作者：赵晓婷 朱少栋 贺权 王丽英

　　【摘要】 目的  探讨复方托吡卡胺滴眼液对测量角膜厚度的影响。 方法  随机挑选科美眼科中心2004年3～4月准分子激光术前检查302例患者，共602眼。所选对象分别在滴散瞳眼药水（复方托吡卡胺滴眼液）前和后用A超测厚，比较散瞳前后角膜厚度的差值;将散瞳需要30min的54例近视患者1周后只滴表麻药（盐酸奥布卡因）测厚，30min后不散瞳再次测厚，比较108例散瞳和不散瞳眼例前后角膜厚度的差值;将散瞳需25min、30min、35min，40min的患者分为A、B、C、D4组，比较散瞳前后测量角膜厚度差值;将<-3.0D、-5.0～-6.0D、-7.0～-8.5D、>-9.0D分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组，比较不同屈光度散瞳前后角膜厚度测量差值有无影响。 结果  经统计学处理进行检验:（1）602眼散瞳后测量的角膜厚度较散瞳前测量的角膜增加（9.34±4.73）μm，散瞳后测量的角膜厚度较散瞳前测得的厚度厚（P<0.05）;（2）散瞳组30min前后角膜厚度的差值为8.63±3.44，对照组30min前后角膜厚度的差值为0.28±2.57，两组间比较差异有显著性（P<0.05）;（3）按散瞳时间划分的A、B、C、D组，用统计学检验，P  AB >0.05，P  AC >0.05，P  AD <0.01，P  BC >0.05，P  BD <0.01，P  CD <0.01;（4）按不同屈光度划分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组，各组间差异无显著性（P>0.05）。 结论  滴复方托吡卡胺滴眼液散瞳后测量的角膜厚度较散瞳前测量的角膜厚（9.34±4.73）μm;108只眼散瞳组和未散瞳组差异有显著性（P<0.05），表麻药对角膜测厚结果无明显影响。散瞳时间对测量角膜厚度差值有一定影响，在一定散瞳时间内无明显差异，随散瞳时间越长，散瞳前后测量的角膜厚度的差异值增大。复方托吡卡胺滴眼液对不同屈光度，散瞳前后测量的角膜厚度差异无显著性（P>0.05）。
    
　　关键词  角膜厚度 复方托吡卡胺 角膜测量
     
　　Investigation on effect of dilating eyedrop on measurement of thickness of cornea 

　　Zhao Xiaoting，Zhu Shaodong，He Quan，et al.
   
　　Kemei Out-patient Department of Shenzhen，Guangzhou518008.
   
　　【Abstract】 Objective To investigate the effect of dilating eyedrop on measurement of thickness of cornea.Methods 302（602eyes）clients received LASIK in the Kemei Ophthalmology Center from March2004to April2004were selected randomly.The thickness at the center of cornea selected clients，where the cornea is the thinnest，were mea-sured for four times by A-ultrasonic before and after applying pupil dilating eyedrop.Average measurement was calculat-ed.The clients were divided into A，B，C and D group by the time of mydriatsis at25，30，35and40minutes.Each group had50eyes.Difference of the thickness of cornea was measured before and after mydriaticing.Clients divided intoⅠ，Ⅱ，ⅢandⅣgroup by diopter to determine if dilating eyedrop had effect on the thickness of cornea measured on clients with different diopters.Results （1）By statistics，the thickness of cornea measured after dilating was obviously increased（9.3361±4.7316）μm than that before dilating（P<0.05）.（2）Clients were devided into A，B，C and D group by dilat-ing time.（P  AB >0.05，P  AC >0.05，P  AD <0.01，P  BC >0.05，P  BD <0.01，P  CD <0.01）.（3）Clients were divided into<-3.0D，-5.0～-6.0D，-7.0～-8.5D，>-9.0DⅠ，Ⅱ，ⅢandⅣgroup by diopter.It is found by statistics that there was no obvious difference among groups（P>0.05）.Conclusion The effect of pupil dilating eyedrop on the thick-ness of cornea should not be ignored.The thickness of cornea measured after dilating is obviously increased（9.3361±4.7316）μm than that before dilating.Pupil dilating eyedrop may cause light edema of cornea epithelium and measurement error，resulting in thicker measurement of cornea after dilating.Dilating time has certain effect on the measurement.For certain dilating time，the thickness of cornea before and after dilating has no obvious difference.The longer the dilating time，the larger the difference of the thickness of cornea before and after dilating.For different diopters，there is no differ-ence in thickness of cornea before and after dilating（P>0.05）.
   
　　Key words cornea thickness mydriatic eyedrop cornea measurement
   
　　近年来准分子激光治疗屈光不正越来越普及，激光术前相关检查数据的精确度一直备受屈光手术医生的关注。角膜厚度是激光手术前一项非常关键的数据，它涉及到病人是否能行激光手术，以及采用何种手术方式（PRK、LASIK、LASEK），角膜厚度测量误差大，会给患者术后角膜安全埋下隐患，在临床上角膜厚度测量，一般是滴散瞳眼药水后用A超测量，笔者在临床中发现，散瞳前后角膜厚度测量存在显著差异，现报告如下。

　　1 资料与方法
    
　　1.1 一般资料 随机选取科美眼科门诊2004年3～4月准分子激光术前检查患者，其中男188例，女204例，单眼2例，右眼301例，左眼301例，共602眼，年龄18～44岁，平均年龄为（28.37±4.29）岁，屈光度-1.0～-12.50（等值球镜），平均屈光度-5.02±1.58;角膜无器质性病变，无戴角膜接触镜史，近期无局部用药史。
   
　　1.2 仪器、药物和方法 使用的A超测厚仪采用日本Tomey SP-3000型角膜测厚仪，超声传播速率1640m/s。复方托吡卡胺滴眼液采用日本参天公司的美多丽（复方托吡卡胺）滴眼液，主要成分为托吡卡胺和盐酸去氧肾上腺素。测量角膜厚度时，先用日本参天的倍诺喜（0.4%盐酸奥布卡因）在结膜囊内点1滴在30s内用测厚探头找出角膜最薄点，测量角膜中央测量4次，取其平均值。患者散瞳药眼药水2滴;滴2～3次，散至瞳孔7.5～8.0mm，所有检测均由同一位操作熟练的护士完成。
   
　　1.3 统计学方法 采用cs20040415简明统计2000软件，资料采用χ 2 检验及用配对t检验。

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