【摘要】 目的：研究国人近视人群角膜前表面散光与眼球散光的关系，为眼屈光手术设计提供参考。方法：连续性资料358眼。采用日本TOMEY公司的TMS4角膜地形图仪进行角膜前表面地形图检查，获取角膜前表面散光度数及轴向;用日本TOPCON公司的RM8000自动电脑验光仪进行散瞳验光，获取眼球散光度数和轴向。结果：眼球散光与角膜前表面散光的比值为0.811±0.665;眼球散光<0.50D者150眼，散光度数差异、散光轴向差异均有统计学意义;散光度数、散光轴向均正相关;0.50D≤眼球散光<1.00D者122眼，散光度数差异有统计学意义;轴向差异无统计学意义;散光度数无相关性，散光轴向正相关;眼球散光≥1.00D者86眼，散光度数差异无统计学意义;散光轴向差异有统计学意义;散光度数、散光轴向均正相关。结论：角膜后表面及晶状体对角膜前表面散光有一定的补偿作用;角膜前表面散光与眼球散光正相关，散光度数越高，相关程度越高;角膜屈光手术根据眼球散光进行手术设计可能较好，屈光性晶状体置换术及白内障手术可根据角膜前表面散光确定手术切口位置。
【关键词】 近视;角膜前表面;散光
Quantitative analysis between the astigmatism of anterior corneal surface and overall astigmatism in myopia
ZhengZai Hu, HongZhuan Ouyang, Lin Li, SiWen Zhang, ZhiLing Zhou, QiongFang Zhang, MengLin Wang
Zhuzhou San San Yi Aier Eye Hospital, Zhuzhou 412002,Hunan Province,China
AbstractAIM: To research the relationship between the astigmatism of anterior corneal surface and overall astigmatism, and provide the reference for the refractive surgery design.METHODS: Totally 358 eyes were enrolled. The astigmatic degree and axis of anterior corneal surface were obtained by the corneal surface topography examination with an topographer (TMS4, TOMEY company, Japan); the degree and axis of the overall astigmatism were from cycloplegic refraction by an automatic refractor (RM8 000, TOPCON company, Japan).RESULTS: The ratio of the overall astigmatism and the astigmatism of anterior corneal surface was 0.811±0.665. In 150 eyes with overall astigmatism less than 0.50D, the differences of astigmatic degree and axis between two astigmatisms were significant respectively; there was positive correlation in astigmatic degree and axis. In 122 eyes with overall astigmatism between 0.50D and 1.00D， significant difference was found in astigmatic degree but not in axis between two astigmatisms. There was no correlation in astigmatic degree and positive correlation in astigmatic axis. 86 eyes with overall astigmatism more than 1.00D，significant difference was found in astigmatic axis but not in degree; There were positive correlation in astigmatic degree and axis.CONCLUSION:The posterior corneal surface and crystalline compensate for the astigmatim of anterior corneal surface. The astigmatism of anterior corneal surface is positively correlated with the overall astigmatism. The higher the astigmatic degree, the higher the correlation. Corneal refractive surgery may be designed better according to the overall astigmatism. The incision location in refractive lens exchange and cataract surgery is determined by the astigmatism of anterior corneal surface.
KEYWORDS: myopia; anterior corneal surface; astig matism
0引言
在眼屈光手术设计时，角膜前表面散光度数与轴向是非常重要的参考。准分子激光角膜屈光手术时，常需要根据它对手术量进行调整;在屈光性角膜切开术中，根据它来决定手术切口的位置;在屈光性晶状体手术甚至白内障手术时，也要根据它来决定角膜切口位置。因此，了解角膜散光在眼球散光中的贡献并对手术设计进行调整很有必要。
1对象和方法
1.1对象 2009年来我院接受准分子激光近视手术的连续性患者资料358眼，年龄18～40(平均25.2±5.9)岁;男182眼，女176眼。所有患者软性角膜接触镜停戴2wk以上，硬性角膜接触镜停戴4wk以上，无活动性感染病变，无白内障、青光眼、临床前期及临床期圆锥角膜等疾病。
1.2方法 采用日本TOMEY公司的TMS-4角膜地形图仪进行角膜前表面地形图检查，获取角膜前表面散光度数及轴向：被检者取坐位，下颌放在颌托上，额部向前顶住额带;被检者双眼睁开，被检眼注视红色固视灯光;检查者将对焦点移到placido盘影像中心并按下按键拍摄;每眼检查>3次，眼表干燥者，滴羟苄唑滴眼液后完成检查。用日本TOPCON公司的RM8000自动电脑验光仪进行散瞳验光，获取眼球散光度数和轴向：被检者取坐位，下颌放在颌托上，额部向前顶住额带;被检者双眼睁开，被检眼注视固视视标;检查者将中央光点移到方框内，并前后移动，将中央光点及两侧光点均调清晰，验光仪自动测量;每眼检查>3次。每个实验对象的检查均由同一个熟练的技师完成。将角膜前表面散光轴向与眼球散光轴向相差>90°的进行转换(加或减180°，并使数据在0°～270°之间)。
统计学分析：将转换后的角膜前表面散光与眼球散光数据用SPSS 13.0进行配对t检验和pearson相关分析，P<0.05为差异有统计学意义。
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