Reinstein Dan Z, Archer Timothy J, Rowe Elizabeth L, Gobbe Marine, Vida Ryan S
J Refract Surg. 2021 Jan 1;37(1):49-58. doi: 10.3928/1081597X-20201109-01.
To report the distribution of pupil offset and angle kappa in 750 myopic, emmetropic, and hyperopic eyes presenting for refractive surgery.
A retrospective study included 750 consecutive eyes screened for corneal refractive surgery between January 2006 and February 2013. The eyes were divided into three equal groups based on manifest refraction spherical equivalent (SEQ): emmetropic group between -0.25 and +0.50 diopters (D) and cylinder up to 1.00 D, myopic group greater than -0.50 D, and hyperopic group greater than +0.50 D. Angle kappa was measured with the Orbscan II software (Bausch & Lomb, Inc) and pupil offset defined as the distance at the corneal plane between the corneal vertex and the pupil center. Correlations with SEQ, cylinder, scotopic pupil diameter, average keratometry, and age were performed.
All results are reported for myopic, emmetropic, and hyperopic groups, respectively. Mean SEQ was -4.84 ± 2.89 D (range: -0.88 to -14.00 D), +0.21 ± 0.23 D (range: -0.25 to +0.50 D), and +2.44 ± 1.58 D (range: +0.63 to +7.75 D). Mean pupil offset magnitude was 0.27 ± 0.14 mm (range: 0.00 to 0.68 mm), 0.34 ± 0.14 mm (range: 0.02 to 0.78 mm), and 0.39 ± 0.13 mm (range: 0.07 to 0.75 mm). Mean pupil offset X-component was -0.18 ± 0.18, -0.28 ± 0.16, and -0.34 ± 0.15 mm (temporally displaced from the corneal vertex). Mean pupil offset Y-component was 0.06 ± 0.15, 0.03 ± 0.16, and 0.01 ± 0.16 mm (superiorly displaced from the corneal vertex). Multivariate linear regression for pupil offset magnitude found statistically significant variables were SEQ, cylinder, scotopic pupil diameter, and average keratometry. For pupil offset X-component, significant variables were SEQ, cylinder, and scotopic pupil diameter. For pupil offset Y-component, significant variables were SEQ and scotopic pupil diameter. Mean angle kappa was 5.28 ± 1.49°, 6.14 ± 1.44°, and 5.77 ± 1.29°.
Contrary to common belief, a pupil offset is present in the vast majority of eyes regardless of refractive error, with the mean temporal offset of at least 0.18 mm. Confirming previous studies, the largest pupil offset was found in the hyperopic group. However, there was also a wide range of pupil offset in myopic and emmetropic eyes. Correlations with SEQ and keratometry support the theory that pupil offset is also correlated with axial length. [J Refract Surg. 2021;37(1):49-58.].
报告750例因屈光手术前来就诊的近视、正视和远视眼的瞳孔偏移及kappa角分布情况。
一项回顾性研究纳入了2006年1月至2013年2月期间连续筛查的750只眼，这些眼接受角膜屈光手术。根据明显屈光等效球镜度（SEQ）将这些眼分为三组，每组数量相等：正视组SEQ在-0.25至+0.50屈光度（D）之间且散光度数最高达1.00 D，近视组SEQ大于-0.50 D，远视组SEQ大于+0.50 D。使用Orbscan II软件（博士伦公司）测量kappa角，瞳孔偏移定义为角膜顶点与瞳孔中心在角膜平面的距离。分析了与SEQ、散光、暗适应瞳孔直径、平均角膜曲率及年龄的相关性。
分别报告了近视、正视和远视组的所有结果。平均SEQ分别为-4.84±2.89 D（范围：-0.88至-14.00 D）、+0.21±0.23 D（范围：-0.25至+0.50 D）和+2.44±1.58 D（范围：+0.63至+7.75 D）。平均瞳孔偏移量分别为0.27±0.14 mm（范围：0.00至0.68 mm）、0.34±0.14 mm（范围：0.02至0.78 mm）和0.39±0.13 mm（范围：0.07至0.75 mm）。平均瞳孔偏移X分量分别为-0.18±0.18、-0.28±0.16和-0.34±0.15 mm（相对于角膜顶点向颞侧偏移）。平均瞳孔偏移Y分量分别为0.06±0.15、0.03±0.16和0.01±0.16 mm（相对于角膜顶点向上方偏移）。对瞳孔偏移量进行多变量线性回归分析发现，具有统计学意义的变量为SEQ、散光、暗适应瞳孔直径和平均角膜曲率。对于瞳孔偏移X分量，具有统计学意义的变量为SEQ、散光和暗适应瞳孔直径。对于瞳孔偏移Y分量，具有统计学意义的变量为SEQ和暗适应瞳孔直径。平均kappa角分别为5.28±1.49°、6.14±1.44°和5.77±1.29°。
与普遍看法相反，绝大多数眼睛无论屈光不正情况如何均存在瞳孔偏移，平均颞侧偏移至少为0.18 mm。正如之前的研究证实，远视组的瞳孔偏移最大。然而，近视和正视眼中也存在较大范围的瞳孔偏移。与SEQ和角膜曲率的相关性支持了瞳孔偏移也与眼轴长度相关的理论。[《屈光手术杂志》。2021年；37(1):49 - 58。]
