[1]陈佳惠,张帆,景清荷,等.不同年龄段马凡综合征晶状体不全脱位患者角膜特征及意义[J].眼科新进展,2017,37(11):1036-1039.[doi:10.13389/j.cnki.rao.2017.0262]
　CHEN Jia-Hui,ZHANG Fan,JING Qing-He,et al.Corneal characteristics in Marfan syndrome patients of different ages with lens subluxation and their significance[J].Recent Advances in Ophthalmology,2017,37(11):1036-1039.[doi:10.13389/j.cnki.rao.2017.0262]
点击复制

不同年龄段马凡综合征晶状体不全脱位患者角膜特征及意义/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
37卷
期数:
2017年11期
页码:
1036-1039
栏目:
应用研究
出版日期:
2017-11-05

文章信息/Info

Title:
Corneal characteristics in Marfan syndrome patients of different ages with lens subluxation and their significance
作者:
陈佳惠; 张帆; 景清荷; 蒋永祥; 卢奕
200031　上海市，复旦大学附属眼耳鼻喉科医院眼科（陈佳惠，景清荷，蒋永祥，卢奕）；844000　新疆维吾尔族自治区喀什地区第二人民医院眼科（张帆）
Author(s):
CHEN Jia-Hui; ZHANG Fan; JING Qing-He; JIANG Yong-Xiang; LU Yi
Department of Ophthalmology，Eye Ear Nose and Throat Hospital of Fudan University（CHEN Jia-Hui，JING Qing-He，JIANG Yong-Xiang，LU Yi），Shanghai 200031，China；Department of Ophthalmology，the Second People’s Hospital of Kashi（ZHANG Fan），Kashi 844000，Xinjiang Uygur Autonomous Region，China
关键词:
马凡综合征; 角膜曲率; 角膜散光; 晶状体不全脱位
Keywords:
Marfan syndrome; corneal curvature; corneal astigmatism; lens subluxation
分类号:
R771.3
DOI:
10.13389/j.cnki.rao.2017.0262
文献标志码:
A
摘要:
目的　比较不同年龄段马凡综合征晶状体不全脱位患者的角膜特征并探讨其临床意义。方法　马凡综合征组45例84眼和对照组84例84眼列入研究，前者按年龄分为两组：儿童组（5~14岁）49眼和非儿童组（>14岁）35眼。使用Pentacam测量角膜曲率、角膜散光和中央角膜厚度。结果　与对照组相比，马凡综合征组患者角膜变平、散光增大，两组间差异均具有统计学意义（均为P=0.000）。马凡综合征患者角膜前表面曲率儿童组为（40.02±1.42）D，非儿童组为（41.03±1.57）D；角膜后表面曲率儿童组为（-5.71±0.23）D，非儿童组为（-5.89±0.31）D；总角膜散光儿童组为（-1.71±0.84）D，非儿童组为（-1.34±0.78）D，两组相比差异均具有统计学意义（均为P<0.05）。角膜前表面散光儿童组高于非儿童组（P=0.017），而后表面散光两组间差异无统计学意义（P=0.377）。儿童组总角膜散光和角膜前表面散光以顺规散光（69.39%）为主，而非儿童组顺规散光和斜向散光的比例相当。两组角膜后表面都以逆规散光为主（儿童组占85.71%，非儿童组占77.14%）。以角膜前表面散光估计总角膜散光时约有一半的患者会高估约0.32 D。结论　马凡综合征晶状体不全脱位患者角膜变平、散光增大。儿童组角膜更扁平，总角膜散光和角膜前表面散光值较高，以顺规散光为主。马凡综合征患者的角膜后表面散光值较稳定，以逆规散光为主。忽视角膜后表面散光，以角膜前表面散光值估计总角膜散光时易高估。
Abstract:
Objective　To compare the corneal characteristics in Marfan syndrome (MFS) patients of different ages with lens subluxation and explore their clinical significance.Methods　Together 84 eyes of 45 MFS patients (MFS group) and 84 eyes of 84 control subjects (control group) were recruited in this study，and the patients in the MFS group were subdivided into two groups by age：5-14 year-old group with 49 eyes and >14 year-old group with 35 eyes.The biometric characteristics，including corneal curvature (i.e.Km)，central corneal thickness，and corneal astigmatism，were measured by Pentacam.Results　Compared with the control group，MFS patients had decreased Km and increased corneal astigmatism，approaching significant difference (both P=0.000).There were significant differences in anterior corneal curvature ［(40.02±1.42)D vs.(41.03±1.57)D］，posterior corneal curvature ［(-5.71±0.23)D vs.(-5.89±0.31)D］，and total corneal astigmatism ［(-1.71±0.84)D vs.(-1.34±0.78)D］ between 5-14 year-old group and >14 year-old group (all P<0.05).The anterior corneal astigmatism was significantly higher in 5-14 year-old group than that in >14 year-old group(P=0.017)，whereas the posterior corneal astigmatism had no significant difference between the two groups(P=0.377).In 5-14 year-old group，the astigmatic type of total cornea and anterior corneal surface was dominated by with-the-rule astigmatism (69.39%)，whereas the proportion of with-the-rule and oblique astigmatism was approximately equal >14 year-old group.The astigmatic type of posterior corneal surface in 5-14 year-old group (accounting for 85.71%) and >14 year-old group (accounting for 77.14%) was dominated by against-the-rule astigmatism.The total corneal astigmatism was overestimated by a mean of 0.32 D when only taking the magnitude of anterior corneal astigmatism into consideration.Conclusion　A flattened cornea and increased corneal astigmatism are the corneal characteristics for MFS patients with lens subluxation especially for the children patients.The magnitude of posterior corneal astigmatism remains unchanged and is primarily against-the-rule astigmatism.And the total corneal astigmatism can be easily overestimated if posterior corneal astigmatism is not taken into consideration.

参考文献/References:

［1］　何守志.晶状体病学［M］.北京：人民卫生出版社，2014：65.
HE SZ.Diseases of the lens［M］.Beijing：People’s medical publishing house，2014：65.
［2］　MAUMENEE IH.The eye in the Marfan syndrome［J］.Trans Am Ophthalmol Soc，1981，79：684-733.
［3］　NAHUM Y，SPIERER A.Ocular features of Marfan syndrome：diagnosis and management［J］.Isr Med Assoc J，2008，10（3）：179-181.
［4］　KONRADSEN TR，KOIVULA A，KUGELBERG M，ZETTERSTR MC.Corneal curvature，pachymetry，and endothelial cell density in Marfan syndrome［J］.Acta Ophthalmol，2012，90（4）：375-379.
［5］　KONRADSEN TR，ZETTERSTRMC.A descriptive study of ocular characteristics in Marfan syndrome［J］.Acta Ophthalmol，2013，91（8）：751-755.
［6］　DROLSUM L，RAND-HENDRIKSEN S，PAUS B，GEIRAN OR，SEMB SO.Ocular findings in 87 adults with Ghent-1 verified Marfan syndrome［J］.Acta Ophthalmol，2015，93（1）：46-53.
［7］　BEENE LC，TRABOULSI EI，SEVEN I，FORD MR，SINHA ROY A，BUTLER RS，et al.Corneal deformation response and ocular geometry：A noninvasive diagnostic strategy in Marfan syndrome［J］.Am J Ophthalmol，2016，161（1）：56-64.
［8］　KINORI M，WEHRLI S，KASSEM IS，AZAR NF，MAUMENEE IH，METS MB.Biometry characteristics in adults and children with marfan syndrome：From the marfan eye consortium of chicago［J］.Am J Ophthalmol，2017，177（2）：144-149.
［9］　KOCH DD，JENKINS RB，WEIKERT MP，YEU E，WANG L.Correcting astigmatism with toric intraocular lenses：Effect of posterior corneal astigmatism［J］.J Cataract Refract Surg，2013，39（12）：1803-1809.
［10］　UENO Y，HIRAOKA T，BEHEREGARAY S，MIYAZAKI M，ITO M，OSHIKA T.Age-related changes in anterior，posterior，and total corneal astigmatism［J］.J Refract Surg，2014，30（3）：192-197.
［11］　REITBLAT O，LEVY A，KLEINMANN G，ABULAFIA A，ASSIA EI.Effect of posterior corneal astigmatism on power calculation and alignment of toric intraocular lenses：Comparison of methodologies［J］.J Cataract Refract Surg，2016，42（2）：217-225.
［12］　LOEYS BL，DIETZ HC，BRAVERMAN AC，CALLEWAERT BL，DE BACKER J，DEVEREUX RB，et al.The revised Ghent nosology for the Marfan syndrome［J］.J Med Genet，2010，47（7）：476-485.
［13］　HEUR M，COSTIN B，CROWE S，GRIMM RA，MORAN R，SVENSSON LG，et al.The value of keratometry and central corneal thickness measurements in the clinical diagnosis of Marfan syndrome［J］.Am J Ophthalmol，2008，145（6）：997-1001.
［14］　STHENEUR C，TUBACH F，JOUNEAUX M，ROY C，BENOIST G，CHEVALLIER B，et al.Study of phenotype evolution during childhood in Marfan syndrome to improve clinical recognition［J］.Genet Med，2014，16（3）：246-250.
［15］　INAGAKI Y.The rapid change of corneal curvature in the neonatal period and infancy［J］.Arch Ophthalmol，1986，104（7）：1026-1027.
［16］　SULTAN G，BAUDOUIN C，AUZERIE O，DE SAINT JEAN M，GOLDSCHILD M，PISELLA PJ，et al.Cornea in Marfan disease：Orbscan and in vivo confocal microscopy analysis［J］.Invest Ophthalmol Vis Sci，2002，43（6）：1757-1764.
［17］　张武林，孟克青，张越，徐晓伟.两种囊袋张力环巩膜固定方法在中重度晶状体不全脱位治疗中的应用研究［J］.眼科新进展，2017，37（7）：647-650.
ZHANG WL，MENG KQ，ZHANG Y，XU XY.Application of two capsular tension ring sclera fixing methods in treatment of moderate and severe lens subluxation［J］.Rec Adv Ophthalmol，2017，37（7）：647-650.
［18］　AGRESTA B，KNORZ MC，DONATTI C，JACKSON D.Visual acuity improvements after implantation of toric intraocular lenses in cataract patients with astigmatism：a systematic review［J］.BMC Ophthalmol，2012，12：41.
［19］　GIMBEL HV，CAMORIANO GD，AMAN-ULLAH M.Bilateral implantation of scleral-fixated cionni endocapsular rings and toric intraocular lenses in a pediatric patient with Marfan’s syndrome［J］.Case Rep Ophthalmol，2012，3（1）：16-23.
［20］　MIYAKE T，SHIMIZU K，KAMIYA K.Distribution of posterior corneal astigmatism according to axis orientation of anterior corneal astigmatism［J］.PLoS One，2015，10（1）：e117194.
［21］　KOCH DD，ALI SF，WEIKERT MP，SHIRAYAMA M，JENKINS R，WANG L.Contribution of posterior corneal astigmatism to total corneal astigmatism［J］.J Cataract Refract Surg，2012，38（12）：2080-2087.
［22］　HO JD，LIOU SW，TSAI RJ，TSAI CY.Effects of aging on anterior and posterior corneal astigmatism［J］.Cornea，2010，29（6）：632-637.
［23］　GOGGIN M，ZAMORA-ALEJO K，ESTERMAN A，VAN ZYL L.Adjustment of anterior corneal astigmatism values to incorporate the likely effect of posterior corneal curvature for toric intraocular lens calculation［J］.J Refract Surg，2015，31（2）：98-102.

相似文献/References:

[1]胡俊 李学喜 林巧雅 叶瑞珍 许敏.不同仪器测量角膜直径和角膜曲率的一致性评价[J].眼科新进展,2012,32(4):000.
[2]孔祥斌 晏世刚 罗书科 苏鹏.中老年人眼球生物学结构参数的年龄相关性改变[J].眼科新进展,2012,32(7):000.
[3]朱梦钧 瞿小妹 冯浩雁.角膜塑形术前后角膜地形图与角膜曲率计一致性研究[J].眼科新进展,2012,32(3):000.
[4]栾国刚 严涛 谌金金 熊莎 章艳.先天性白内障形觉剥夺时间对眼主要屈光参数的影响[J].眼科新进展,2012,32(3):000.
[5]布娟 张莹 刘敬 庞红蕾 林淑芳 王乐今.马凡综合征一家系的临床研究及致病基因的连锁分析[J].眼科新进展,2012,32(4):000.
[6]杨璐,刘永琰,张莉花,等.青年近视眼角膜前表面高阶像差的研究[J].眼科新进展,2014,34(6):538.[doi:10.13389/j.cnki.rao.2014.0147]
[7]徐欢欢,赵长霖,薛春燕,等. 年龄相关性白内障患者角膜Q值的分布及影响因素[J].眼科新进展,2014,34(7):681.[doi:10.13389/j.cnki.rao.2014.0187]
[8]唐秀侠,买志彬,聂晓丽,等.电脑验光仪、IOLMaster、LenstarLS900测量角膜曲率的对比分析[J].眼科新进展,2014,34(11):1081.[doi:10.13389/j.cnki.rao.2014.0300]
　TANG Xiu-Xia,MAI Zhi-Bin,NIE Xiao-Li,et al.Comparison of corneal curvature measured by auto-refractometer ,IOL master , and Lenstar LS900[J].Recent Advances in Ophthalmology,2014,34(11):1081.[doi:10.13389/j.cnki.rao.2014.0300]
[9]周路坦,石迎辉. 软性与透气性硬性角膜接触镜配戴者角膜地形图及前房深度对比分析[J].眼科新进展,2015,35(9):851.[doi:10.13389/j.cnki.rao.2015.0232]
　ZHOU Lu-Tan,SHI Ying-Hui. Comparison of corneal topography and anterior chamber depth between patients wearing RGPCL and SCL[J].Recent Advances in Ophthalmology,2015,35(11):851.[doi:10.13389/j.cnki.rao.2015.0232]
[10]刘洋,赵少贞,杨瑞波,等.角膜缘松解切开术矫正白内障术前散光对角膜曲率的影响[J].眼科新进展,2016,36(4):340.[doi:10.13389/j.cnki.rao.2016.0092]
　LIU Yang,ZHAO Shao-Zhen,YANG Rui-Bo,et al.Changes of corneal curvature following phacoemulsification combined with limbal relaxing incisions on correction of astigmatism[J].Recent Advances in Ophthalmology,2016,36(11):340.[doi:10.13389/j.cnki.rao.2016.0092]

备注/Memo

备注/Memo:
国家自然科学基金联合基金资助（编号：U1503124）；新疆维吾尔自治区自然科学基金资助（编号：2015211C225）
更新日期/Last Update: 2017-11-01