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研究生:陳韻怡
研究生(外文):Yun-i Chen
論文名稱:雷射原位角膜成型術後近視回退之預測模型
論文名稱(外文):Predictive Model for Myopic Regression after Laser in Situ Keratomileusis (LASIK)
指導教授:簡國龍簡國龍引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:預防醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:英文
論文頁數:82
中文關鍵詞:近視回退雷射原位角膜成型術
外文關鍵詞:myopic regressionlaser in situ keratomileusis (LASIK)
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目的: 在學童近視盛行率日益升高的台灣,成年後接受雷射原位角膜成型術 ( LASIK ) 來矯正近視之患者亦有日益增多之趨勢。然而醫師們於術後追蹤期間發現某些患者有部分近視度數回退的情形,回退度數深者甚至可能大幅影響患者裸眼視物的清晰程度而需要再次手術。因此本研究為評估何種術前因子可能影響方法: 本研究回溯蒐集311位接受LASIK手術之近視患者(共615 隻眼睛)的資料,包括患者之年齡及性別,術前屈光狀態,角膜厚度及弧度,眼壓值,基礎淚水分泌量( Schirmer test),雷射削切深度及光學區大小等相關因子,並紀錄術後患者之屈光狀態變化情形以判別其有無近視回退的發生。本研究提出三種預測模型: 邏輯迴歸模型、Cox氏比例危害回歸迴歸模型、以及interval censored 三種模型來預估近視患者在LASIK術結果: 根據邏輯迴歸模型,可能影響LASIK 術後之度數回退且具統計學上顯著意義之預測因子包括: 術前屈光度數,術前角膜弧度,光學區之大小及術後度數欠矯。年紀則具邊緣性顯著意義。Cox氏比例危害迴歸模型及interval censored 模型亦顯示上述的預測因子 (除了年紀),會影響LASIK 術後較早發生度數回退。我們利用接受操作特徵曲線分析( ROC curve analysis )作模型的準確度預測,三種模式之準確度皆相當接近。
結論: 此研究以回溯性世代 (retrospective cohort) 及交互驗證(cross-validated) 的研究設計來評估可能導致LASIK術後之近視度數回退之預測因子。利用三種預測模型: 邏輯迴歸模式、Cox氏比例危害迴歸模型、以及interval censored 模式來預估近視患者在LASIK 術後追蹤期間發生近視度數回退的可能性。
Objectives: To evaluate the effects of preoperative characteristics on refractive outcomes (myopic regression) after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism and to develop a predictive model to predict myopic regression after LASIK.
Setting: Universal Eye Center, an ophthalmology clinic franchise, Taipei, Taiwan
Methods: The medical records of 615 eyes of 311 patients undergoing LASIK from June 2003 to Dec 2003 were retrospectively reviewed. The surgeries were performed by one experienced surgeon using the Nidek''s Excimer Laser EC-5000. Preoperative variables such as refraction errors, corneal thickness, keratometry reading, intraocular pressure (IOP), basic tear secretion (Schirmer test), ablation depth of transition zone and optic zone, diameter of optic zone and transition zone were collected from chart reviews. Age, sex were also recorded. Postoperative examinations of refraction errors were done 1 day, 1 week, 1, 3, 6, 12 months or even more if it is feasible. Three types of predictive models including logistic regression mode, Cox proportional hazards regression model, and interval-censored model were adopted to develop predictive model for estimating the probability of myopic regression after LASIK given specific time of follow-up.
Results: According to the logistic analysis, greater manifest refraction errors, lower preoperative keratometry reading, smaller size of optic zone, greater undercorrection and older age (borderline significance) lead to higher probability of myopic regression after LASIK. After taking into account time to myopic regression, the results of Cox proportional hazards regression model revealed that the variables identified in the logistic regression model except age, led to higher probability of earlier myopic regression. Similar findings were noted while using interval-censored model. According to ROC curve analysis, the predictive validity of the three models were rather identical.
Conclusions: A retrospective cohort with a cross-validated design was employed to identify significant preoperative variables associated with myopic regression covering all eyes with mild and severe regression after LASIK. Three predictive models, logistic regression, Cox proportional hazards regression model, and interval-censored model, were successfully developed on the basis of these associations to predict the probability of myopic regression by follow-up time.
Contents I
摘要 1
Abstract 3
Chapter 1 Background 6
Chapter 2 Literature Review 10
2.1 Definition of myopic regression after LASIK 10
2.2 The biologic mechanism of myopic regression after LASIK 11
2.3 Incidence of myopic regression after LASIK 13
2.4 Time period of myopic regression after LASIK 14
2.5 Factors associated with the refractive outcome (regression) after LASIK 15
2.5.1 Preoperative refraction error with changes in corneal thickness and corneal steepening 16
2.5.2 Undercorrection 17
2.5.3 Optic zone size (diameter) 18
2.5.4 Chronic dry eye 19
2.5.5 Flap thickness 19
2.5.6 Preoperative keratometry 20
2.5.7 Humidity 21
2.6 Limitation of previous studies 23
Chapter 3 Material and methods 24
3.1 Study population 24
3.2 Study design 26
3.3 Laser in situ keratomileusis (LASIK) procedure 27
3.4 Variables and outcome measurement 28
3.5 Statistical analysis 29
Chapter 4 Results 32
4.1 Descriptive findings 32
4.1.1 Baseline characteristics 32
4.1.2 Refraction change after LASIK 33
4.2 Selection of preoperative variables 34
4.3 Univariate analysis 35
4.4 Predictive model 36
4.4.1 Logistic regression model 36
4.4.2 Cox proportional hazards regression model 38
4.4.3 Interval-censored model 39
4.4.4 Model validation 40
Chapter 5 Discussion 41
5.1 Major findings 41
5.2 Strength 43
5.3 Limitation 44
5.4 Implication 45
Reference 47

Contents of Tables


Table 2.1 (a) Summary of selected literatures on myopic regression or retreatment after LASIK 51
Table 2.1 (b) Summary of selected literatures on myopic regression or retreatment after LASIK 53
Table 2.2 Review of Incidence of myopic regression 55
Table 2.3 Comparison of current study to previous studies with respect to preoperative variables associated with regression or retreatment 56
Table 4.1 Basic characteristics of study subjects 57
Table 4.2 Basic characteristics of preoperative variables 58
Table 4.3 Basic characteristics of preoperative variables stratified by age 59
Table 4.4 Mean spherical equivalent before and after LASIK 60
Table 4.5 Correlation coefficients of preoperative variables 61
Table 4.6 High correlation among variables in each group 63
Table 4.7 Tolerance and variance inflation factor of the selected variables 64
Table 4.8 (a)Univariate analysis of logistic regression model for all relevant covariates 65
Table 4.8 (b) Univariate analysis of logistic regression model for selected variables 66

Table 4.10 Estimated results of logistic regression model 68
Table 4.11 (a) Univariate analysis using Cox regression model 69
Table 4.11(b) AIC criteria for Cox regression model selection 70
Table 4.11 (c) Estimated results of Cox regression model 71
Table 4.12 Selected parameters adjusted by period using interval-censored model 72
Table 4.13 Deviances on fitting interval-censored model 72
Table 4.13 Deviances on fitting interval-censored model 73
Table 4.14 Estimated results of interval censored model 74

Contents of Figures

Fig 3.1 Recruitment of study population 75
Fig 3.2 Cross-validation design for developing predictive model 76
Fig 4.1 Mean spherical equivalent with follow-up time 77
Fig 4.2 Mean refraction over time, stratified by myopia degree 78
Fig 4.3 Mean refraction over time, stratified by pre-operative myopia degree 79
Fig 4.4 ROC curve for the validation of logistic model 80
Fig 4.5 ROC curve for the Cox model 81
Fig 4.6 ROC curve for the validation of interval-censored model 82
Reference
1.Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore 2004;33:27-33.
2.Knorz MC, Liermann A, Seiberth V, Steiner H, Wiesinger B. Laser in situ keratomileusis to correct myopia of -6.00 to -29.00 diopters. J Refract Surg 1996;12:575-84.
3.Sekundo W, Bonicke K, Mattausch P, Wiegand W. Six-year follow-up of laser in situ keratomileusis for moderate and extreme myopia using a first-generation excimer laser and microkeratome. J Cataract Refract Surg 2003;29:1152-8.
4.Condon PI, Mulhern M, Fulcher T, Foley-Nolan A, O''Keefe M. Laser intrastromal keratomileusis for high myopia and myopic astigmatism. Br J Ophthalmol 1997;81:199-206.
5.Maldonado-Bas A, Onnis R. Results of laser in situ keratomileusis in different degrees of myopia. Ophthalmology 1998;105:606-11.
6.Williams DK. Excimer laser photorefractive keratectomy for extreme myopia. J Cataract Refract Surg 1996;22:910-4.
7.Hu DJ, Feder RS, Basti S, et al. Predictive formula for calculating the probability of LASIK enhancement. J Cataract Refract Surg 2004;30:363-8.
8.Gimbel HV, Penno EE, van Westenbrugge JA, Ferensowicz M, Furlong MT. Incidence and management of intraoperative and early postoperative complications in 1000 consecutive laser in situ keratomileusis cases. Ophthalmology 1998;105:1839-47; discussion 1847-8.
9.Patel NP, Clinch TE, Weis JR, Ahn C, Lundergan MK, Heidenreich K. Comparison of visual results in initial and re-treatment laser in situ keratomileusis procedures for myopia and astigmatism. Am J Ophthalmol 2000;130:1-11.
10.Febbraro JL, Buzard KA, Friedlander MH. Reoperations after myopic laser in situ keratomileusis. J Cataract Refract Surg 2000;26:41-8.
11.Lyle WA, Jin GJ. Retreatment after initial laser in situ keratomileusis. J Cataract Refract Surg 2000;26:650-9.
12.Chayet AS, Assil KK, Montes M, Espinosa-Lagana M, Castellanos A, Tsioulias G. Regression and its mechanisms after laser in situ keratomileusis in moderate and high myopia. Ophthalmology 1998;105:1194-9.
13.Pan Q, Gu YS, Wang J, et al. Differences between regressive eyes and non-regressive eyes after LASIK for myopia in the time course of corneal changes assessed with the Orbscan. Ophthalmologica 2004;218:96-101.
14.Rao SK, Cheng AC, Fan DS, Leung AT, Lam DS. Effect of preoperative keratometry on refractive outcomes after laser in situ keratomileusis. J Cataract Refract Surg 2001;27:297-302.
15.Albietz JM, Lenton LM, McLennan SG. Chronic dry eye and regression after laser in situ keratomileusis for myopia. J Cataract Refract Surg 2004;30:675-84.
16.Perez-Santonja JJ, Bellot J, Claramonte P, Ismail MM, Alio JL. Laser in situ keratomileusis to correct high myopia. J Cataract Refract Surg 1997;23:372-85.
17.Pallikaris IG, Siganos DS. Excimer laser in situ keratomileusis and photorefractive keratectomy for correction of high myopia. J Refract Corneal Surg 1994;10:498-510.
18.Goggin M, Foley-Nolan A, Algawi K, O''Keefe M. Regression after photorefractive keratectomy for myopia. J Cataract Refract Surg 1996;22:194-6.
19.Kim JH, Kim MS, Hahn TW, Lee YC, Sah WJ, Park CK. Five years results of photorefractive keratectomy for myopia. J Cataract Refract Surg 1997;23:731-5.
20.Kamiya K, Oshika T. Corneal forward shift after excimer laser keratorefractive surgery. Semin Ophthalmol 2003;18:17-22.
21.Spadea L, Fasciani R, Necozione S, Balestrazzi E. Role of the corneal epithelium in refractive changes following laser in situ keratomileusis for high myopia. J Refract Surg 2000;16:133-9.
22.Moller-Pedersen T, Cavanagh HD, Petroll WM, Jester JV. Stromal wound healing explains refractive instability and haze development after photorefractive keratectomy: a 1-year confocal microscopic study. Ophthalmology 2000;107:1235-45.
23.Wilson SE, Mohan RR, Hong JW, Lee JS, Choi R, Mohan RR. The wound healing response after laser in situ keratomileusis and photorefractive keratectomy: elusive control of biological variability and effect on custom laser vision correction. Arch Ophthalmol 2001;119:889-96.
24.Lian J, Zhang Q, Ye W, Zhou D, Wang K. [An analysis of regression after laser in situ keratomileusis for treatment of myopia]. Zhonghua Yan Ke Za Zhi 2002;38:363-6.
25.Zaldivar R, Davidorf JM, Shultz MC, Oscherow S. Laser in situ keratomileusis for low myopia and astigmatism with a scanning spot excimer laser. J Refract Surg 1997;13:614-9.
26.Magallanes R, Shah S, Zadok D, et al. Stability after laser in situ keratomileusis in moderately and extremely myopic eyes. J Cataract Refract Surg 2001;27:1007-12.
27.Ditzen K, Handzel A, Pieger S. Laser in situ keratomileusis nomogram development. J Refract Surg 1999;15:S197-201.
28.Eleftheriadis H, Prandi B, Diaz-Rato A, Morcillo M, Sabater JB. The effect of flap thickness on the visual and refractive outcome of myopic laser in situ keratomileusis. Eye 2004.
29.Hersh PS, Schein OD, Steinert R. Characteristics influencing outcomes of excimer laser photorefractive keratectomy. Summit Photorefractive Keratectomy Phase III Study Group. Ophthalmology 1996;103:1962-9.
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