应用Corvis ST新参数分析圆锥角膜生物力学特性

doi:10.3760/cma.j.cn115909-20210304-00087

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摘要目的：应用可视化角膜生物力学分析仪（Corvis ST）新参数分析临床期圆锥角膜、亚临床期圆锥角膜及正常角膜的生物力学特性，评价其在圆锥角膜诊断中的价值。方法：病例对照研究。选取2019年 1月至2021年1月在襄阳爱尔眼科医院就诊的圆锥角膜患者68例（68眼），其中亚临床期圆锥角膜（SKC） 28例（28眼）为SKC组，临床期圆锥角膜（CKC）40例（40眼）为CKC组；选取同一时间段在本院屈光手术中心接受角膜屈光手术的近视患者60例（60眼）作为对照组。使用Corvis ST进行检测，分析变形幅度比（DAR）、综合半径（IR）、水平方向Ambrosio相关厚度（ARTh）、硬度参数（SP-A1）、Corvis 生物力学指数（CBI）等参数。采用方差分析、Kruskal-Wallis H检验、Mann-Whitney U检验对数据进行统计分析，绘制受试者工作特征曲线（AUC）。结果：SKC组的IR、CBI高于对照组，差异有统计学意义（U=2.461，P=0.042；U=2.450，P=0.043），2组的DAR、ARTh、SP-A1差异无统计学意义； CKC组的DAR、IR、CBI均高于对照组，差异有统计学意义（U=7.645，P<0.001；U=8.477，P<0.001； U=8.965，P<0.001），但ARTh、SP-A1低于对照组（U=-8.593，P<0.001；U=-7.517，P<0.001）。在 SKC组，IR、CBI具有较好诊断效率，其AUC分别为0.669（敏感度为50.0%、特异度为77.5%）、0.656 （敏感度为67.9%、特异度为60.0%）。在CKC组，DAR、IR、CBI具有良好诊断效率，其AUC分别为 0.956（敏感度为90.0%、特异度为93.3%）、0.968（敏感度为92.5%、特异度为91.7%）、1.000（敏感度为100.0%、特异度为100.0%）。结论：SKC生物力学特性较健康角膜部分参数有改变，其中IR、CBI 对SKC具有较好的诊断效率；CKC生物力学特性较健康角膜明显改变，其中DAR、IR、CBI对KC均具有良好的诊断效率。

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关键词 ： Corvis ST, 圆锥角膜, 角膜生物力学, 新参数

Abstract：Objective: To analyze the corneal biomechanical properties in clinical keratoconic eyes, subclinical keratoconic eyes and normal eyes using the new biomechanical parameters of corneal visualization Scheimpflug technology (Corvis ST), and to evaluate diagnostic values for keratoconus. Methods: In this case-control study, 28 subclinical keratoconic patients (SKC group) (28 eyes), 40 keratoconic patients (CKC group) (40 eyes), and 60 myopic patients (control group) (60 eyes) were enrolled from January 2019 to January 2021 in Xiangyang Aier Eye Hospital. Five corneal biomechanical parameters of all eyes, including deformation amplitude ratio (DAR), integrated radius (IR), Ambrosio relational thickness to the horizontal profile (ARTh), applanation 1 stiffness parameter (SP-A1) and Corvis biomechanical index (CBI) were obtained with Corvis ST. All parameters were compared among the SKC group, CKC group and the control group. ANOVA, Kruskal-Wallis H rank sum test, and Mann-Whitney U rank sum test were used. The receiver operating characteristic (ROC) curves were plotted to distinguish keratoconus and subclinical keratoconus from normal eyes. Results: IR and CBI in the SKC group were higher than those in the control group, with significant differences between the two groups (U=2.461, P=0.042; U=2.450, P=0.043), but the differences in DAR, ARTh, and SP-A1 between the two groups were not statistically significant. In the SKC group, IR and CBI had better diagnostic value, with an AUC of 0.669 (sensitivity of 50.0%, specificity of 77.5%) and 0.656 (sensitivity of 67.9%, specificity of 60.0%), respectively. DAR, IR, and CBI in the CKC group were higher than those in the control group, with significant differences (U=7.645, P<0.001; U=8.477, P<0.001; U=8.965, P<0.001), but ARTh and SP-A1 were lower than those in the control group, with significant differences between the two groups (U=-8.593, P<0.001; U=-7.517, P<0.001). In the CKC group, DAR, IR, and CBI have good diagnostic value, with an AUC of 0.956 (sensitivity of 90.0%, specificity of 93.3%), and 0.968 (sensitivity of 92.5%, specificity of 91.7%), 1.000 (sensitivity of 100.0%, specificity of 100.0%), respectively. Conclusions: The corneal biomechanical properties of subclinical keratoconus are changed compared with normal eyes, among them, IR and CBI have better diagnostic value for subclinical keratoconus. Clinical keratoconus has a great change in biomechanics compared with normal eyes, and DAR, IR and CBI have great diagnostic value for keratoconus.

Key words： Corvis ST keratoconus corneal biomechanics novel biomechanical parameters

收稿日期: 2021-03-04

基金资助:国家自然科学基金青年基金项目（11702063）

通讯作者: 王曙亮（ORCID：0000-0002-0202-1935），Email：eyexfan@163.com

引用本文:

肖明1 张晓宇2 王曙亮1. 应用Corvis ST新参数分析圆锥角膜生物力学特性[J]. 中华眼视光学与视觉科学杂志, 2021, 23(9): 641-646. Ming Xiao1,Xiaoyu Zhang2,Shuliang Wang1. Assessment of Corneal Biomechanical Properties in Keratoconus Using the New Parameters of Corvis ST. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(9): 641-646. DOI: 10.3760/cma.j.cn115909-20210304-00087

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210304-00087 或 https://www.cjoovs.com/CN/Y2021/V23/I9/641

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