亚临床期圆锥角膜与单纯高度散光的Pentacam角膜地形图比较

doi:DOI:10.3760/cma.j.issn.1674-845X.2017.07.009

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摘要

目的：评价Pentacam三维眼前节分析系统在亚临床期圆锥角膜与单纯高度散光鉴别诊断中的作用。方法：病例对照研究。选取亚临床期圆锥角膜患者（符合Rabinowitz诊断标准）46 例（50 眼，亚临床期圆锥角膜组）及单纯高度散光患者（散光度＞2.5 D）52例（76眼，单纯高度散光组）。使用Pentacam三维眼前节分析系统测量各组角膜最薄点的前后表面高度、角膜最薄厚度、曲率对称性指数（IVA）、高度偏中心指数（IHD）、平均角膜厚度进展指数及Belin角膜扩张分析D值，采用独立样本t 检验分析各指标的组间差异并进行受检者工作特征（ROC）曲线分析，筛选出有用参数，通过ROC曲线分析确定出最佳诊断界点。结果：亚临床期圆锥角膜组与单纯高度散光组间角膜最薄点前表面高度（t =6.77，P < 0.001）、角膜最薄点后表面高度（t =9.00，P < 0.001）、角膜最薄厚度（t =3.12，P =0.002）、IVA（t =8.35，P < 0.001）、IHD（t =8.94，P < 0.001）、平均角膜厚度进展指数（t =5.59，P < 0.001）、Belin角膜扩张分析D值（t =13.01，P < 0.001）之间差异均有统计学意义。Pentacam对亚临床期圆锥角膜和单纯高度散光鉴别诊断价值较高的指标（ROC曲线下面积≥0.9）为角膜最薄点后表面高度和Belin角膜扩张分析D值。结论：应用Pentacam三维眼前节分析系统对高度散光患者的角膜参数进行分析，有助于亚临床期圆锥角膜的筛查。

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	胡启迪
	许玲俐
	朱冬青
	张哲
	毛伟
	周雨声
	李钦波

关键词 ：角膜地形图, 圆锥角膜, 亚临床期, 散光, Pentacam

Abstract：

Objective: To evaluate the differential diagnosis between subclinical keratoconus and simple high myopic astigmatism by using a Pentacam anterior segment analyzer. Methods: Fifty eyes of 46 patients with subclinical keratoconus (Rabinowitz diagnosis standard) and 76 eyes of 52 patients with simple high myopic astigmatism (>2.5 diopter) were included in this retrospective case control study. A Pentacam was used to measure the anterior and posterior corneal elevation parameters, minimum pachymetry (MinPachy),the index of vertical asymmetry (IVA), the index of highest decentration (IHD), the average corneal thickness progression index, and the Belin D value of the Belin/Ambrosio Enhanced Ectasia Display. An independent samples t-test was used to analyze the differences between the two groups. Receiver operating characteristic (ROC) curves were used to screen the useful parameters and determine the best diagnosis point. Results: There were significant differences between the two groups for the anterior corneal elevation parameters (t=6.77, P<0.001), posterior corneal elevation parameters (t=9.00, P<0.001), MinPachy (t=3.12,P=0.002), IVA (t=8.35, P<0.001), IHD (t=8.94, P<0.001), the average corneal thickness progression indexes (t=5.59, P<0.001), and the D values of the Belin/Ambrosio Enhanced Ectasia Display (t=13.01, P<0.001). The posterior corneal elevation parameter and the D value of the Belin/Ambrosio Enhanced Ectasia Display had the highest relevance in the differential diagnosis between subclinical keratoconus and simple high myopic astigmatism (area under the ROC curve ≥ 0.9). Conclusion: Analyzing the corneal indexes of high myopic astigmatism contributes to the screening of subclinical keratoconus.

Key words： corneal topography keratoconus subclinical astigmatism Pentacam

收稿日期: 2017-02-15

基金资助:

宁波市自然科学基金（2010A610033）

通讯作者: 胡启迪，Email：huqidi2007@163.com

引用本文:

胡启迪,许玲俐,朱冬青,张哲,毛伟,周雨声,李钦波. 亚临床期圆锥角膜与单纯高度散光的Pentacam角膜地形图比较[J]. 中华眼视光学与视觉科学杂志, 2017, 19(7): 433-437. Qidi Hu,Lingli Xu,Dongqing Zhu,Zhe Zhang,Wei Mao,Yusheng Zhou,Qinbo Li. A Comparison of Corneal Topography between Subclinical Keratoconusand Simple High Myopic Astigmatism Using a Pentacam Analyzer. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(7): 433-437. DOI: DOI:10.3760/cma.j.issn.1674-845X.2017.07.009

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