近视眼角膜高阶像差特征及与全眼高阶像差的关系

目的 探讨近视患者角膜高阶像差的特点及与全眼高阶像差的相关关系。方法 横断面研究。随机选取拟行角膜屈光手术的近视散光患者216例（216眼），应用角膜波前像差分析仪与全眼波前像差分析仪（Schwind）在4 mm与6 mm瞳孔直径下分别对角膜与全眼进行波前像差测量。采用独立样本t检验比较分析角膜与全眼各主要高阶像差项的差异，采用Pearson直线相关分析患者角膜主要高阶像差项与球镜度、柱镜度、年龄的相关性，采用单因素方差分析比较散光顺规组与逆规组组间角膜高阶像差对比情况。结果 4 mm和6 mm瞳孔直径下，总高阶像差、总球差、水平彗差（C3+1）、球差（C40）在角膜与全眼之间差异均有统计学意义（4 mm：t=-2.364、-7.587、-2.197、-6.320，P＜0.05；6 mm：t=-4.794、-7.631、-7.945、-7.413，P＜0.01）。4、6 mm的角膜C40（顺规组与逆规组）与球镜度呈明显正相关（顺规组：r=0.211、0.255，P＜0.01；逆规组：r=0.697、0.562，P＜0.01）；逆规组各瞳孔直径角膜C3+1与柱镜度呈正相关（r=0.470、0.429，P＜0.05）。6 mm的顺规组与逆规组间的垂直彗差（C3-1）差异有统计学意义（P＜0.05）。结论 同一直径范围下角膜高阶像差各Zernike项均值从高到低依次为球差、垂直彗差、水平彗差、斜向三叶草、水平三叶草，与全眼像差排列顺序不甚相同。角膜与眼内像差可能存在补偿或迭加作用。顺规组与逆规组角膜高阶像差值略有不同，即使全眼散光表现为逆规，但角膜散光多为顺规，且与像差之间具有一定特异性关系。

The characteristics of corneal higher-order aberrations in myopia and the correlation between corneal and ocular higher-order aberrations

Objective To analyze the characteristics of corneal higher-order aberrations in myopia and the relationship between corneal and ocular higher-order aberrations. Methods Two hundred sixteen eyes of 216 myopic subjects were included in this cross-sectional study. The SCHWIND corneal and ocular aberrometer was used to measure the higher-order aberrations of eyes at two pupil sizes （4 and 6 mm）. An independent-samples t test was used to analyze the difference between corneal and ocular higher-order aberrations. And a Pearson correlation analysis was used to assess the correlations between anterior corneal higher-order aberrations and age， myopia and astigmatism. The differences in corneal higher-order aberrations between subjects who had with-the-rule （WR） astigmatism and those with against-the-rule （AR） astigmatism were analyzed by one-way ANOVA. Results There were differences between corneal and ocular total higher-order aberrations， total spherical aberrations， horizontal coma （C3+1）， and spherical aberration （C40） both at 4 mm and 6 mm pupils （4 mm： t=-2.364， -7.587， -2.197， -6.320， P＜0.05； 6 mm： t=-4.794， -7.631， -7.945， -7.413， P＜0.01）. A positive correlation was found between C40 （WR & AR） and myopia both at the 4 mm and 6 mm ranges（WR： r=0.211， 0.255， P＜0.01； AR： r=0.697， 0.562， P＜0.01）. Astigmatism was positively correlated with corneal C3+1 in the AR group at both pupil sizes （4 and 6 mm） （r=0.470， 0.429， P＜0.05）. There was a difference in vertical coma （C3-1） between the WR and AR groups at 6 mm （P＜0.05）. Conclusion Under the same pupil diameter， the root mean square of corneal higher-order aberrations from high to low in turn is： C40， C3-1， C3+1， C3-3， C3+3. Ocular aberrations show a difference. There are differences between the distribution of corneal and ocular higher-order aberrations， which indicated that there is compensation and superposition between corneal and internal higher-order aberrations. There are some differences in corneal higher-order aberrations between the WR and AR groups， although ocular astigmatism is against the rule and corneal astigmatism is almost always with the rule. Corneal astigmatism has some correlation with corneal higher-order aberrations.