甲状腺相关眼病对角膜对称性及角膜屈光力的影响

目的研究甲状腺相关眼病对角膜形态学及角膜屈光力的影响。方法前瞻性病例对照研究。收集2012年12月至2013年5月在温州医科大学附属眼视光医院确诊为甲状腺相关眼病稳定期的患者24例（46眼）作为观察组，甲状腺相关眼病活动性的评估主要依据临床活动度评分CAS标准进行评估。收集与之年龄、性别相匹配的正常人30例（30眼）作为对照组。采用Pentacam测量2组角膜形态学参数及角膜屈光力，包括角膜表面变异指数（ISV）、垂直不对称指数（IVA）、高度不对称性指数（IHA）、高度离心指数（IHD）和最小曲率半径（Rim），角膜中央厚度（CCT），角膜前、后表面屈光力，角膜前、后表面散光度及散光轴向。应用眼球突出计（Hertel眼突计）测量观察组眼球突出度。用独立样本t检验或秩和检验对2组参数进行比较。结果甲状腺相关眼病ISV中位数为21．0（10～71），高于正常组的14．0（10～34）．Z=1．31，P〈0．01；IVA为0．180（0．07～0．70），高于正常组的0．100（0．50±0．37），Z=1．08，P〈0．01；IHA为5．95（0．0～28．7），高于正常组的1．65（0．2±13．9），Z=84．34，P〈0．01；IHD为0．020±0．015，高于正常组的（0．010±0040），t=5．67，P〈0．01；Rim为（7．43±0．30）mm，低于正常组的（7．62±0．26）mm，t=-2．505，P〈0．01；CCT为（523．74±26．00）μm，低于正常组的（546．25±28．84）μm，t=3．230，P〈0．01；角膜前表面K1为（43．58±1．18）D，高于正常组的（42．86±1．43）D，t=2．123，P〈0．05；角膜后表面K1为-6．20D（7．2～5．7D），高于正常组的-6．10D（-6．6—5．7D），Z=101．4，P〈0．01；角膜前、后表面陡峭屈光力，角膜前、后表面散光轴向及大小与正常组相比差异无统计学意义。结论甲状腺相关眼病能引起角膜对称性降低，角膜屈光力增加。

A clinical research of the cornea symmetry and refractive power of thyroid.associated ophthalmology disease

Objective To investigate the effect on comea topographical characteristcs of thyroid-associated ophthalmology （TAO） disease. Methods In this prospective case control study, 46 eyes of 24 patients diagnosed with the inactive TAO were recruited as study group, 30（30 eyes） age and sex matched healthy volunteers were as control group. TAO was diagnosed based on the basis of criteria of Eruopean Group Grave＇s Orbitopathy and the activity was decided by the Clinical Activity Score （CAS）. Cornea topographical characteristics of each group was obtained by using Pentacam system via one experienced doctor, including the index surface virance （ISV）, index of vertical asymmetry （IVA）, index of highest asymmetry （IHA）, index of highest decentration （IHD） and minimal sagittal curvature （Rim）, central comea thickness （CCT）, refractive power and astigmatism of front and back cornea. Data were analyzed using independent to test and rank sum test. Results ISV in TAO was 21.00（10-71）, higher than control group [14.0（10-34）] （Z=1.31, P〈0.01）; IVA was 0.180（0.07-0.70）, higher than control group [0.100（0.50-0.37）]（Z=1.08, P〈0.01）; IHA was 5.950（0.0-28.7）, higher than control group [1.65（0.2-13.9）]（Z=84.34, P〈0.01）; IHD was 0.020：L-0.015,higher than control group （0.010±0.004）（t=5.67, P〈0.01）; Rim was 7.43±0.30 mm, lower than control group （7.62±0.26 mm）（t=2.505, P〈0.01）; CCT was 523.74±26.00 μm, lower than control group （546.25±28.84 μm）（t=3.230, P〈0.01）; K1 of front cornea was 43.58±1.18 D, higher than control group （42.86±1.43 D）, （t=2.123, P〈0.05）; K1 of back cornea was -6.20 D（-7.2-5.7 D）, higher than control group [-6.10 D（-6.6-5.7 D）]（Z=101.4, P〈0.01）. There was no siginificant difference in K2, astigmatism between study and control group. Conclusion The TAO may lead to the decrease of cornea symmetry and have an effect on refractive power of cornea.