[1]《角膜屈光手术术前视功能和影像检查规范操作指南（0）》专家组中国医药教育协会眼科影像与智能医疗分会.角膜屈光手术术前视功能和影像学检查规范操作指南（2023）[J].眼科新进展,2023,43(7):505-513.[doi:10.13389/j.cnki.rao.2023.0103]
　Expert Workgroup of Guidelines for Standardized Operation for Visual Function and Imaging Examinations Before Corneal Refractive Surgery0,Ophthalmic Imaging and Intelligent Medicine Branch of China Medical Education Association.Guidelines for standardized operation for visual function and imaging examinations before corneal refractive surgery (2023)[J].Recent Advances in Ophthalmology,2023,43(7):505-513.[doi:10.13389/j.cnki.rao.2023.0103]
点击复制

角膜屈光手术术前视功能和影像学检查规范操作指南（2023）/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
43卷
期数:
2023年7期
页码:
505-513
栏目:
述评
出版日期:
2023-07-05

文章信息/Info

Title:
Guidelines for standardized operation for visual function and imaging examinations before corneal refractive surgery (2023)
作者:
《角膜屈光手术术前视功能和影像检查规范操作指南（2023）》专家组中国医药教育协会眼科影像与智能医疗分会
Author(s):
Expert Workgroup of Guidelines for Standardized Operation for Visual Function and Imaging Examinations Before Corneal Refractive Surgery（2023）;Ophthalmic Imaging and Intelligent Medicine Branch of China Medical Education Association
关键词:
角膜屈光手术; 角膜地形图; 波前像差; 客观视觉质量; 角膜生物力学
Keywords:
corneal refractive surgery;  corneal topography;  wavefront aberration;  objective visual quality;  corneal biomechanics
分类号:
R778
DOI:
10.13389/j.cnki.rao.2023.0103
文献标志码:
A
摘要:
角膜屈光手术术前检查操作的规范、检查结果的精确及可重复，对于全面衡量和评估患者的病情、合理地选择手术适应证、保证手术的安全性、有效性和远期稳定性有着十分重要的意义。近年来，各种屈光手术术前检查仪器及软件的临床应用和持续更新，为我们的角膜屈光手术术前检查提供了更多有效的检查方法。角膜屈光手术术前视功能和影像学检查包括眼球生物学参数测量、角膜地形图检查、角膜内皮镜检查、双眼视功能检查、波前像差检测、对比敏感度及眩光检查、客观视觉质量分析、非接触式眼表综合分析、角膜生物力学检查、超广角眼底成像、眼前节及眼底OCT检查等。本指南总结了角膜屈光手术术前视功能和影像学检查中各项检查的操作流程及注意事项，以期为角膜屈光手术术前视功能和影像学检查规范化提供参考依据，提升术前检查的精准性和可重复性。
Abstract:
The standardized examinations before corneal refractive surgery and the accuracy and repeatability of examination results are very important for evaluating the patient’s conditions comprehensively,selecting the surgical indications reasonably,and ensuring the safety,effectiveness and long-term stability of the surgery.In recent years,the continuous update and clinical application of instruments and software for preoperative examinations have facilitated examinations before corneal refractive surgery.Visual function and imaging examinations before corneal refractive surgery include ocular biological parameter measurement,corneal topography,corneal endothelioscopy,binocular visual function evaluation,wavefront aberration detection,contrast sensitivity and glare testing,objective visual quality analysis,non-contact ocular surface analysis,corneal biomechanics testing,ultra-wide-field fundus imaging,optical coherence tomography for the anterior segment and fundus,etc.These guidelines summarize the procedures and precautions for the visual function and imaging examinations before corneal refractive surgery,in order to provide references for the standardization of these examinations and improve the accuracy and repeatability of the examination results.

参考文献/References:

［1］　中华医学会眼科学分会角膜病学组.激光角膜屈光手术临床诊疗专家共识(2015年)［J］.中华眼科杂志,2015,51(4):249-254.
Corneopathy Group of Ophthalmology Branch of Chinese Medical Association.Expert consensus on clinical diagnosis and treatment of laser corneal refractive surgery (2015)［J］.Chin J Ophthalmol,2015,51(4):249-254.
［2］　中华医学会眼科学分会眼视光学组.我国飞秒激光小切口角膜基质透镜取出手术规范专家共识(2018年)［J］.中华眼科杂志,2018,54(10):729-736.
Optometry Group of Ophthalmology Branch of Chinese Medical Association.Expert consensus on the specification of femtosecond laser small incision corneal stromal lens removal in China (2018)［J］.Chin J Ophthalmol,2018,54(10):729-736.
［3］　中华医学会眼科学分会眼视光学组.中国经上皮准分子激光角膜切削术专家共识(2019年)［J］.中华眼科杂志,2019,55(3):169-173.
Optometry Group of Ophthalmology Branch of Chinese Medical Association.Expert consensus of transepithelial excimer laser keratectomy in China (2019)［J］.Chin J Ophthalmol,2019,55(3):169-173.
［4］　中国医师协会眼科医师分会屈光手术学组.中国伴年龄相关性调节不足屈光不正患者激光角膜屈光手术专家共识(2021年)［J］.中华眼科杂志,2021,57(9):651-657.
Refractive Surgery Group of the Ophthalmologist Branch of Chinese Medical Doctor Association.Chinese expert consensus on laser corneal refractive surgery for correction of refractive errors with age-related accommodation deficiency (2021)［J］.Chin J Ophthalmol,2021,57(9):651-657.
［5］　PARK S H,CHOI S K,LEE D,JUN E J,KIM J H.Corneal thickness measurement using orbscan,pentacam,Galilei,and ultrasound in normal and post-femtosecond laser in situ keratomileusis eyes［J］.Cornea,2012,31(9):978-982.
［6］　RANDLEMAN J B,LYNN M J,PEREZ-STRAZIOTA C E,WEISSMAN H M,KIM S W.Comparison of central and peripheral corneal thickness measurements with scanning-slit,Scheimpflug and fourier-domain ocular coherence tomography［J］.Br J Ophthalmol,2015,99(9):1176-1181.
［7］　华焱军,黄锦海,王勤美.角膜厚度的临床意义及测量方法进展［J］.国际眼科杂志,2011,11(8):1376-1378.
HUA Y J,HUANG J H,WANG Q M.Clinical meaning of corneal thickness and progress of corneal pachymetry［J］.Int Eye Sci,2011,11(8):1376-1378.
［8］　YILDIRIM Y,OLCUCU O,AGCA A,KARAKUCUK Y,ALAGOZ N,MUTAF C,et al.Topographic and biomechanical evaluation of corneas in patients with ocular rosacea［J］.Cornea,2015,34(3):313-317.
［9］　USTUNDAG C,BAHCECIOGLU H,OZDAMAR A,ARAS C,YILDIRIM R,OZKAN S.Optical coherence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis1［J］.J Cataract Refract Surg,2000,26(10):1458-1462.
［10］　BRAR S,GANESH S,GAUTAM M,DEVI R C.Comparison of clinical outcomes and visual quality using a medium versus small contact glass in patients undergoing SMILE with large corneal diameters［J］.J Refract Surg,2021,37(3):150-157.
［11］　曹开伟,刘李娜,孙煜林,张韬,白继,刘莛.不同角膜直径对Pentacam角膜地形图中BAD系统关于角膜扩张分析结果的影响［J］.中华眼科杂志,2020,56(10):761-767.
CAO K W,LIU L N,SUN Y L,ZHANG T,BAI J,LIU T.The influence of different corneal diameters on Belin/Ambrósio enhanced ectasia display of Pentacam corneal topography［J］.Chin J Ophthalmol,2020,56(10):761-767.
［12］　ALARCN A,RUBIO M,PREZ-OCN F,JIMNEZ J R.Theoretical analysis of the effect of pupil size,initial myopic level,and optical zone on quality of vision after corneal refractive surgery［J］.J Refract Surg,2012,28(12):901-906.
［13］　LIU Q,YANG X,LIN L,LIU M,LIN H,LIU F,et al.Review on centration,astigmatic axis alignment,pupil size and optical zone in SMILE［J］.Asia Pac J Ophthalmol,2019,8(5):385-390.
［14］　HAN T,ZHAO F,CHEN X,MIAO H,CHEN Z,ZHOU X.Evaluation of disk halo size after small incision lenticule extraction (SMILE)［J］.Graefes Arch Clin Exp Ophthalmol,2019,257(12):2789-2793.
［15］　JIMNEZ J R,ALARCN A,ANERA R G,BARCO L J D.Qoptimized algorithms:theoretical analysis of factors influencing visual quality after myopic corneal refractive surgery［J］.J Refract Surg,2016,32(9):612-617.
［16］　HALKIADAKIS I,CHATZIRALLI I,DRAKOS E,KATZAKIS M,SKOURIOTIS S,PATSEA E,et al.Causes and management of small pupil in patients with cataract［J］.Oman J Ophthalmol,2017,10(3):220-224.
［17］　LIU M,SUN Y,WANG D,ZHANG T,ZHOU Y,ZHENG H,et al.Decentration of optical zone center and its impact on visual outcomes following SMILE［J］.Cornea,2015,34(4):392-397.
［18］　SHAO T,WANG Y,NG A L K,CHAN T C Y,HAO W,ZHANG J,et al.The effect of intraoperative angle kappa adjustment on higher-order aberrations before and after small incision lenticule extraction［J］.Cornea,2020,39(5):609-614.
［19］　程丹,徐菁菁,保金华,潘建东,吕帆.人眼Kappa角的影响因素权重分析［J］.中华实验眼科杂志,2014,32(5):425-429.
CHENG D,XU J J,BAO J H,PAN J D,L F.Weight analysis of influencing factors of human angle Kappa［J］.Chin J Exp Ophthalmol,2014,32(5):425-429.
［20］　LAU J K,WAN K,CHEUNG S W,VINCENT S J,CHO P.Weekly changes in axial length and choroidal thickness in children during and following orthokeratology treatment with different compression factors［J］.Trans Vis Sci Tech,2019,8(4):9.
［21］　OHNO-MATSUI K,JONAS J B.Posterior staphyloma in pathologic myopia［J］.Prog Retin Eye Res,2019,70:99-109.
［22］　SHAJARI M,CREMONESE C,PETERMANN K,SINGH P,MLLER M,KOHNEN T.Comparison of axial length,corneal curvature,and anterior chamber depth measurements of 2 recently introduced devices to a known biometer［J］.Am J Ophthalmol,2017,178:58-64.
［23］　GHARIEB H M,OTHMAN I S,ELKITKAT R S.Orbscan 3 versus pentacam HR:evaluating the possible interchangeable use of various parameters［J］.Cornea,2020,39(5):649-653.
［24］　KAUR K,GURNANI B.Specular Microscopy［M］.Treasure Island:StatPearls Publishing,2022.
［25］　吕帆.斜弱视和双眼视处理技术［M］.2版.北京:高等教育出版社,2014.
L F.Oblique amblyopia and binocular vision processing technology［M］.2nd ed.Beijing:Higher Education Press,2014.
［26］　高雅萍.眼屈光检查［M］.北京:人民卫生出版社,2012.
GAO Y P.Ophthalmic refractive examination［M］.Beijing:People’s Medical Publishing House,2012.
［27］　KANG M J,HWANG J,CHUNG S H.Comparison of corneal wavefront-optimized and wavefront-guided alcohol-assisted photorefractive keratectomy using schwind amaris 750S laser for myopia［J］.Korean J Ophthalmol,2020,34(3):210-218.
［28］　PELLI D G,BEX P.Measuring contrast sensitivity［J］.Vis Res,2013,90:10-14.
［29］　YAP M,GREY C,COLLINGE A,HURST M.The arden gratings in optometric practice［J］.Ophthalmic Physiol Opt,1985,5(2):179-183.
［30］　LONG Y,LI X,ZHOU T,YE B,GUO D,SHEN Y.Short-term evaluation of visual quality,amplitude of accommodation,and stereoacuity between patients with moderate-to-high myopia who underwent ICLV4c implantation and SMILE［J］.J Refract Surg,2022,38(10):632-640.
［31］　亚洲干眼协会中国分会,海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组,中国医师协会眼科医师分会眼表与干眼学组.中国干眼专家共识：检查和诊断(2020年)［J］.中华眼科杂志,2020,56(10):741-747.
China Branch of the Asian Dry Eye Association,Eye Surface and Tear Disease Group of Ophthalmology Professional Committee of the Cross Strait Medical and Health Exchange Association,Eye Surface and Dry Eye Group of the Ophthalmologists Branch of the Chinese Medical Doctor Association.Expert consensus on dry eye in China:examination and diagnosis (2020)［J］.Chin J Ophthalmol,2020,56(10):741-747.
［32］　PANJIYAR M,SADHU S,SHOBHA P S,SARANYA S,AGARWAL S,SRINIVASAN B,et al.Structural and functional evaluation of meibomian glands and its correlation with dry eye parameters in Stevens-Johnson syndrome［J］.Am J Ophthalmol,2022,240:187-193.
［33］　蒲琪,马倩,李新宇.角膜硬度的测量方法及与眼部疾病相关性研究进展［J］.眼科新进展,2021,41(4):381-385.
PU Q,MA Q,LI X Y.Progress of corneal stiffness measurements and its relationship with ocular diseases［J］.Rec Adv Ophthalmol,2021,41(4):381-385.
［34］　WANG B,YANG L,CHENG J,WANG J,MEI Y.In-vivo high-speed biomechanical imaging of the cornea using Corvis ST and digital image correlation［J］.Comput Biol Med,2023,153:106540.
［35］　LISA R,ROBERT H,GEORG L,JASPER CAROLIN S,PILLUNAT LUTZ E,PILLUNAT KARIN R.Evaluation of corneal biomechanical properties using the ocular response analyzer and the dynamic Scheimpflug-Analyzer Corvis ST in high pressure and normal pressure open-angle glaucoma patients［J］.PLoS One,2023,18(1):e0281017.
［36］　NAGIEL A,LALANE R A,SADDA S R,SCHWARTZ S D.Ultra-widefield fundus imaging［J］.Retina,2016,36(4):660-678.
［37］　DESMOND T,TRAN V,MAHARAJ M,CARNT N,WHITE A.Correction to:diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure:a systematic review and meta-analysis［J］.Albrecht Von Graefes Arch Fur Klin Und Exp Ophthalmol,2022,260(1):385.
［38］　《眼表疾病常用非接触式影像学检查设备规范操作指南（2023）》专家组，中国医药教育协会眼科影像与智能医疗分会，世界中医药学会联合会眼科专委会．眼表疾病常用非接触式影像学检查设备规范操作指南（2023）［Ｊ］．眼科新进展，2023，43（6）：421-428．
Expert Work Group of Standard operating guidelines for non-contact imaging equipment commonly used in ocular surface diseases（2023）,Ophthalmic Imaging and Intelligent Medicine Branch of China Medical Education Association，Ophthalmology Branch of World Federation of Chinese Medicine Societies.Standard operating guidelines for non-contact imaging equipment commonly used in ocular surface diseases（2023）［J］.Rec Adv Ophthalmol,2023，43（6）:421-428．
［39］　GEEVARGHESE A,WOLLSTEIN G,ISHIKAWA H,SCHUMAN J.Optical coherence tomography and glaucoma［J］.Annu Rev Vis Sci,2021,7:693-726.

相似文献/References:

[1]吴东芳 张小兰 邱乐梅 王顺清 孙成淑 邓应平.圆锥角膜的诊断与治疗[J].眼科新进展,2012,32(12):000.
[2]刘太祥 李海祥 石容 王铮.ORK程序中两种切削模式治疗近视术后角膜像差变化及对视觉功能的影响[J].眼科新进展,2013,33(1):000.
[3]董雯佳 裴重刚 邵毅 周琼 易敬林 刘新华 李汉林.个性化显微斜视矫正术矫正儿童斜视的临床研究[J].眼科新进展,2012,32(2):000.
[4]赵向阳 李卫平 陈瑞合 杨德胜.弃瓣与留瓣LASEK治疗近视的临床疗效对比[J].眼科新进展,2012,32(9):000.
[5]赵武校 蓝方方 刘洪婷 李志超 甘露. 屈光参差性近视的Orbscan Ⅱz角膜地形图特性研究[J].眼科新进展,2014,34(1):051.
[6]肖建和 李世洋 蒋华. 军人角膜屈光手术[J].眼科新进展,2014,34(3):294.
[7]郭琳,马波. IOLMaster、角膜地形图及Pentacam测量年龄相关性白内障患者角膜散光的比较[J].眼科新进展,2014,34(9):868.[doi:10.13389/j.cnki.rao.2014.0240]
[8]李凯,王育良,张传伟,等.不同大小切口飞秒激光基质透镜切除术矫正近视术后角膜地形图对比研究[J].眼科新进展,2014,34(12):1137.[doi:10.13389/j.cnki.rao.2014.0315]
　LI Kai,WANG Yu-Liang,ZHANG Chuan-Wei,et al.Effects of different incision sizes on Corne topography changes after femtosecond lenticule extraction surgery for myopia[J].Recent Advances in Ophthalmology,2014,34(7):1137.[doi:10.13389/j.cnki.rao.2014.0315]
[9]李仲佶,李雪. 飞秒激光在角膜屈光手术应用中的并发症[J].眼科新进展,2015,35(2):197.[doi:10.13389/j.cnki.rao.2015.0054]
　LI Zhong-Ji,LI Xue. Complications of femtosecond laser in corneal refractive surgery[J].Recent Advances in Ophthalmology,2015,35(7):197.[doi:10.13389/j.cnki.rao.2015.0054]
[10]李勇,李晶,魏升升,等.正常角膜伴近视散光眼角膜各形态参数分布特征及与全眼屈光参数的关系[J].眼科新进展,2016,36(1):050.[doi:10.13389/j.cnki.rao.2016.0014]
　LI Yong,LI Jing,WEI Sheng-Sheng,et al.Investigation of corneal shape parameters distribution in normd cornea with myopic astigmatism and correlation with ocular refractive parameters[J].Recent Advances in Ophthalmology,2016,36(7):050.[doi:10.13389/j.cnki.rao.2016.0014]

备注/Memo

备注/Memo:
国家自然科学基金（编号：82160195; 81800804）；江西省双千计划科技创新高端领军人才项目（编号：jxsq2023201036）；江西省重大（重点）研发专项计划（编号：20223BBH80014，20181BBG70004，20203BBG73059）；江西省杰出青年基金（编号：20192BCBL23020）
注：本指南的国际实践指南注册号为 IPGRP-2023CN368（http://www.guidelines-redistry.cn/）。
更新日期/Last Update: 2023-07-05