influence of pupil and optical zone diameter on higher-order aberrations after wavefront-guided myopic LASIK[J]．J Cataract Refract Surg， 2005，31(12):2272-2280. DOI： 10.1016/j.jcrs.2005.10.023 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Hou J , Wang Y , Lei Y ，et al. Corneal epithelial remodeling and its effect on corneal asphericity after transepithelial photorefractive keratectomy for myopia[J/OL]．J Ophthalmol， 2016，2016:8582362[2019-11-09]．https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031833/. DOI： 10.1155/2016/8582362 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
危平辉，王雁，李华，等．飞秒激光小切口角膜基质透镜取出术光学区大小对角膜生物力学特性影响的研究[J]．中华眼科杂志， 2017，53(3):182-187. DOI： 10.3760/cma.j.issn.0412-4081.2017.03.007 .
返回引文位置Google Scholar
百度学术
万方数据
Wei PH , Wang Y , Li H ，et al. Effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction[J]．Chin J Ophthalmol， 2017，53(3):182-187. DOI： 10.3760/cma.j.issn.0412-4081.2017.03.007 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[18]
El Danasoury AM , Holladay J , Waring GO 3rd ，et al. A contralateral，randomized comparison of optimized prolate ablation and conventional LASIK for myopia with the NIDEK excimer laser platform[J]．J Refract Surg， 2012，28(7):453-461. DOI： 10.3928/1081597X-20120621-01 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Jain R , Dilraj G , Grewal SP . Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis[J]．Indian J Ophthalmol， 2007，55(5):341-347.
返回引文位置Google Scholar
百度学术
万方数据
[20]
黄云丽，王雁，窦瑞，等．SMILE术后角膜形变与角膜生物力学变化的研究[J]．中华眼科杂志， 2017，53(1):11-17. DOI： 10.3760/cma.j.issn.0412-4081.2017.01.004 .
返回引文位置Google Scholar
百度学术
万方数据
Huang YL , Wang Y , Dou R ，et al. Analysis on corneal deformation and corneal biomechanical changes after small incision lenticule extraction[J]．Chin J Ophthalmol， 2017，53(1):11-17. 10.3760/cma.j.issn.0412-4081.2017.01.004 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[21]
窦瑞，王雁，吴文静，等．飞秒激光小切口角膜基质透镜取出术术后角膜生物力学的影响因素分析[J]．中华实验眼科杂志， 2016，34(5):448-455. DOI： 10.3760/cma.j.issn.2095-0160.2016.05.013 .
返回引文位置Google Scholar
百度学术
万方数据
Dou R , Wang Y , Wu WJ ，et al. Influencing factors of corneal biomechanics following small incision lenticule extraction[J]．Chin J Exp Ophthalmol， 2016，34(5):448-455. DOI： 10.3760/cma.j.issn.2095-0160.2016.05.013 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[22]
Roberts C ．Corneal topography[M]// Azar DT . Refractive surgery. Columbus：Mosby Elsevier， 2007:103-116.
返回引文位置Google Scholar
百度学术
万方数据
[23]
孟虎，陆燕，候培莉，等．调制传递函数对全飞秒激光近视屈光手术后早期视觉质量的评价[J]．中华实验眼科杂志， 2014，32(5):420-424. DOI： 10.3760/cma.j.issn.2095-0160.2014.05.008 .
返回引文位置Google Scholar
百度学术
万方数据
Meng H , Lu Y , Hou PL ，et al. Application of the modulation transfer function to evaluate the early visual quality after full femtosecond laser refractive surgery[J]．Chin J Exp Ophthalmol， 2014，32(5):420-424. DOI： 10.3760/cma.j.issn.2095-0160.2014.05.008 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[24]
王雁，刘永基．人眼的光学质量评估[M]//王雁，赵堪兴．波前像差与临床视觉矫正．北京：人民卫生出版社， 2011:77-88.
返回引文位置Google Scholar
百度学术
万方数据
Wang Y , Liu YJ . Optical quality assessment of human eyes[M]// Wang Y ， Zhao KX . Wavefront aberration and clinical visual correction. Beijing：People's Health Publishing House， 2011:77-88.
Goto Citation Goto Citation
[25]
郑艳珍，任蕾，邱岩，等．正常人眼全角膜光学质量调制传递函数的分析[J]．中华眼视光学与视觉科学杂志， 2012，14(3):157-160. DOI： 10.3760/cma.j.issn.1674-845X.2012.03.008 .
返回引文位置Google Scholar
百度学术
万方数据
Zheng YZ , Ren L , Qiu Y ，et al. An analysis of optical quality and modulation transfer function of normal human cornea[J]．Chin J Optom Ophthalmol Vis Sci， 2012，14(3):157-160. DOI： 10.3760/cma.j.issn.1674-845X.2012.03.008 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
备注信息
A
王雁，Email： mocdef.aabnis.piv3417naygnaw
B
所有作者均声明不存在任何利益冲突
C
国家自然科学基金项目 (81670884、81873684)
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大