不同光照条件下近视患者Kappa角的特征及变化规律

目的 观察预行飞秒激光原位角磨镶术(FS-LASIK)的近视患者在不同光照条件下Kappa角的特征及其变化规律。方法 采用自身前后对照试验。选取2021年6月至8月在江西省人民医院近视矫正中心预行FS-LASIK的近视患者104例(208眼)。用Sirius三维角膜地形图分别测量患者双眼在明视、黄昏视和暗视条件下的瞳孔直径和瞳孔中心偏移量。并将瞳孔中心偏移量在直角坐标系中转换为Kappa角水平分量和Kappa角垂直分量,并分析其变化规律。分析患者双眼瞳孔直径和Kappa角之间的关系。结果 患者右眼Kappa水平分量在明视、黄昏视和暗视条件下分别为(0.00±0.13)mm、(-0.06±0.13)mm、(-0.12±0.13)mm,差异有统计学意义(P<0.05);患者左眼Kappa角水平分量在明视、黄昏视和暗视条件下分别为(-0.04±0.14)mm、(0.02±0.13)mm、(0.08±0.13)mm,差异有统计学意义(P<0.001)。患者双眼瞳孔直径在不同光照条件下差异均有统计学意义(均为P<0.001)。两两比较结果显示,患者双眼瞳孔直径和Kappa角水平...     

白内障患者Kappa角特点及明暗状态下的变化

目的 探讨Kappa角特点及明暗状态下的变化规律。方法 系列病例研究。选取2016年5月至2017年10月于厦门大学附属厦门眼科中心行白内障手术的患者394例（788眼）,采用OPD-Scan Ⅲ进行检查,搜集的数据包括患者的临床数据（年龄、性别、眼部病史及手术史）,及术前生物测量数据如平均角膜曲率（Mean K）、角膜球差（CSA）、白到白距离（WTW）、明视瞳孔直径（Photopic）、暗视瞳孔直径（Mesopic）,明视瞳孔时Kappa角的大小和位移角度（PDist@Angle）、暗视瞳孔时Kappa角的大小和位移角度（MDist@Angle）、暗视瞳孔中心相对于明视瞳孔中心位移的大小和角度（MPDist@Angle）等。数据采用秩和检验、卡方检验、多元回归统计分析处理。结果 双眼各生物测量因素对比中Mean K、MPDist、PDist、WTW、CSA差异无统计学意义（P>0.05）,而Photopic、Mesopic、MDist左右眼差异有统计学意义（Z=2.276、3.284、2.388,均P<0.05）。双眼明暗状态下均为正Kappa角占多数;双眼由明瞳向暗瞳转变时瞳孔中心多向颞下方位移。分别将双眼临床、生物测量数据与MPDist进行多元回归分析,右眼回归方程为：MPDist=0.033+0.505×MDist+0.041×CSA-0.319×PDist（F=45.0,P<0.001）,左眼回归方程为：MPDist=-0.002+0.547×MDist+0.013×Mesopic-0.350×PDist（F=61.6,P<0.001）。结论 白内障患者正Kappa角占多数;不同明暗度下瞳孔大小的改变会影响Kappa角的大小,而且明暗瞳孔大小及明暗交替时瞳孔中心的大小和位移角度在不同患者间存在较大差异;MPDist的变化与PDist、MDist、Mesopic、CSA存在线性回归关系,其中双眼MPDist均与PDist存在负相关,双眼MDist均对MPDist的变化影响相对较大。     

Pentacam三维眼前节分析诊断系统 与Keratron Scout角膜像差仪测量 Kappa角的比较

目的：比较Pentacam三维眼前节分析诊断系统与Keratron Scout角膜像差仪测量屈光手术患者Kappa 角大小的差异。方法：系列病例研究。选取空军军医大学西京医院眼科屈光矫正中心术前筛查患 者98例（196眼）。在同一环境下进行Pentacam与Keratron Scout检查,记录2种检查方式的瞳孔直径、 Kappa角大小（采用直角坐标系表示）,从而获得Kappa角在角膜的x轴和y轴偏移量,比较2种检查方 法测量的Kappa角大小的差异及2种检查方法的相关性。采用配对t检验以及Pearson相关分析进行 数据处理。结果：Pentacam与Keratron Scout测量近视患者的瞳孔直径分别为右眼（3.17±0.44）mm、 （3.19±0.53）mm,左眼（3.25±0.65）mm、（3.33±0.48）mm,二者差异均无统计学意义。Pentacam与 Keratron Scout测得双眼的Kappa角x轴以及y轴偏移量的差异均无统计学意义,2种方法测得的Kappa 角偏移量具有显著相关性（P<0.05）,右眼x轴相关系数为0.966,y轴为0.969,左眼x轴为0.956,y轴 为0.913。结论：在瞳孔直径一致的条件下,Pentacam三维眼前节分析诊断系统与Keratron Scout角膜 像差仪测量近视以及近视散光患者Kappa角无差异,在手术设计中均可作为Kappa角调整的参考。     

角膜屈光手术患者明暗瞳孔下Kappa角的变化及分析

目的：观察角膜屈光手术患者明暗瞳孔下Kappa角的大小及明暗瞳孔时Kappa角的变化规律。方法：选取近视手术患者118例234眼,采用 Keratron Scout角膜地形图仪分别于室内照明及暗室情况下进行检查,记录明暗瞳孔直径大小、明暗瞳孔时Kappa角的大小。结果：左右眼明暗瞳孔直径大小的差异有统计学意义（P＜0．01）。明瞳时,左右眼Kappa角鼻上方分布较多;暗瞳时,左右眼Kappa 角颞上分布较多。明暗瞳孔下, Kappa角的水平及垂直偏移的差异均有统计学意义（ P＜0．01）。结论：不同明暗度下瞳孔大小的改变会影响Kappa角的大小,这种变化可能对依据Kappa角进行居中设计的角膜屈光手术的准确性产生影响。     

明视、暗视及药物散瞳状态下的瞳孔位置

目的观察明视、暗视及药物散瞳状态下的瞳孔位置,评价瞳孔位置是否随瞳孔直径而改变及其与年龄、屈光不正等因素的相关性。方法运用Asc lep ion波前像差仪检测获得130例(130眼)屈光不正患者在明视、暗视及药物散瞳状态下的眼前节图像,设计软件计算图像中的瞳孔中心位置、角巩膜缘几何中心位置。结果随着瞳孔直径的增大,瞳孔中心位置始终向颞侧偏移。从明视到暗视,瞳孔直径平均由4.06 mm增至6.37 mm,而瞳孔中心平均向颞侧移动0.133 mm(t=4.604,P<0.01);从暗视到药物散瞳状态,瞳孔直径平均由6.37 mm增至7.58 mm,而瞳孔中心平均向颞上方移动0.162 mm(t=4.180,P<0.01);从明视到药物性散瞳,瞳孔中心平均向颞上方移动0.183 mm(t=7.378,P<0.01);但瞳孔中心位置的移动量与年龄、屈光不正度及瞳孔直径的改变值无显著相关性。结论瞳孔中心位置随着瞳孔直径的增大而主要向颞侧偏移同时略向上移动,但总的移动量不大。     

Usher综合征一例

患者女 ,18岁。聋哑 17年 ,双眼视力进行性下降伴夜盲 5年 ,加重 1周 ,于 2 0 0 0年 8月 2 5日就诊。全身检查未见异常。眼部检查 :视力右眼 0 .5 ,针孔 0 .5 ;左眼 0 .0 8,针孔 0 .1,双眼视力不能矫正。眼压 :右眼 2 6 mm Hg(1mm Hg=0 .133k Pa) ,左眼2 5 mm Hg。双眼外眼正常 ,角膜透明 ,前房轴深 2 .4 mm,周边前房 1/ 3CT,右眼瞳孔直径 3mm ,对光反应灵敏 ,左眼瞳孔直径 5 mm,对光反应迟钝 ,双眼晶状体透明 ,玻璃体絮状混浊、液化。眼底检查 :双眼视盘蜡黄色萎缩 ,呈垂直椭圆形 ,边界清晰 ,视杯凹陷深。杯 /盘 :右眼 0 .95 ,左眼 1.0 …     

Adie瞳孔伴双眼悬韧带松弛一例

患者,女,16岁,因“视近不清2 d”于西安市第一医院眼科门诊就诊。患者2 d前无明显诱因下出现视近不清,无眼红、眼痛、视物变形等不适症状,平素身体健康,否认全身系统疾病,诉既往1周前邻桌同学有流涕等上呼吸道感染症状。眼部检查示：视力：右眼0.3,左眼0.12;眼压：右眼17 mmHg（1 mmHg=0.133 kPa）,左眼18 mmHg。结膜无充血水肿,角膜透明,前房略深,双眼虹膜震颤,虹膜卷缩轮未见明显蠕虫样自发运动,右眼瞳孔直径5 mm,直接对光反应迟钝,间接对光反应消失 ;左眼瞳孔直径3 mm,直接对光反应灵敏,间接对光反应存在,传入性瞳孔障碍（Relative afferent pupillary defect,RAPD）（-）（见图 1）。眼底未见异常。小瞳验光示：右眼-2.75 DS=1.0,左眼-4.25 DS=1.0。     

特高度远视眼一例

患儿蒋某,女,4岁6个月,2 0 0 2年3月因双眼视力差就诊。患儿为第三胎第一产,经保胎足月剖宫产,其母妊娠期间无发热、过敏、中毒及用药等异常情况。父双眼无异常情况,母有高度近视眼(右眼- 7 5 0D ,左眼- 8 0 0D)。视力检查:远视力双眼均为0 1;近视力右眼0 2 5 ,左眼0 2 ;眼压:右眼12mmHg(1mmHg =0 133kPa)左眼16mmHg。眼轴长度:右眼16 0 0mm ,左眼16 72mm ;角膜屈光度:右眼5 1 0 0D ,左眼5 2 0 0D ;角膜直径:右眼9mm ,左眼10mm。外眼无异常,角膜及晶状体透明,形态未见明显异常,瞳孔正圆,直径2 5mm ,对光反射敏感,眼底:视乳头偏…     

真性小眼球合并青光眼一例

患者女 62岁因双眼反复胀痛视力下降两年于2006年2月13日入院.既往健康.检查:视力:右眼无光感,左眼0.1;眼压:右眼81 mmHg、左眼53mmHg;双眼轻度睫状充血;角膜轻度水肿,直径10mm;前房浅Ⅱ度;瞳孔直径约6 mm,右眼对光反射消失,左眼迟钝;右眼晶状体重度混浊,左眼轻度混浊;眼底右眼窥不进,左眼小视盘,C/D=0.3;眼轴17.12mm;房角全部关闭.诊断:(1)双眼慢性闭角型青光眼(右眼绝对期);(2)双眼老年性白内障;(3)双眼真性小眼球.     

配戴RGPCL后水平彗差的变化及其与瞳孔中心位移的关系

目的分析RGPCL配戴前后,全眼球和角膜像差的变化情况以及与瞳孔中心位移之间的关系。方法前瞻性病例自身对照研究。21例志愿者（42眼）,平均年龄（26.7±4.1）岁,平均屈光度（-3.59±1.36）D,散光度（-0.67±0.24）D;用鹰视角膜地形图测量瞳孔中心相对于角膜中心的偏移量、瞳孔直径以及角膜像差,鹰视波前像差仪测量裸眼的全眼球像差。然后由同一名视光师给予验配美尼康RGPCL,在配戴RGPCL 1个月后回访,用相同仪器分别测量戴镜时的瞳孔中心偏移、瞳孔直径、角膜像差和全眼球像差。统计分析6 mm直径下的前4阶14项波前像差。采用配对t检验和相关分析对数据进行分析。结果配戴RGPCL 1个月后,双眼瞳孔中心向颞侧水平偏移,瞳孔直径轻微增大,其变化量如下：?譹?訛水平位移：右眼戴前为（-0.067±0.141）mm,戴后（-0.103±0.129）mm（t=2.240,P＜0.05）;左眼戴前为（0.059±0.159）mm,戴后（0.114±0.132）mm（t=-3.371,P＜0.01）。?譺?訛瞳孔直径：戴前为（3.69±0.61）mm,戴后为（3.91±0.49）mm（t=-2.865,P＜0.01）。角膜和全眼球的水平彗差变化均有统计学意义：?譹?訛角膜水平彗差减少,右眼戴前为（-0.104±0.075）μm,戴后（0.019±0.050）μm（t=-5.697,P<0.01）,左眼戴前为（0.127±0.074）μm,戴后（-0.001±0.079）μm（t=5.113,P<0.01）;?譺?訛全眼球水平彗差增加,右眼戴前为（0.012±0.072）μm,戴后（0.097±0.054）μm（t=-5.291,P<0.01）;左眼戴前为（-0.038±0.071）μm,戴后（-0.099±0.051）μm（t=4.378,P<0.01）。在这些有变化的参数中瞳孔中心水平位移分别与角膜和全眼球水平彗差差值呈负相关（r=-0.583、-0.534,P<0.01）;并且瞳孔中心水平位移与瞳孔直径的改变有较大相关性（r=0.501,P<0.01）。结论配戴RGPCL后,瞳孔中心发生颞侧向的水平位移,从而角膜和全眼球水平彗差也相应改变,原来的角膜和眼内彗差的互补平衡被打破。瞳孔直径的轻微增加可能是造成此种改变的原因之一。     

近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化

目的 探讨行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化.方法 选取2018年12月至2020年8月在延边大学附属医院眼科行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者117例(234眼)为研究对象.采用ALLEGRO Topolyzer角膜地形图仪(德国...     

Pupil center shift relative to the coaxially sighted corneal light reflex under natural and pharmacologically dilated conditions

PURPOSE: To evaluate the location and shift of the pupil center relative to the coaxially sighted corneal reflex on horizontal and vertical planes under natural and pharmacologically dilated conditions. METHODS: Ninety-four (64 myopic and 30 hyperopic) eyes of 47 patients underwent pupillometry with the NIDEK OPD-Scan under photopic and mesopic conditions before and after instillation of cyclopentolate 1%. Horizontal, vertical, and vectorial shift of the pupil center were calculated between each condition. RESULTS: The pupil center was located temporally to the coaxially sighted corneal reflex a mean distance of 0.336 +/- 0.181, 0.345 +/- 0.195, and 0.339 +/- 0.170 mm under photopic, mesopic, and pharmacologically dilated conditions, respectively. The pupil center shifted primarily inferotemporally (44%), followed by inferonasally (22%), superotemporally (19%), and superonasally (15%) from photopic to pharmacologic dilation. Mean magnitude of pupil shift was 0.084 +/- 0.069 mm (range: 0.010 to 0.385 mm) from mesopic to photopic, 0.149 +/- 0.080 mm (range: 0.013 to 0.384 mm) from photopic to pharmacologic dilation, and 0.102 +/- 0.104 mm (range: 0 to 0.530 mm) from mesopic to pharmacologic dilation. Mean distance between the pupil center and the coaxially sighted corneal reflex was greater in hyperopes than in myopes (P < .05), but no significant difference was observed in pupil center shifts between myopes and hyperopes under all three conditions (P > .05). CONCLUSIONS: The pupil center is located temporally and shifts in every direction, primarily inferotemporally, relative to the coaxially sighted corneal reflex with natural and pharmacologic dilation. The horizontal distance between the pupil center and the coaxially sighted corneal reflex was significantly higher in hyperopes than in myopes.     

Measurement of the spatial shift of the pupil center

PURPOSE: To evaluate the effectiveness of the pupil center as an anatomic landmark for excimer laser treatments. SETTING: Sekal-Microchirurgia-Rovigo Centre, Rovigo, Italy. METHODS: Pupillometry with the Costruzione Strumenti Oftalmici S.R.L. (CSO) pupil-measuring module (incorporated in Eye Top videokeratoscope) was performed in 52 patients with a diagnosis of myopia and in 25 patients with a diagnosis of hyperopia. Measurements both in mesopic and photopic conditions consisted of pupil diameters, spatial shift of the pupil center, and the distance between the pupil center and keratoscopic axis. RESULTS: The mean pupil diameter in photopic conditions of illumination in myopic eyes was 3.52 mm +/- 0.56 (SD), while in mesopic conditions it was 5.37 +/- 0.78 mm; in hyperopic eyes the mean photopic pupil diameter was 3.01 +/- 0.46 mm, while the mean mesopic diameter was 5.12 +/- 0.48 mm. The mean spatial shift of the pupil center in myopic eyes was 0.086 mm (maximum 0.269 mm), while in the hyperopic eyes it was 0.095 mm (maximum 0.283 mm). The mean distance between the pupil center and keratoscopic axis in myopic eyes was 0.226 +/- 0.13 mm (maximum 0.75 mm), while in hyperopic eyes it was 0.45 +/- 0.19 mm (maximum 0.8 mm). CONCLUSIONS: The mean of the measured pupil sizes was greater in myopic eyes than in hyperopic eyes. The spatial shift of the pupil center, as the pupil dilates, was relatively small in all groups; therefore, the pupil center is a good anatomic landmark for both traditional refractive surgery and wavefront-guided treatments. The mean distance between the keratoscopic axis and pupil center was greater in the hyperopic group than in the myopic group. Therefore, centration of any laser treatment on the basis of the keratoscopic analysis should be done carefully, especially in hyperopic eyes and in cases in which the pupil center is meaningfully shifted from keratoscopic axis, even in photopic conditions of illumination.     

Changes in pupil size and centroid shift in eyes with uncomplicated in-the-bag IOL implantation

PURPOSE: To determine changes in entrance pupil size and pupil center shift under low mesopic and photopic conditions of illumination in eyes with in-the-bag intraocular lens (IOL) implantation. METHODS: Entrance pupil size and pupil center shift were measured under low mesopic (0.06 lux) and photopic (60 lux) conditions of illumination in 55 patients with unilateral pseudophakia (study group) and 55 age- and sex-matched patients with bilateral cataracts (control group) using the NIDEK OPD-Scan. Pseudophakic eyes had an uncomplicated intraoperative and postoperative course and best spectacle-corrected visual acuity of 20/20. Cataractous eyes had no additional ocular or systemic problems affecting the pupil. Both groups were analyzed with respect to pupil size and shift in both conditions of illumination. RESULTS: Mean patient age was 64.2 +/- 6.8 and 63.6 +/- 4.3 years in the study and control groups, respectively (P = .45). In the study group, differences in pupil size under low mesopic (5.12 +/- 1.02 and 5.13 +/- 0.96 mm for pseudophakic and phakic eyes, respectively) and photopic (3.44 +/- 0.39 and 3.45 +/- 0.39 mm for pseudophakic and phakic eyes, respectively) conditions of illumination were not statistically significant (P = 1.00 and P = .95 for pseudophakic and phakic eyes, respectively). Differences in pupil shift between pseudophakic (0.11 +/- 0.08 mm) and phakic (0.12 +/- 0.10 mm) eyes were not statistically significant (P = .83) in the study group. In the control group, differences in pupil size under low mesopic (P = .59) and photopic conditions of illumination (P = .60) in the right and left eyes as well as pupil shift (P = .71) were not statistically significant. CONCLUSIONS: Uncomplicated in-the-bag IOL implantation has no influence on pupil size and shift.     

Changes in vaulting of myopic and toric implantable collamer lenses in different lighting conditions

Purpose: To evaluate the changes in vaulting of myopic and toric Implantable Collamer Lenses (ICLs) in different lighting conditions. Methods: Thirty‐seven eyes of 37 patients implanted with a myopic ICL and 26 eyes of 26 patients implanted with a toric ICL were examined using Visante optical coherence tomography (OCT) in photopic (257 lux) and mesopic (2 lux) conditions. Pupil diameter and distance changes between the ICL and adjacent intraocular structures were measured. Results: The mean horizontal pupillary diameters in mesopic conditions were 5.3 ± 0.9 (SD) mm. In photopic conditions, a mean decrease of –1.8 ± 0.6 mm [95% confidence interval (95% CI) ?2.0 to ?1.7; p < 0.0001] was observed. The mean distances between the ICL and the crystalline lens in mesopic conditions were 0.33 ± 0.17 mm. In photopic conditions, a mean decrease of ?0.04 ± 0.06 mm (95% CI ?0.05 to ?0.02; p < 0.0001) in the ICL‐crystalline lens distance was found. There was a ?0.02 ± 0.04 mm (95% CI ?0.03 to ?0.01; p = 0.0022) decrease in the anterior chamber depth and a 0.02 ± 0.06 mm (95% CI 0.002 to 0.032; p = 0.0275) increase in the distance between the cornea and the ICL. We found no difference in the change in vaulting between the two ICLs in different lighting conditions. Conclusion: There is a decrease in the central vaulting of myopic and toric ICLs in photopic conditions. This is due to both posterior movement of the ICL and anterior protrusion of the crystalline lens.     

近视眼飞秒激光小切口基质透镜取出术后角膜光学质量的客观评估

背景 目前评价飞秒激光小切口基质透镜取出术(SMILE)术后角膜光学质量的方法多基于单一的散射、衍射或像差因素,因此不能对角膜光学质量进行全面和客观评价,而调制传递函数(MTF)及斯特列尔比(SR)综合了上述多因素评价方法,是评估术后角膜光学质量方法学的研究方向. 目的 利用角膜MTF及SR客观分析SMILE术后术眼在明视和暗视环境下(分别为3 mm和6 mm瞳孔直径)角膜光学质量的变化.方法 采用系列病例观察研究方法和术眼手术前后自身对照研究设计,纳入2013年12月至2014年3月在天津市眼科医院接受SMILE的患者32例63眼,分别于术前、术后1周、1个月及3个月记录裸眼视力(UCVA)、最佳矫正视力(BCVA)和有效性指数(术后UCVA/术前BCVA);分别于上述时间点对术眼行电脑验光和综合验光仪验光,记录手术前后术眼屈光度变化;采用Sirius眼前节分析系统测定3 mm和6 mm瞳孔直径下不同空间频率(10、20、30、40、50和60 c/d)角膜前表面MTF和SR值,并测定术眼手术前后角膜前表面总高阶像差均方根值(RMS),以评估术眼SMILE手术前后角膜光学质量变化. 结果 术后1周、1个月、3个月UCVA(LogMAR)≥0.8者分别为59、62和63眼,分别占93.65％、98.41％和100％,术眼上述时间点有效性指数分别为1.104±0.128、1.126±0.145和1.158±0.208.术眼术后3个月等效球镜度和柱镜度均在正常范围.术眼术后各时间点3 mm瞳孔直径垂直及水平子午线各空间频率下MTF值较术前均明显增加,6 mm瞳孔直径下垂直子午线10、20、30和40 c/d空间频率MTF值较术前明显增加,差异均有统计学意义(均P＜0.05),而手术前后不同时间点6 mm瞳孔直径下水平子午线各空间频率MTF值总体比较差异均无统计学意义(均P＞0.05).术眼术后各时间点3 mm及6 mm瞳孔直径下的SR与术前相比呈上升趋势,差异均有统计学意义(均P＜0.05);且各时间点3 mm瞳孔直径下SR均大于相应的6 mm瞳孔直径下SR值,差异均有统计学意义(均P＜0.05).术眼手术前后不同时间点3 mm及6 mm瞳孔直径下角膜前表面RMS总体比较差异均无统计学意义(3 mm瞳孔直径:F=1.348,P=0.184;6 mm瞳孔直径:F=1.990,P=0.137). 结论 SMILE手术可有效改善近视及近视散光患者术后角膜光学成像质量,术眼术后明视环境下较暗视环境下角膜光学质量改善更为明显.