显微定量角膜检查镜测量角膜敏感性的检测分析

目的检测分析显微角膜检查镜在手术显微镜下定量测量角膜散光的敏感性.方法序贯选取温州医学院附属第二医院眼科门诊患者及部分志愿者共49人92眼,进行角膜地形图、角膜曲率计、显微定量角膜检查镜的检查,按不同散光量(diopter,D)进行分组:A组:0～,B组:1～,C组:2～,D组:3～,并对检查结果进行散光轴向及散光量的定量分析.结果 (1)散光轴向:A组散光轴向的检出率稍低(为80%),B、C、D 3组均能全部捡出(为100%),且与角膜地形图(rs=0.464)、角膜曲率计(rs=0.613)的结果相关性良好.(2)散光量:角膜检查镜与角膜地形图(r=0.965)、角膜曲率计(r=0.951)相关性良好;角膜检查镜与角膜曲率计读数差异无统计学意义(t=-1.799,P=0.075),不同分组间差异无统计学意义(F=0.678,P=0.568);与角膜地形图差异有显著统计学意义(t=5.513,P=0.000),不同分组间差异有显著统计学意义(F=4.531,P=0.005);进一步分组两两比较后发现,D组与其他3组间的差异有显著统计学意义(P=0.001、0.001、0.018),其余各组间差异无统计学意义.结论本研究的显微定量角膜检查镜在不同散光量分组的屈光不正人群中,无论是散光轴向还是散光量的检测均有较高的敏感性.     

显微定量角膜检查镜的研制

本文介绍一种新型角膜检查镜。其原理是根据等量交叉柱面透镜的合成原理制成可变量合成圆柱面透镜,合成柱面透面的轴向不变,并结合暗亮相间的同心圆环和分划板透射照明的角膜反射像形状的调整观察,可定量测量角膜表面的散光度和轴的方向。本角膜检查镜可用于手术显微镜下眼内手术时角膜散光检测的便携式角膜检查镜,在工作距离0．025m时,可测量的角膜散光度数可达8．50D,测量误差〈0．20D。显微定量角膜检查镜结构简单、方便准确,有助于对术眼角膜的散光度数和轴向进行检测和调整。     

显微定量角膜检查镜临床应用的评估

目的通过多家眼科单位对显微定量角膜检查镜（简称角膜镜）的临床试用检验角膜镜检查角膜散光度的准确性和稳定性。方法前瞻性多中心临床试验研究。4家眼科单位分别用角膜镜和角膜曲率计对被检者156例156眼（均取右眼）进行角膜散光测量,其中角膜镜每眼测3次,角膜曲率计每眼测1次,将角膜镜测量均值与角膜曲率计测量值进行比较,采用组内相关系数分析角膜镜3次测量间的稳定性,采用Bland-Altman散点图评价角膜镜与角膜曲率计测量散光度的准确性和一致性。结果角膜镜与角膜曲率计测量角膜散光度均值分别为（-1.96±1.16）D和（-1.84±1.17）D,二者呈高度线性相关（r=0.929,P=0.000）,配对t检验示二者差异有统计学意义（t=-3.020,P=0.003）。角膜镜与角膜曲率计测量角膜散光度差值为（-0.12±0.44）D。角膜镜与角膜曲率计测量角膜散光轴向的中位数均为0°,配对Wilcoxon符号秩检验示差异无统计学意义（Z=-1.775,P=0.076）。单因素方差分析显示角膜镜散光度3次测量间差异无统计学意义（F=0.153,P=0.859）。角膜镜对角膜散光度测量的组内相关系数（ICC）为0.975,对角膜散光轴向测量的ICC为0.988。角膜镜和角膜曲率计测量角膜散光度的一致性范围（差值均数±1.96SD）为（-1.00,0.76）D;将测量范围0～-8D分为0～、-1D～、-2D～、-4～-8D组段,结果显示角膜镜和角膜曲率计对各组段散光度测量的一致性范围均小于或接近于1.0D。结论角膜镜测量角膜散光度具有良好的准确性和稳定性。     

显微定量角膜检查镜测量角膜散光的临床观察

目的观察显微定量角膜检查镜（以下简称角膜检查镜）预测角膜表面的散光度和轴的方向的符合程度。方法用显微定量检查镜在手术显微镜下对68例（101眼）受检者做角膜散光检查（共检查3次,取平均值）,检查后再做角膜曲率计和角膜地形图的角膜散光检查。通过统计学分析．比较角膜检查镜与角膜曲率计和角膜地形图测量值的符合程度。结果角膜检查镜、角膜曲率计、角膜地形图检查角膜散光度数的值分别为（2．62±20）D、（2．66±1．26）D、（2．66±26）D：轴位的值分别为92．29°＋10．90°、92．81°±11．15°、93．33°±10．94°。角膜检查镜检查的角膜散光度数和轴向的测量值与角膜曲率计和角膜地形图的测量值差异无统计学意义。结论显微定量角膜检查镜预测角膜散光具有较高的临床参考价值。     

角膜检查镜在眼显微手术中的应用

报告透射式角膜检查镜在白内障摘除及人工晶体植入术中应用的临床效果。患者分为两组，一组卡用用膜检查镜，另一组用此镜，测两组手术前后的角膜曲率并对照观察。结果表明，使用该镜在显微镜下控制角膜曲率及进行连续缝线的调整，效果较好。该组术后角膜散光在２Ｄ以下者占６３％，３Ｄ以下者占９１％，无＞４Ｄ的散光。     

反射式角膜镜检测儿童角膜散光的临床研究

反射式角膜镜用于无角膜曲率计情况下临床角膜曲率定性检测，操作较Ｐｌａｃｉｄｏ盘方便。对１３０只儿童角膜散光眼作角膜镜与角膜曲率计检测，以角膜曲率计检测结果为准，反射式角膜镜检测结果与之比较，两法检测相关密切（Ｐ＜０．００５），符合率高（８９．２３％）。说明反射式角膜镜检出角膜散光的效用与角膜曲率计基本一致，对儿童角膜散光早期诊断颇具价值，可为进一步的检查和矫治提供依据。     

配戴一年以上的夜用角膜塑形镜停戴后角膜参数的变化

目的 观察夜用角膜塑形镜停戴后角膜参数的变化。设计 回顾性病例系列。研究对象 2010年10月至2013年3月在北京新力眼科验配角膜塑形镜并坚持戴镜且欲停戴重新验配的近视患者26例（49眼）。方法 采用Pentacam眼前节分析仪测量角膜曲率、角膜散光及角膜厚度,观察配戴前、连续戴镜12个月、停戴3~4周后各指标的变化。主要指标 角膜平坦轴曲率、角膜陡峭轴曲率、角膜散光、角膜厚度。结果 角膜平坦轴曲率配戴前、连续戴镜12个月、停戴3~4周后分别为（42.32±1.87）D、（40.18±1.83）D、（41.97±1.86）D,角膜陡峭轴曲率分别为（43.46±1.76）D、（41.46±1.74）D、（43.30±1.90）D,两指标配戴前与停戴后比较均无统计学差异（P=0.534,0.777）。各时间点角膜散光比较无统计学差异。戴镜中角膜厚度略变薄,配戴前及连续戴镜12个月分别为（546.23±24.33）μm、（537.18±27.89）μm,停戴后逐渐恢复至（541.23±22.25）μm,各时间点比较均无统计学差异。塑形效果稳定后每矫正-1.00 D屈光度实际下降K值为（0.52±0.18）D,实际角膜厚度变薄为（2.35±2.23）μm。停戴3~4周后K值恢复程度为（86±15）%,角膜厚度恢复程度为（68±45）%。结论 停戴夜用角膜塑形镜3~4周后各角膜参数恢复至接近戴镜前水平。（眼科,2016, 25： 306-309）     

角膜软镜治疗角膜外伤和角膜瘘

我院用亲水性角膜接触镜(简称软镜)戴入眼内治疗角膜穿通伤和角膜瘘在临床上进行了观察,取得了良好的疗效,现将介绍如下:摘要情况:88年     

A quantitative scale for the Barrett keratoscope

By allowing the surgeon to measure and modify corneal curvature during wound closure, intraoperative keratometry can reduce postoperative astigmatic errors. A number of keratometric devices have been developed over the last 10 years, each offering a compromise between cost, accuracy and ease of use. The Barrett keratoscope is a simple, inexpensive hand-held device which gives a qualitative indication of the degree of astigmatism. Addition of a transparent overlay, as described in this paper, sets the distance at which the keratoscope is held and allows the magnitude of the astigmatism to be determined, thereby enabling refined adjustment of the suture tension during wound closure. We describe the error in estimation of astigmatism due to the effect of the distance at which the keratoscope is held from the cornea.     

角膜曲率计在测量角膜散光中的作用

目的 :探讨角膜曲率计检查在测量角膜散光中的作用。方法 :采用角膜曲率计、散瞳验光、显然验光三种方法对屈光不正患者 2 2 4只眼进行检查。结果 :本组病例中散光度数以 1 0 0D以下为主。散瞳验光和显然验光所测出的散光轴位与角膜曲率计所测出的散光轴位比较 ,差异无显著性 (P >0 0 5)。在散光度数上 ,散瞳验光和显然验光测出的散光度数与角膜曲率计所测出的散光度数比较 ,差异有非常显著性 (P <0 0 1 )。散瞳验光与显然验光之间在散光度数上比较 ,差异无显著性 (P >0 0 5)。结论 :角膜曲率计对于散光轴位的测量在散瞳验光和显然验光中起到重要的辅助作用     

An assessment of the orthogonal astigmatism test for the subjective measurement of astigmatism

The orthogonal astigmatism test (OAT) is a newly developed method for assessing ocular astigmatism. This study compares the OAT with the Jackson crossed-cylinder (JCC), Raubitschek arrow (RA) and the fan and block (FB) (fan chart). Fifty emmetropes or corrected spherical ametropes (<0.25 DC of astigmatism) were recruited, with a visual acuity of at least 6/5 in both eyes. Pseudo-astigmatism was induced by placing a +0.75 DC lens in front of the right eye at a random axis. With the left eye occluded, each subjective test was performed in a random order and the correcting lens power and axis noted. No significant difference was found in the ability of the OAT to locate the power and axis of the induced astigmatism over the JCC, RA and FB. In conclusion, the OAT offers the clinician an alternative method for locating and correcting ocular astigmatism. It has a similar but not superior accuracy to the other three subjective tests assessed.     

Effects of posterior corneal astigmatism on the accuracy of AcrySof toric intraocular lens astigmatism correction

AIM: To evaluate the effects of posterior corneal surface measurements on the accuracy of total estimated corneal astigmatism. METHODS: Fifty-seven patients with toric intraocular lens (IOL) implantation and posterior corneal astigmatism exceeding 0.5 diopter were enrolled in this retrospective study. The keratometric astigmatism (KA) and total corneal astigmatism (TA) were measured using a Pentacam rotating Scheimpflug camera to assess the outcomes of AcrySof IOL implantation. Toric IOLs were evaluated in 26 eyes using KA measurements and in 31 eyes using TA measurements. Preoperative corneal astigmatism and postoperative refractive astigmatism were recorded for statistical analysis. The cylindrical power of toric IOLs was estimated in all eyes. RESULTS: In all cases, the difference of toric IOL astigmatism magnitude between KA and TA measurements for the estimation of preoperative corneal astigmatism was statistically significant. Of a total of 57 cases, the 50.88% decreased from Tn to Tn-1, and 10.53% decreased from Tn to Tn-2. In all cases, 5.26% increased from Tn to Tn+1. The mean postoperative astigmatism within the TA group was significantly lower than that in the KA group. CONCLUSION: The accuracy of total corneal astigmatism calculations and the efficacy of toric IOL correction can be enhanced by measuring both the anterior and posterior corneal surfaces using a Pentacam rotating Scheimpflug camera.     

散光的合理治疗策略

本文通过分析正常人眼散光的生理性变化规律,阐述了目前临床应用的散光治疗方法及优缺点比较.强调治疗前应充分细致地分析患眼的散光状态,个性化地设计治疗方案,为患者提供完美的术后效果,从而有效地提高视觉质量.     

A quantitative scale for the Barrett keratoscope.

By allowing the surgeon to measure and modify corneal curvature during wound closure, intraoperative keratometry can reduce postoperative astigmatic errors. A number of keratometric devices have been developed over the last 10 years, each offering a compromise between cost, accuracy and ease of use. The Barrett keratoscope is a simple, inexpensive hand-held device which gives a qualitative indication of the degree of astigmatism. Addition of a transparent overlay, as described in this paper, sets the distance at which the keratoscope is held and allows the magnitude of the astigmatism to be determined, thereby enabling refined adjustment of the suture tension during wound closure. We describe the error in estimation of astigmatism due to the effect of the distance at which the keratoscope is held from the cornea.     

PRK与LASIK矫正近视性散光准确性及预测性的比较

目的：评价对比准分子激光屈光性角膜切削术（PRK）与准分子激光原位角膜磨削术（LASIK）矫治近视性散光的疗效及预测性,进一步分析两种手术在治疗中存在的问题。方法：采用LASIK及PRK,对40例近视散光患者进行了分组治疗。结果：近视球镜矫正的准确性,LASIK组高于PRK组;近视散光度数的矫正及散光轴位矫正的准确性两组无明显改变;术后6个月裸眼视力达到或超过术前最佳矫正视力眼,LASIK组大于PRK组;解膜表面规则性指数（SRI）及角膜表现非规则性指数（SAI）在手术前后的变化,LASIK及PRK组无明显差异。结论：LASIK治疗近视性散光的疗效优于PRK。     

不同年龄段前角膜散光和后角膜散光相关性的横断面研究

目的：以不同年龄段分组评估前角膜散光(ACA)和后角膜散光(PCA)。同时分析各年龄段ACA、PCA之间散光程度、散光轴的相关性。

方法：横断面研究,包括381眼。将临床测得的散光数值转换为向量记法,以分析ACA和PCA。在整体人群和四个不同年龄段(5～19, 20～39, 40～59, 和≥60)中评估ACA和PCA之间散光程度、散光轴的关系。使用随机效应线性回归模型评估ACA、PCA散光程度之间的关系。

结果：在5～9岁儿童中,ACA平均散光度最高为3.59D,PCA为0.50D。总体上来说,ACA在1～10.0D,PCA在0～3.5D。在较年轻的分组中(5～19岁),ACA和PCA显著相关(r=0.85, P<0.001)。在60岁以上组中,ACA每增加1D,PCA增加0.04D(95%CI： 0.005, 0.07; P=0.03),增加程度相比其余组最少。

结论：在60岁以上人群中,相比仅仅依靠经验公式,通过ACA数据计算IOL度数,更为谨慎的方法是同时测定后角膜散光度和散光轴。