臺灣博碩士論文加值系統

前言：近年來由於雷射屈光手術之崛起，使得研究角膜厚度之重要性日趨增加。甚至在其他相關方面的研究也有增加之趨勢，例如：角膜厚度與青光眼之間的關係。然而上述文獻僅僅只局限於西方人種的研究，在我國甚至東方國家鮮少有此方面的基本資料。因此藉由研究屈光度正常之飛行員族群，來建立我國正常角膜厚度的區間值，以及作為日後屈光手術（超級視力 super vision）之參考。實驗目的：探討屈光度正常之角膜厚度分佈情形以及角膜厚度與左右眼、球面屈光度、年齡、眼內壓及飛行時數等因子之相關性。實驗方法：本研究利用Orbscan Ⅱ角膜地形圖儀測量209位現役飛行員兩眼(418隻眼睛)之角膜厚度，並擷取出98點角膜厚度資料(角膜最薄處、角膜中心點以及距中心點每0.5mm開始每30度取一點直至4mm處 )來加以分析。實驗結果:（1）正常視力之飛行員中心點角膜厚度平均為554 ± 36.7μm (範圍介於470～643μm)（2）眼球內之角膜厚度分佈並非均勻分佈，而是呈現外下側之角膜厚度較鼻上側方位之角膜厚度來得薄之趨勢，且有統計上之差異( p < 0.05 )。（3）近視組、正常組與遠視組三組間以及左右眼間之角膜厚度皆無統計上之差異。（4）中央角膜厚度與年齡（r2=0.065）及飛行時數（r2=0.113）之間無相關性。（5）眼內壓6～10以及11～15mmHg此兩組之中央角膜厚度皆與眼內壓16～20及21～25mmHg兩組有顯著上之差異 ( p < 0.05 )；而且中央角膜厚度與眼內壓之間呈現低度正相關 ( r2= 0.339)。結論：由本實驗得知，我國飛行員之角膜厚度參數與西方人種比較起來略有不同，但大體上並無太大差異；雖然在單一眼球內之正常角膜厚度分佈並非均勻呈現，但整合來看左右眼之角膜厚度分佈情形仍有以鼻縱軸呈現鏡像對稱之情形，就如同我們身體各部位是以脊椎為軸呈現鏡像對稱。另在本實驗得知眼內壓為影響角膜厚度參數因子之一，而年齡、球面屈光度、左右眼以及飛行時數並非影響角膜厚度之參數因子。

Introduction: Refractive surgery has become widespread recently, thus corneal thickness measurement has become more important. However, studies about normal human corneas are rare, and mostly restricted to the western. At the present study we investigated the corneal thickness distribution in military pilots who are greatly dependent upon their eyes for flight performance. Some database of normal corneal thickness in military pilots was anticipated to be developed as well. Therefore, more information can be available for performing photorefractive keratectomy (PRK) on pilots to make possibly their super vision in the future. Purpose: The purpose of this study is to investigate the “normal” corneal thickness distribution in military pilots and the relationships between corneal thickness and age, refraction errors, different eyes, intraocular pressure (IOP) and flying time. Methods: Four hundred and eighteen healthy corneas of 209 pilots were analyzed with the Orbscan Topography SystemⅡ. All data of 98 points were obtained at the center, the thinnest and in the 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0-mm zone from the center at a location every 30 degrees. Results: (1) The mean corneal thickness at the center in the emmetropia pilots was 554.0 ± 36.7μm, and the range was between 470 to 643μm. (2) The corneal thickness near the superior or nasal side was significantly thicker than the corneal thickness near the inferior or temporal side. (3) The corneal thickness of center, thinnest, and 1.0, 2.0, 3.0, 4.0 mm from the center in 12 directions were no statistically significant differences among the three groups (normal, myopia and hyperopia group) and between the right and left eyes. (4) There was no significant correlation between CCT and age (r2=0.065, P=0.352), flying time (r2=0.113, P=0.123). (5) There was a significantly positive correlation between IOP and CCT (r2=0.339, P=0.0001). Conclusion: The normal distribution of corneal thickness was uneven in one eye; the corneal thickness in superonasal side was thicker than that in the temporal inferior side, but it was still symmetric distributed between the right eye and left eye along the naso-horizontal axis. Meanwhile, corneal thickness was found to be positively and significantly correlated with intraocular pressure, but not with age, refractive error and flying time.

目 錄
目錄..........................................................................................................Ⅰ
表次..........................................................................................................Ⅳ
圖次..........................................................................................................Ⅴ
中文摘要..................................................................................................Ⅶ
英文摘要..................................................................................................Ⅸ
第一章 緒論
第一節 角膜之解剖學、生理學及光學折射簡介....................................1
第二節 角膜厚度測量法之演進歷史......................................................5
第三節 角膜厚度測量法..........................................................................7
第四節 角膜厚度測量法於臨床上之應用............................................14
第五節 實驗動機....................................................................................16
第六節 實驗目的....................................................................................17

第二章 材料與方法
第一節 研究對象....................................................................................18
第二節 資料參數與研究工具................................................................19
第三節 資料分組....................................................................................24
第四節 統計分析....................................................................................25

第三章 研究結果
第一節 受試飛行員之一般生理參數及眼科參數值............................26
第二節 球面屈光度對角膜厚度之影響................................................27
第三節 不同眼對角膜厚度之影響........................................................37
第四節 年齡對中央角膜厚度之影響....................................................41
第五節 眼內壓對中央角膜厚度之影響................................................43
第六節 飛行時數對中央角膜厚度之影響............................................46
第七節 實驗結果摘要............................................................................48

第四章 討論
第一節 不同角膜厚度測量法之比較....................................................49
第二節 正常角膜厚度之分佈情形........................................................52
第三節 不同眼對角膜厚度之影響........................................................57
第四節 球面屈光度對角膜厚度之影響................................................60
第五節 年齡對中央角膜厚度之影響....................................................61
第六節 眼內壓對中央角膜厚度之影響................................................62
第七節 種族對中央角膜厚度之影響....................................................63
第八節 飛行員之角膜厚度與一般正常人之比較................................67
第九節 角膜厚度特殊分佈情形與視覺功能關係之探討....................68
第五章 結論與建議.....................................71
第六章 參考文獻.........................................73

表 次
表一 各角膜厚度測量法之比較............................................................13
表二 受試飛行員之一般生理參數及眼科參數值................................29
表三 3組不同屈光度數分組中的角膜厚度比較..................................36
表四 左、右眼的角膜厚度比較..............................................................40
表五 各不同國家文獻研究中以Orbscan測量出的中央角膜角膜厚度之比較............................................................................................65
表六 不同亞洲國家文獻研究中以不同設備測量出的中央角膜厚度之比較................................................................................................66

圖 次
圖1a 右眼屈光正常組中，距離中央角膜1.0及2.0毫米處的角膜厚度分佈情形..................................................................................30
圖1b 右眼屈光正常組中，距離中央角膜3.0及4.0毫米處的角膜厚度分佈情形.................................................................................31
圖2a 左眼屈光正常組中，距離中央角膜1.0及2.0毫米處的角膜厚度分佈情形.................................................................................32
圖2b 左眼屈光正常組中，距離中央角膜3.0及4.0毫米處的角膜厚度分佈情形.................................................................................33
圖3角膜厚度在不同方向（鼻側、顳側、上側和下側方向）從0.5毫米增至4.0毫米之斜率比較............................................................34
圖4 距離中央角膜3.0處之角膜厚度在三組不同屈光度數下之比較....................................................................................................35
圖5a 左右眼間12個方位的角膜厚度比較（距離中央角膜1.0及2.0毫米處）.......................................................................................38
圖5b 左右眼間12個方位的角膜厚度比較（距離中央角膜3.0及4.0毫米處）....................................................................................39
圖6 年齡與中央角膜厚度之關係圖......................................................42
圖7 各眼內壓分組之角膜厚度比較......................................................44
圖8 眼內壓（IOP）與中央角膜厚度之關係..........................................45
圖9 飛行時數與中央角膜厚度之關係..................................................47
圖10 非同中心之角膜前、後表面造成的分佈情形…......…............…56
圖11 左右眼以鼻縱軸成鏡像對稱圖....................................................59
圖12a 右眼屈光正常組中，距離中央角膜1.0及2.0毫米處的角膜屈光度分佈情形..............................................................................69
圖12b 右眼屈光正常組中，距離中央角膜3.0及4.0毫米處的角膜屈光度分佈情形.............................................................................70

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