不同屈光状态学龄期儿童角膜前表面区域Q值的研究

目的：应用Pentacam眼前节分析仪测量我国学龄期儿童角膜形态，通过正切曲率半径计算各区域 角膜前表面Q值，分析不同屈光状态下各区域角膜前表面Q值的特点。方法：系列病例研究。选取 2018年9月至2019年10月在温州医科大学附属第二医院育英儿童医院眼科门诊就诊的学龄期儿童 192例，以右眼作为研究对象，按右眼等效球镜度（SE）分成中度近视组、低度近视组、正视组、低 度远视组、中度远视组这5组。应用Pentacam眼前节分析仪测量其角膜形态，通过正切曲率半径计 算鼻侧（315°-45°）、上方（45°-135°）、颞侧（135°-225°）、下方（225°-315°）这4个区 域角膜前表面Q值。采用方差分析比较各区域角膜Q值差异和各区域角膜Q值在不同屈光组间的差 异；采用Pearson相关分析SE和角膜Q值的相关性。结果：鼻、上、颞、下4个区域角膜前表面Q值 分别为-0.50±0.13、-0.62±0.15、-0.31±0.10、-0.42±0.18，4个区域角膜Q值差异有统计学意义 （F=215.19，P<0.001），颞、下、鼻、上4个区域角膜前表面变平坦趋势依次增快。不同屈光组间仅鼻侧、 下方角膜前表面Q值存在差异（F=6.00，P<0.001；F=2.95，P=0.022）。随着SE的增加，鼻侧、下方角 膜Q值变小，呈负相关（r=-0.38，P<0.001；r=-0.16，P=0.031）。不同屈光组在上方和颞侧2个区域 角膜前表面Q值差异均无统计学意义。不同屈光组的鼻颞侧Q值差值差异存在统计学意义（F=10.40， P<0.001），且随SE的增加，鼻颞侧Q值差异增大，二者有相关性（r=-0.42，P<0.001）。结论：学龄期 儿童各区域的角膜前表面Q值存在差异，不同屈光状态的鼻侧及下方角膜Q值、鼻颞侧差值均存在 差异，且均与SE存在相关性，提示不同屈光度的儿童矫正屈光不正时需考虑各区域角膜Q值，以提 高成像质量。

Research on the Anterior Corneal Q Values of Different Regions of SchoolAged Children's Eyes with Different Refractive Statuses

Objective: To calculate the school-aged children's anterior corneal Q values of different regions with the tangential radius of curvature acquired from the Pentacam anterior segment analyzer and analyze its distribution characteristics in different refractive status groups. Methods: A case series study was conducted. One hundred and ninty-two school-aged children were recruited from September 2018 to October 2019 in the Department of Ophthalmology of the Second Affiliated Hospital of Wenzhou Medical University. Only the right eyes were selected as objects of research. The patients were grouped by the magnitude of the spherical equivalent (SE) refractive error of the right eye: moderate myopia, low myopia, emmetropia, low hyperopia and moderate hyperopia. The Pentacam anterior segment analyzer was used to measure the cornea. The anterior corneal Q values of the nasal (315°-45°), superior (45°-135°), temporal (135°-225°) and inferior (225°-315°)region were calculated by the tangential radius with linear regression equation. Data was analyzed using ANOVA and Pearson correlation analysis. Result: The mean Q values of the nasal, superior, temporal and inferior region were -0.50±0.13, -0.62±0.15, -0.31±0.10 and -0.42±0.18. The difference of them was statistically significant (F=215.19, P<0.001). Only the nasal and inferior Q values were found significantly different among the different refracive groups (F=6.00, P<0.001; F=2.95, P=0.022).The relationship between Q values and SE was negative (r=-0.38, P<0.001; r=-0.16, P=0.031). No difference was found for superior and temporal Q values among the different refracive groups respectively. By further analysis, we revealed the Q values difference between the nasal-temporal region was significantly different among the different refracive groups (F=10.40, P<0.001). A trend toward higer the Q values difference between the nasal-temporal region was found as the SE increased. Pearson analysis showed the relationship between them was statistically significant (r=-0.42, P<0.001). Conclusion: The anterior corneal Q values of different regions of school-aged children's eyes were different. The nasal Q values, inferior Q values and the Q values difference between the nasaltemporal region were all significantly different among the different refracive groups and correlated with SE. It's critically important to considere the anterior corneal Q values of different regions when correctting refraction for different refractive children.