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中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 375 -379. doi: 10.3877/cma.j.issn.2095-2007.2021.06.010

综述

角膜屈光手术术前筛查早期圆锥角膜的研究进展
刘佳1, 贺瑞2,†(), 李晓娜3, 高妍2   
  1. 1. 030001　太原，山西医科大学第一临床医学院2019级研究生
    2. 030002　太原，山西省眼科医院准分子激光科
    3. 030024　太原，太原理工大学生物医学工程学院
  • 收稿日期:2021-04-28 出版日期:2021-12-28
  • 通信作者: 贺瑞
  • 基金资助:
    国家自然科学基金项目(12072218); 山西省卫计委科技攻关项目(2017099)

Research progress of early keratoconus screening before refractive surgery

Jia Liu1, Rui He2,†(), Xiaona Li3, Yan Gao2   

  1. 1. Master′s degree 2019, the First Clinical Medical College of Shanxi Medical University, Taiyuan 030001, China
    2. Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, China
    3. College of Biomedical Engineering Taiyuan University of Technology, Taiyuan 030024, China
  • Received:2021-04-28 Published:2021-12-28
  • Corresponding author: Rui He
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刘佳, 贺瑞, 李晓娜, 高妍. 角膜屈光手术术前筛查早期圆锥角膜的研究进展[J]. 中华眼科医学杂志(电子版), 2021, 11(06): 375-379.

Jia Liu, Rui He, Xiaona Li, Yan Gao. Research progress of early keratoconus screening before refractive surgery[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(06): 375-379.

目前，角膜屈光手术是许多近视眼患者的选择，但术后继发性圆锥角膜会严重损害患者的视力。有研究结果表明，术前筛查圆锥角膜是预防继发性圆锥角膜发生的重要手段之一。本文中笔者对角膜屈光手术术前筛查圆锥角膜的检查设备和检查方法进行汇总，并重点阐述角膜地形图和角膜生物力学检查各项参数的研究进展，以期为临床应用的选择提供参考。

关键词: 早期圆锥角膜筛查, Pentacam三维眼前节分析仪, 角膜地形图, 角膜生物力学

Refractive surgery is the choice of many myopia patients. However, secondary keratoconus, a postoperative complication, has the great harm to the visual acuity of patients. The one of the important means to prevent it is to screen preoperatively. Therefore, the examination of keratoconus before corneal refractive surgery was summarized, and the parameters of corneal topographic map and corneal biomechanical examination was compared, which to provide a reference for clinical choice.

Key words: Early keratoconus screening, Pentacam anterior segment analysis system, Corneal topographic map, Corneal biomechanics
图2 患者左眼Pentacam的圆锥角膜检查结果　图2A示角膜前表面曲率图，基本呈对称领结型；图2B示前表面高度图，基本对称，前表面最高点+5 mm，属正常范围；图2C示角膜厚度图，呈同心圆分布，角膜最薄点厚度为619 mm，属于正常范围；图2D示角膜后表面高度图，基本对称，后表面最高点为+16 mm，属可疑圆锥范围；Ambrosio Enhanced Ectasia Display-D为1.07，属正常范围，提示角膜形态学尚可；Corvis ST联合Pentacam检查获得的断层生物力学指数为0.48，提示患者左眼可疑有圆锥角膜，建议定期复查
表1 临床期圆锥角膜和亚临床期圆锥角膜的分类标准
类别 临床表现及辅助检查结果
临床期圆锥角膜 有近视眼和(或)散光病史；视力下降，矫正视力<1.0；裂隙灯显微镜检查角膜基质变薄、锥状向前膨隆、Fleischer环、Vogt线、上皮或上皮下瘢痕。以上体征至少1项阳性；角膜地形图检查示角膜前表面中央屈光度>47.00 D；角膜中心下方3 mm处与上方3 mm处屈光度差值>3.00 D；双眼角膜中央前表面屈光度差值>1.00 D
亚临床期圆锥角膜 不满足临床期圆锥角膜的诊断标准；角膜中央的屈光度>46.50 D；下方与上方3 mm角膜屈光度差值>1.26 D；同一患者双眼角膜屈光度差值>0.92 D；一眼确诊为临床期圆锥角膜，而按照目前诊断标准仍属正常范围的对侧眼
表2 Corvis ST检测可重复性和准确性良好参数的文献汇总
序号 重复性较好 准确性较好 参考文献
1 CCT、角膜变形幅度、A1T及IOP 角膜变形幅度 [36]
2 CCT和IOP CCT和IOP [41]
3 IOP、CCT、最大压陷时的角膜变形幅度及A1T   [42]
4 IOP、角膜厚度、最大压陷时的角膜变形幅度及A1T 最大压陷时的角膜曲率半径 [48]
5 CCT CCT [49]
6 IOP IOP [50]
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