目的:研究托吡卡胺滴眼液所致的睫状肌麻痹前后成人高度近视患者眼球生物学参数的变化。方法:选取25例(47眼)成人高度近视患者,0.5%托吡卡胺滴眼麻痹睫状肌,睫状肌麻痹前后用IOL-Master700测量角膜曲率(flat keratometry, FK; steep keratometry, SK)、中央角膜厚度(central corneal thickness, CCT)、前房深度(anterior chamber depth, ACD)、晶状体厚度(lens thickness, LT)和眼轴(axial length, AL),分析睫状肌麻痹前后各参数的变化。结果:角膜曲率(FK, SK):用药前后差异无统计学意义(均P > 0.05);中央角膜厚度(CCT):用药后增加约3 um,差异有统计学意义(P < 0.05);前房深度(ACD):用药后增加约0.06 mm,差异有统计学意义(P < 0.05);晶状体厚度(LT):用药后减少约0.02 mm,差异有统计学意义(P < 0.05);眼轴(AL):用药后减少约0.007 mm,差异有统计学意义(P < 0.05)。结论:睫状肌麻痹剂托吡卡胺,对成人高度近视患者,不影响K值、但可致CCT增厚、ACD增加、LT变薄,AL减少。 Objective: To investigate the changes of ocular biometry before and after cycloplegia induced by tropicamide in high myopia patients. Methods: Twenty-five high myopia patients (47 eyes) were selected, cycloplegia was induced by 0.5% tropicamide. Keratometry (flat keratometry, FK; steep keratometry, SK), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL) were measured with IOL-Master700. The changes of parameters before and after cycloplegia were analyzed. Results: The K (FK/SK) was no significant difference (both P > 0.05). After cycloplegia, CCT increased about 3 um, ACD increased about 0.06 mm, the differences were statistically significant (both P < 0.05); LT decreased about 0.02 mm, AL decreased about 0.007 mm, the differences were statistically significant (both p < 0.05). Conclusion: In high myopia patients, tropicamide had no effect on K, but may cause a significant increase in CCT and ACD, and a significant decrease in LT and AL.
目的:研究托吡卡胺滴眼液所致的睫状肌麻痹前后成人高度近视患者眼球生物学参数的变化。方法:选取25例(47眼)成人高度近视患者,0.5%托吡卡胺滴眼麻痹睫状肌,睫状肌麻痹前后用IOL-Master700测量角膜曲率(flat keratometry, FK; steep keratometry, SK)、中央角膜厚度(central corneal thickness, CCT)、前房深度(anterior chamber depth, ACD)、晶状体厚度(lens thickness, LT)和眼轴(axial length, AL),分析睫状肌麻痹前后各参数的变化。结果:角膜曲率(FK, SK):用药前后差异无统计学意义(均P > 0.05);中央角膜厚度(CCT):用药后增加约3 um,差异有统计学意义(P < 0.05);前房深度(ACD):用药后增加约0.06 mm,差异有统计学意义(P < 0.05);晶状体厚度(LT):用药后减少约0.02 mm,差异有统计学意义(P < 0.05);眼轴(AL):用药后减少约0.007 mm,差异有统计学意义(P < 0.05)。结论:睫状肌麻痹剂托吡卡胺,对成人高度近视患者,不影响K值、但可致CCT增厚、ACD增加、LT变薄,AL减少。
托吡卡胺,睫状肌麻痹,高度近视,眼球生物学测量,人工晶体生物测量仪
Xuemei Hao, Tiantian Zhang, Xiaomei Guo, Pinghui Hu
Li Xiang Eye Hospital of Soochow University, Suzhou Jiangsu
Received: Nov. 8th, 2021; accepted: Dec. 2nd, 2021; published: Dec. 17th, 2021
Objective: To investigate the changes of ocular biometry before and after cycloplegia induced by tropicamide in high myopia patients. Methods: Twenty-five high myopia patients (47 eyes) were selected, cycloplegia was induced by 0.5% tropicamide. Keratometry (flat keratometry, FK; steep keratometry, SK), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL) were measured with IOL-Master700. The changes of parameters before and after cycloplegia were analyzed. Results: The K (FK/SK) was no significant difference (both P > 0.05). After cycloplegia, CCT increased about 3 um, ACD increased about 0.06 mm, the differences were statistically significant (both P < 0.05); LT decreased about 0.02 mm, AL decreased about 0.007 mm, the differences were statistically significant (both p < 0.05). Conclusion: In high myopia patients, tropicamide had no effect on K, but may cause a significant increase in CCT and ACD, and a significant decrease in LT and AL.
Keywords:Tropicamide, Cycloplegia, High Myopia, Ocular Biometry, IOL Master
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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在临床,运用睫状肌麻痹剂托吡卡胺进行眼部检查,尤其是屈光检查,是常规检查方法之一。但用药后,眼部形态和眼解剖特点会发生改变,甚至眼部某些生物参数亦会发生改变 [
苏州大学附属理想眼科医院2019年9月~2019年12月在屈光科就诊的高度近视患者25人47眼。其中男性13眼,女性34眼;年龄最小18岁,最大45岁,平均年龄27.96 ± 7.33岁;屈光度:最低−6.50D,最高−17.75D,平均屈光度:−9.49 ± 2.52D。本研究通过我院伦理委员会批准,遵守赫尔辛基宣言,并取得受试者的知情同意。
纳入标准:1) 球镜度数 > −6.00D;2) 18岁 ≤ 年龄 < 50岁;3) 眼前节检查正常,屈光间质透明不影响检查者;4) 精神正常,配合接受检查。
排除标准:1) 年龄 < 18岁或年龄 ³ 50岁;2) 有角膜疾病(角膜白斑、圆锥角膜等)、活动性眼部疾病、矫正视力不良者或出现青光眼、眼底出血、视网膜脱离、脉络膜新生血管等并发症者;3) 有精神疾病史,或不配合检查者;4) 有全身疾病史,如高血压、糖尿病、血液病等。
角膜曲率(平K、陡K)、中央角膜厚度(CCT)、前房深度(ACD)、晶状体厚度(LT)和眼轴(AL)。所有测量均由同一位经验丰富的医师完成。0.5%托吡卡胺点眼,分别在用药前、用药后30分钟(5 min点眼1次,共3次)瞳孔对光反射消失后测量。嘱受试者下颌置于检查设备的下颌托上,上额紧贴额托,睁开双眼,注视固视灯,并嘱患者完全瞬目以确保泪膜光滑。每次测量以IOL-Master700指示灯显示绿色,获得合格参数,测量3次,取平均值。
SPSS23.0统计软件进行统计学分析,数据以 X ¯ ± s 表示,经Kolmogorov-Smirnov进行数据的正态分布检验。用药前后参数比较采用配对t检验,P < 0.05为差异具有统计学意义。
用药前后眼球生物参数的变化:角膜曲率(平K、陡K):用药前后差异均无统计学意义(均P > 0.05)。中央角膜厚度(CCT):用药后增加,约增厚3 um,差异有统计学意义(t = −3.430, P = 0.001)。前房深度(ACD):用药后增加,约增加0.06 mm,差异有统计学意义(t = −9.68, P = 0.000)。晶状体厚度(LT):用药后减少,约0.02 mm,差异有统计学意义(t = 5.767, P = 0.000)。眼轴(AL):用药后减少约0.007 mm,差异有统计学意义(t = 2.441, p = 0.019),具体见表1。
参数 | 散瞳前 | 散瞳后 | t值 | p值 |
---|---|---|---|---|
FK (D) | 43.24 ± 1.08 | 43.18 ± 1.11 | 1.154 | 0.255 |
SK (D) | 44.44 ± 1.15 | 44.43 ± +1.22 | 0.128 | 0.899 |
CCT (um) | 531.0 ± 33.52 | 534.76 ± 33.37 | −3.430 | 0.001 |
ACD (mm) | 3.73 ± 0.23 | 3.79 ± 0.23 | −9.68 | 0.000 |
LT (mm) | 3.67 ± 0.25 | 3.65 ± 0.24 | 5.767 | 0.000 |
AL (mm) | 27.47 ± 1.14 | 27.47 ± 1.14 | 2.441 | 0.019 |
表1. 睫状肌麻痹前后眼球生物参数的变化( X ¯ ± s , n = 47)
角膜曲率(K值)、中央角膜厚度(CCT)、前房深度(ACD)、晶状体厚度(LT)和眼轴(AL),这些眼部参数,是白内障手术、青光眼手术、屈光手术等的重要参考指标,在手术方案的选择、手术安全性及术后屈光度数稳定性的评估 [
对于高度近视患者,在睫状肌麻痹剂托吡卡胺应用前后眼球生物参数的改变,本研究结果显示:
角膜曲率:用药前后,角膜曲率(平K、陡K)差异无统计学意义,与既往研究报道一致 [
中央角膜厚度(CCT):用药后CCT值增加约3 um,用药前后差异具有统计学意义(P = 0.001),与文献报道高度一致 [
前房深度(ACD)和晶状体厚度(LT):用药后ACD值约增加0.06 mm,差异有统计学意义(P = 0.000)。而用药后LT减少约0.02 mm,差异具有统计学意义(P = 0.000)与文献报道高度一致 [
眼轴(AL):本研究显示:用药后AL减少约0.007 mm,差异有统计学意义(p = 0.019)。这与既往文献研究不一致。Khambhiphant B [
综上所述,睫状肌麻痹剂托吡卡胺对成人高度近视患者的眼前节参数,用药前后:K值不影响;但用药后,CCT增厚、ACD增加、LT变薄,AL少量减少,因此,在对高度近视患者,尤其是拟手术患者,进行眼部生物参数评估和屈光术前检查时应将睫状肌麻痹剂的影响考虑在内,以提高手术的精确性。
郝雪梅,张甜甜,郭晓枚,胡平会. 托吡卡胺所致的睫状肌麻痹对高度近视患者眼球生物学测量的影响 Effect of Cycloplegia Induced by Tropicamide on Ocular Biometry in Patients with High Myopia[J]. 眼科学, 2021, 10(04): 174-177. https://doi.org/10.12677/HJO.2021.104022