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中华眼视光学与视觉科学杂志
中华眼视光学与视觉科学杂志

瞿佳

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1674-845X

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0577-86699366

325035

浙江省温州市茶山高教园区温州医学院

中华眼视光学与视觉科学杂志/Journal Chinese Journal of Optometry Ophthalmology and Visual ScienceCSCDCSTPCD北大核心
查看更多>>中华医学会主办，温州医学院承办。本刊是眼科学与视光学领域的高级学术性期刊。以广大眼科医生、视光配镜师、眼视光学科研人员为主要读者对象。报道眼视光学与视觉科学领域的最新研究成果、临床诊疗经验，以及与本学科相关的基础理论研究的最新进展。本刊主要栏目有：专家述评，专题论著，论著，临床研究，病例报告，文献综述。本刊原刊名为《眼视光学杂志》，目前已被国内外数十种权威数据库收录。
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    低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识（2022）

    瞿佳季魏红
    401-409页
    查看更多>>摘要：当前全球近视患病率呈快速增长趋势，预计至2050年全球将有47.58亿近视人口，占总人口的49.8% [1]。中华人民共和国国家卫生健康委员会公布，2020年中国儿童青少年近视患病率为52.7%，其中小学生为35.6%，初中生为71.1%，高中生为80.5% [2]。由于近视呈现低龄化、高度化和患病率持续升高趋势，病理性近视患病率也显著增高。病理性近视可因脉络膜新生血管，视网膜变性、裂孔和脱离等眼底改变，造成不可逆的视觉损害，严重者可致盲，给个人、家庭和社会带来沉重负担。因此，预防近视发生、延缓近视进展、防止病理性近视发生刻不容缓。

    低浓度阿托品滴眼液近视防控有效性安全性使用规范

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    Visumax飞秒激光辅助LASIK的新型制瓣模式对不透明气泡层发生的影响

    李仕明何曦翟长斌张丽...
    410-415页
    查看更多>>摘要：目的： 探究Visumax飞秒激光辅助准分子激光原位角膜磨镶术（LASIK）的新型制瓣模式对术中不透明气泡层（OBL）产生的影响，分析影响OBL发生的相关因素。 方法： 病例对照研究。收集2020年4—8月于首都医科大学附属北京同仁医院屈光手术中心行飞秒激光辅助制瓣的LASIK者72例（128眼）的术前病历资料及手术设计参数，通过手术录像确定制瓣过程是否产生OBL及其分型。根据制瓣方式不同将术眼分为传统制瓣组64眼（38例）和新型制瓣组（采用新型制瓣模式）64眼（34例）。采用卡方检验对2组间OBL发生率及OBL各类型发生率的差异进行分析。采用单因素和Logistic回归分析OBL产生的相关影响因素。 结果： 传统制瓣组与新型制瓣组间年龄及眼部相关参数差异均无统计学意义。传统制瓣组OBL发生率明显高于新型制瓣组（44% vs. 16%，χ2=12.13，P<0.001）。传统制瓣组硬型OBL发生率明显高于新型制瓣组（28%vs. 0%，χ2=12.21，P<0.001）。传统制瓣组单因素分析中得到角膜瓣厚度与角膜厚度的比值较小为OBL发生的危险因素（Z=-1.04, P=0.030）。新型制瓣组单因素分析中发现较高的近视度数（Z=-2.33, P=0.020）及较小的角膜直径（Z=-2.64, P=0.010）为OBL发生的危险因素。Logistic回归得到角膜直径增加可降低OBL发生风险（OR=0.05，95%CI：0.03~0.65，P=0.023）。 结论： Visumax飞秒激光辅助LASIK的新型制瓣模式有助于减少OBL发生，角膜瓣厚度与角膜厚度比值较小及角膜直径较小者更易产生OBL。 Objective: To investigate if a new flap-making pattern of Visumax femtosecond laser-assisted laser in situ keratiomileusis (LASIK) could impact the occurrence of an opaque bubble layer (OBL), and to analyze related factors affecting the formation of an OBL. Methods: This was a case-control study. The preoperative medical records and surgical design parameters of 72 patients (128 eyes) who underwent FS-LASIK in the Refractive Surgery Center of the Beijing Tongren Hospital, Capital Medical University, from April to August 2020 were collected. The OBL and its classification were determined by the operation video. The operative eyes were divided into two groups based on the different patterns of flap-making. There were 64 eyes each in the traditional (38 patients) and new pattern (34 patients) groups, of which a new pattern was adopted for the latter group. The baseline data of the two groups were compared, and the incidence of overall OBLs and OBL types in the two groups were counted. A Chi-square test was used to analyze whether there was any difference. In addition, univariate analysis was performed for the two groups, and significance parameters were incorporated into a logistic regression to further analyze the related influencing factors of OBL. Results: Baseline data was balanced between the two groups. The incidence of OBL in the traditional group was significantly higher than that in the new group (44% vs. 16%, χ2=12.13, P<0.001), and the incidence of hard OBL in the traditional group was significantly higher than that in the new group (28%vs. 0%, χ2=12.21, P<0.001). Univariate analysis showed a smaller flap thickness to central corneal thickness ratio in the traditional flap-making group (Z=-1.04, P=0.030), while a higher degree of myopia (Z=-2.33, P=0.020) and smaller corneal diameter (Z=-2.64, P=0.010) ratio were risk factors for OBL in the new flap-making group. Logistic regression showed that an increased corneal diameter could reduce the risk of OBL (OR=0.05, 95%CI: 0.03-0.65, P=0.023). Conclusion: A new flap-making pattern with Visumax femtosecond laser-assisted LASIK can reduce the occurrence of an OBL. It is more likely to occur in patients with a smaller flap thickness to central corneal thickness ratio and a smaller corneal diameter.

    不透明气泡层Visumax飞秒激光准分子激光原位角膜磨镶术

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    矢量分析法比较FS-LASIK矫正混合散光和远视散光的精准性和稳定性

    王树林庞辰久张波李金...
    416-422页
    查看更多>>摘要：目的： 采用标准化的矢量分析法观察和比较飞秒激光辅助的准分子激光原位角膜磨镶术（FS-LASIK）矫正混合散光和远视散光的精准性和稳定性。 方法： 回顾性非随机对照研究。选取2017年1月至2021年1月在河南省立眼科医院接受FS-LASIK矫正散光的患者41例（62眼），其中混合散光组21例（30眼），远视散光组20例（32眼）。分别于术前，术后1周、1个月、3个月和6个月对术眼进行视力、验光、裂隙灯显微镜、眼压及角膜地形图等检查。采用标准化的散光矢量分析法和报告屈光手术散光结果的国际标准图表对手术指标进行评价，包括等效球镜度（SE）、目标散光矢量（TIA）、手术引起的散光矢量（SIA）、误差的幅度（ME）、误差角度的绝对值（|AE|）、差异矢量的绝对值（|DV|）、矫正指数（CI）、成功指数（IOS）等指标。组间ME、|AE|、|DV|、CI、IOS和SE差异的比较采用Mann-Whitney检验，组间不同时间点|AE|、|DV|、ME、SE之间差异比较采用Kruskal-Wallis检验。 结果： 术后6个月时，混合散光组的|AE|和SE小于远视散光组，差异有统计学意义（Z=-2.02，P=0.043；Z=-2.77，P=0.006）；混合散光组的ME为负值，CI值大于1，远视散光组的ME为正值，CI值小于1，组间ME和CI差异有统计学意义（Z=-4.93，P<0.001；Z=-4.28，P<0.001）；组间|DV|差异无统计学意义。混合散光组术后6个月内各时间点|AE|之间差异无统计学意义，|DV|、ME、SE之间差异有统计学意义（H=15.98，P=0.001；H=10.54，P=0.014；H=10.90，P=0.012）。远视散光组术后6个月内各时间点|AE|、|DV|、ME之间差异无统计学意义，SE差异有统计学意义（H=10.11，P=0.018）。 结论： 术后6个月内，FS-LASIK矫正混合散光的精准性优于远视散光，矫正远视散光的稳定性优于混合散光，矫正混合散光时有过矫倾向，矫正远视散光时有欠矫倾向。 Objective: To investigate and compare the accuracy and stability of femtosecond-assisted laser in situ keratomileusis(FS-LASIK) in the correction of mixed astigmatism and hyperopic astigmatism by vector analysis. Methods: A retrospective and non-randomized controlled study was performed. Thirty mixed astigmatism eyes of 21 patients and 32 hyperopic astigmatism eyes of 20 patients underwent the FS-LASIK in Henan Eye Hospital were enrolled from January 2017 to January 2021. The visual acuity, refraction, slit-lamp microscopy, intraocular pressure and corneal topography were measured preoperatively and 1 week, 1 month, 3 months and 6 months postoperatively. Standardized astigmatism vector analysis and international standard for reporting astigmatism results of refractive surgery were used to evaluate the surgical indicators, including spherical equivalent (SE), target induced astigmatism vector (TIA), surgically induced astigmatism vector (SIA), magnitude of error (ME), absolute value of angle of error (|AE|), absolute value of difference vector (|DV|), correction index (CI) and index of success (IOS). The differences of ME, |AE|, |DV|, CI, IOS and SE between mixed astigmatism group and hyperopic astigmatism group were compared by Mann-Whitney test, and the differences between |AE|, |DV|, ME and SE at different time points between the groups were compared by Kruskal-Wallis test. Results: Six months postoperatively, AE and SE in mixed astigmatism group were less than those in hyperopic astigmatism group (Z=-2.02, P=0.043 Z=-2.77, P=0.006). The ME of mixed astigmatism group was negative, the CI value was greater than 1. The ME of hyperopic astigmatism group was positive, and the CI value was less than 1. The difference of ME and CI between the two groups was statistically significant (Z=-4.93, P<0.001 Z=-4.28, P<0.001). There was no significant difference in |DV| between the two groups. In the mixed astigmatism group, within 6 months postoperatively, there was no significant difference in |AE| on the whole, and there was significant difference in |DV|, ME, SE (H=15.98, P=0.001 H=10.54, P=0.014 H=10.90, P=0.012). In hyperopic astigmatism group, there was no significant difference in |AE| , |DV|, ME within 6 months postoperatively on the whole, and there was significant difference in SE (H=10.11, P=0.018). Conclusion: The accuracy of mixed astigmatism corrected by FS-LASIK are better than that of hyperopic astigmatism, the stability of correction of hyperopia astigmatism is better than that of mixed astigmatism, and it tends to be overcorrected in mixed astigmatism, while undercorrected in hyperopic astigmatism within 6 months postoperatively.

    散光远视矢量分析准分子激光飞秒激光

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    不同瞳孔参数对于Q值调整FS-LASIK的影响

    林颖苏焕钧张霞张泳...
    423-428,433页
    查看更多>>摘要：目的： 探讨术前不同瞳孔参数对伴老视的近视飞秒激光辅助的准分子激光角膜原位磨镶术（FS-LASIK）后视力的影响。 方法： 前瞻性病例对照研究。选取2020年1—12月于广西壮族自治区柳州市工人医院连续就诊的中度近视合并老视患者60例（120眼）。患者在中间视觉环境（1 cd/m2）按瞳孔大小分为3组：小瞳孔（SPG）组（≤5.5 mm）、中瞳孔（MPG）组（5.6~6.4 mm）和大瞳孔（LPG）组（≥6.5 mm）。各组分别于术前，术后1个月、3个月、6个月均行视力、瞳孔反应以及像差检查，比较3组裸眼视力（UCVA）、近视力（UCNVA）、瞳孔反应以及像差。采用重复测量方差分析比较不同时间点瞳孔参数、视力、像差的变化，术前不同组间各瞳孔反射参数比较采用ANOVA方差分析。 结果： 术后3、6个月时MPG组和SPG组的UCVA高于LPG组（术后3个月：F=10.62，P<0.001；F=14.21，P<0.001；术后6个月：F=14.88，P<0.001；F=14.81，P<0.001）；SPG组和MPG组的UCNVA均优于LPG组（术后3个月：F=37.62，P<0.001；F=25.62，P<0.001；术后6个月：F=37.60，P<0.001；F=38.11，P<0.001）。在术后6个月的随访中，MPG组患者的满意度高于LPG组和SPG组。术后1、3、6个月，MPG组和SPG组患者的收缩幅度、收缩速度和瞳孔收缩持续时间均优于LPG组，差异均有统计学意义（均P<0.001）；瞳孔扩张潜伏期MPG组和SPG组优于LPG组，差异有统计学意义（P<0.05）；扩张持续时间和扩张速度在3组患者间比较差异无统计学意义；3组患者垂直彗差（C7），水平彗差（C8）和球差（C12）均增加，LPG组患者增加最多，差异有统计学意义（P<0.001）。 结论： 老视激光屈光手术后6个月，中、小瞳孔大小的患者均可以获得更好的视觉质量。 Objective: To evaluate the effect of pupil parameters on quality of vision after laser refractive surgery for presbyopia. Methods: In this prospective study, 60 consecutive presbyopic patients (120 eyes) with moderate myopia were included from January to December 2020 at Liuzhou Workers’ Hospital. Subjects were divided into three groups according to pupil size at an intermediate visual environment (1 cd/m2): small pupil group (SPG) (≤5.5 mm), medium pupil group (MPG) (5.6-6.4 mm), and large pupil group (LPG) (≥6.5 mm). The uncorrected visual acuity (UCVA), near vision (UCNVA), pupil parameters and aberrations were examined and compared before surgery, and at 1, 3, and 6 months after surgery. Repeated measurement analysis of variance was used to compare the changes in pupil parameters, visual acuity and aberration differences at different time points before and after surgery. ANOVA analysis of variance was used to compare the pupil parameters among the different groups before surgery. Results: The UCVA of the MPG and SPG groups was higher than that of the LPG group at 3 and 6 months after surgery (3 months after surgery: F=10.62, P<0.001 F=14.21, P<0.001 6 months after surgery:F=14.88, P<0.001 F=14.81, P<0.001). The UCNVA of the SPG and MPG groups was better than that of the LPG group (3 months after surgery:F=37.62, P<0.001 F=25.62, P<0.001 6 months after surgery:F=37.60, P<0.001 F=38.11, P<0.001). In the 6-month follow-up, patient satisfaction in the MGP group was higher than that in the LPG and SPG groups. At 1, 3 and 6 months after surgery, the amplitude, velocity, and duration of contraction in the MPG and SPG groups were better than those in the LPG group, and the differences were statistically significant (P<0.001). The latency of pupil dilation in the MPG and SPG groups was better than that in the LPG group (P<0.05). There was no significant difference in duration or velocity of dilation among the three groups. The values of the vertical coma (C7), horizontal coma (C8) and spherical aberrations (C12) all increased in the three groups, and most significantly in the LPG group (P<0.001). Conclusions: Six months after laser refractive surgery for presbyopia, patients with medium and small pupil size can have better visual quality.

    瞳孔老视Q值调整FS-LASIK像差

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    急性闭角型青光眼高眼压状态下行白内障摘除对角膜内皮细胞的影响

    沈嘉琪邵玉婷林慧刘歆...
    429-433页
    查看更多>>摘要：目的： 观察急性闭角型青光眼高眼压状态下行白内障摘除联合人工晶状体植入对角膜内皮细胞的影响。 方法： 回顾性系列病例研究。选择2018年1月至2021年8月在同济大学附属同济医院眼科就诊的急性闭角型青光眼发作且药物保守治疗及前房穿刺不能稳定控制眼压患者41例（55眼），眼压（47.3±4.8）mmHg（1 mmHg=0.133 kPa），同时伴不同程度晶状体混浊。所有患者行白内障摘除联合人工晶状体植入及房角分离术。术前及术后3个月内行常规眼科检查，并获取角膜内皮相关指标，包括角膜内皮细胞密度（ECD）、中央角膜厚度（CCT）及变异系数（CV）等。手术前后各指标差值比较采用配对t检验或Wilcoxon符号秩和检验。 结果： 术后第1天眼压为（16.7±3.7）mmHg，其中4眼眼压仍高[（24.9±2.2）mmHg]需药物控制，其余患眼眼压在正常范围内；术后3个月眼压为（15.7±3.1）mmHg，与术前相比差异有统计学意义（t=36.48, P<0.001）。术后ECD[（1 023±344）个/mm2]明显较术前[（2 062±300）个/mm2]下降（t=-22.75, P<0.001）。术后CV（33.5%±6.8%）明显较术前CV（22.7%±2.6%）增大（t=13.62, P<0.001）。手术前后患眼最佳矫正视力明显改善（Z=-4.94, P<0.001）。所有患者均未发生术中或术后并发症。 结论： 急性闭角型青光眼高眼压状态下行白内障摘除联合人工晶状体植入可快速有效控制眼压，但角膜内皮细胞损伤明显。 Objective: To investigate the effect of cataract extraction under high intraocular pressure on corneal endothelial cells in acute angle closure glaucoma patients. Methods: This retrospective case series study was conducted with 41 patients (55 eyes) with acute angle closure glaucoma and cataract from January 2018 to August 2021 in the Ophthalmology of Tongji Hospital Affiliated to Tongji University. Preoperative mean intraocular pressure was (47.3±4.8)mmHg (1 mmHg=0.133 kPa). Both pharmacotherapy and anterior chamber paracentesis can’t reduce the intraocular pressure, and all patients subsequently underwent cataract extraction combined with intraocular lens implantation and goniosynechialysis. Routine ophthalmic examination and corneal endothelium parameters including endothelial cell density, central corneal thickness and coefficient of variation were examined in all patients before surgery and during the three-month follow-up period. For the difference before and after surgery, either a paired t test or a Wilcoxon rank sum test was applied. Results: The average intraocular pressure (IOP) was (16.7±3.7)mmHg at 1 day after the operation, 4 eyes still needed medication to control the IOP[(24.9±2.2) mmHg], while the IOP in the other eyes stabilized in a normal range. IOP of all the affected eyes stabilized in (15.7±3.1)mmHg at 3 months after the operation, and the difference was statistically significant compared with preoperative IOP (t=36.48, P<0.001). Postoperative ECD [(1 023±345 )each/mm2] significantly declined compared with preoperative ECD[(2 063±300) each/mm2] (t=-22.75, P<0.001). Postoperative CV (33.5%±6.8%) was significantly increased compared with preoperative CV (t=13.62, P<0.001).There was a significant improvement in postoperative BCVA (Z=-4.94, P<0.001). No intraoperative or postoperative complications occurred in all patients. Conclusion: Cataract extraction combined with intraocular lens implantation in acute angle closure glaucoma under high intraocular pressure can control the IOP effectively, but significantly damage the corneal endothelial cells.

    闭角型青光眼白内障摘除术高眼压角膜内皮细胞

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    扫频OCT CASIA2测量白内障患者术前晶状体与术后人工晶状体偏心和倾斜的相关性

    唐玉玲廖萱谭青青钱玖林...
    434-440页
    查看更多>>摘要：目的： 应用眼前节扫频OCT CASIA2研究白内障患者术前晶状体和术后人工晶状体（IOL）偏心和倾斜的相关性。 方法： 自身对照研究。纳入2020年3月至7月于川北医学院附属医院接受白内障手术的患者109例（157眼），其中右眼80眼，左眼77眼，年龄为48~88（69.8±9.1）岁。应用CASIA2于白内障手术前、术后1周测量散瞳前、后晶状体和IOL的偏心和倾斜，3次测量并取其矢量平均值。采用Pearson相关分析术后IOL与术前晶状体相同指标间的相关性。 结果： 在散瞳前，白内障患者右眼术后IOL偏心量与术前晶状体无相关性，术后IOL偏心轴向、倾斜度及倾斜轴向与术前晶状体的相同指标均分别呈正相关（r=0.48, P<0.001 r=0.53, P<0.001 r=0.36, P=0.002）；左眼术后IOL偏心量与术前晶状体同样无相关性，术后IOL倾斜度与术前晶状体的倾斜度呈中等强度相关性（r=0.44, P<0.001），术后IOL偏心轴向、倾斜轴向与术前晶状体的相同指标分别呈较强相关性（r=0.62, P<0.001 r=0.91, P<0.001）。散瞳后测量，右眼术后IOL偏心量与术前晶状体呈弱相关性（r=0.26, P=0.024），右眼术后IOL偏心轴向、倾斜度和倾斜轴向与术前晶状体的相同指标均分别成正相关性（r=0.34, P=0.004 r=0.56, P<0.001 r=0.36, P=0.002）；左眼术后IOL偏心量与术前晶状体无相关性，左眼术后IOL与术前晶状体的偏心轴向、倾斜度及倾斜轴向均分别呈较强的正相关性（r=0.64, P=0.010 r=0.55, P<0.001 r=0.93, P<0.001）。 结论： 除偏心量外，CASIA2测量白内障患者术后IOL和术前晶状体的偏心轴向、倾斜度和倾斜轴向均分别呈正相关，且倾斜轴向的相关性最高。临床可参考白内障术前晶状体的偏心和倾斜，为患者选择更合适的IOL。 Objective: To measure the correlation of decentration and tilt between crystalline lens and intraocular lens (IOL) in cataract patients with anterior segment swept-source ocular coherence tomography (SS-OCT) CASIA2. Methods: A self-control design was carried out in this study. One hundred and fifty-seven eyes of 109 cataract patients who underwent cataract surgery in Affiliated Hospital of North Sichuan Medical College from March to July in 2020 were included. The age ranged from 48 to 88 years (69.8±9.1). CASIA2 was used to measure the decentration and tilt of crystalline lens for three consecutive times under non-mydriatic and mydriatic conditions respectively, and to measure the decentration and tilt of IOL for three times one week after cataract surgery vector averages of the three measures were calculated. Pearson correlation analysis was used to detect the correlation between preoperative crystalline lens and postoperative IOL. Results: There was no correlation in the decentration between IOL and crystalline lens in the right eyes under non-mydriatic condition, while there was a positive correlation in the axis of decentration, tilt and the axis of tilt (r=0.48, P<0.001 r=0.53, P<0.001 r=0.36, P=0.002). In the left eyes, there was no correlation in the decentration between IOL and crystalline lens, while moderate correlation in tilt (r=0.44, P<0.001) and robust correlation in the axis of decentration and tilt (r=0.62, P<0.001 r=0.91, P<0.001) were found. After mydriasis, there was a poor correlation in decentration (r=0.26, P=0.024), and positive correlation in the axis of decentration, tilt and the axis of tilt (r=0.34, P=0.004 r=0.56, P<0.001 r=0.36, P=0.002). There was no correlation in decentration between IOL and crystalline lens in the left eyes, while there was a strongly positive correlation in the axis of decentration, tilt and the axis of tilt (r=0.64, P=0.010 r=0.55, P<0.001 r=0.93, P<0.001). Conclusions: Except for decentration, there was a positive correlation in the axis of decentration, tilt and the axis of tilt between IOL and crystalline lens in cataract patients measured by CASIA2. The most robust correlation was found in the axis of tilt. A more appropriate IOL could be selected for patients by referring to the decentration and tilt of crystalline lens before cataract surgery.

    光学相干断层扫描，扫频白内障人工晶状体偏心倾斜相关性

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    不同屈光状态学龄期儿童角膜前表面区域Q值的研究

    郭燕琚霄慧金卡露夏哲人...
    441-446页
    查看更多>>摘要：目的： 应用Pentacam眼前节分析仪测量我国学龄期儿童角膜形态，通过正切曲率半径计算各区域角膜前表面Q值，分析不同屈光状态下各区域角膜前表面Q值的特点。 方法： 系列病例研究。选取2018年9月至2019年10月在温州医科大学附属第二医院育英儿童医院眼科门诊就诊的学龄期儿童192例，以右眼作为研究对象，按右眼等效球镜度（SE）分成中度近视组、低度近视组、正视组、低度远视组、中度远视组这5组。应用Pentacam眼前节分析仪测量其角膜形态，通过正切曲率半径计算鼻侧（315°-45°）、上方（45°-135°）、颞侧（135°-225°）、下方（225°-315°）这4个区域角膜前表面Q值。采用方差分析比较各区域角膜Q值差异和各区域角膜Q值在不同屈光组间的差异；采用Pearson相关分析SE和角膜Q值的相关性。 结果： 鼻、上、颞、下4个区域角膜前表面Q值分别为-0.50±0.13、-0.62±0.15、-0.31±0.10、-0.42±0.18，4个区域角膜Q值差异有统计学意义（F=215.19，P<0.001），颞、下、鼻、上4个区域角膜前表面变平坦趋势依次增快。不同屈光组间仅鼻侧、下方角膜前表面Q值存在差异（F=6.00，P<0.001；F=2.95，P=0.022）。随着SE的增加，鼻侧、下方角膜Q值变小，呈负相关（r=-0.38，P<0.001；r=-0.16，P=0.031）。不同屈光组在上方和颞侧2个区域角膜前表面Q值差异均无统计学意义。不同屈光组的鼻颞侧Q值差值差异存在统计学意义（F=10.40，P<0.001），且随SE的增加，鼻颞侧Q值差异增大，二者有相关性（r=-0.42，P<0.001）。 结论： 学龄期儿童各区域的角膜前表面Q值存在差异，不同屈光状态的鼻侧及下方角膜Q值、鼻颞侧差值均存在差异，且均与SE存在相关性，提示不同屈光度的儿童矫正屈光不正时需考虑各区域角膜Q值，以提高成像质量。 Objective: To calculate the school-aged children's anterior corneal Q values of different regions with the tangential radius of curvature acquired from the Pentacam anterior segment analyzer and analyze its distribution characteristics in different refractive status groups. Methods: A case series study was conducted. One hundred and ninty-two school-aged children were recruited from September 2018 to October 2019 in the Department of Ophthalmology of the Second Affiliated Hospital of Wenzhou Medical University. Only the right eyes were selected as objects of research. The patients were grouped by the magnitude of the spherical equivalent (SE) refractive error of the right eye: moderate myopia, low myopia, emmetropia, low hyperopia and moderate hyperopia. The Pentacam anterior segment analyzer was used to measure the cornea. The anterior corneal Q values of the nasal (315°-45°), superior (45°-135°), temporal (135°-225°) and inferior (225°-315°)region were calculated by the tangential radius with linear regression equation. Data was analyzed using ANOVA and Pearson correlation analysis. Result: The mean Q values of the nasal, superior, temporal and inferior region were -0.50±0.13, -0.62±0.15, -0.31±0.10 and -0.42±0.18. The difference of them was statistically significant (F=215.19, P<0.001). Only the nasal and inferior Q values were found significantly different among the different refracive groups (F=6.00, P<0.001 F=2.95, P=0.022).The relationship between Q values and SE was negative (r=-0.38, P<0.001 r=-0.16, P=0.031). No difference was found for superior and temporal Q values among the different refracive groups respectively. By further analysis, we revealed the Q values difference between the nasal-temporal region was significantly different among the different refracive groups (F=10.40, P<0.001). A trend toward higer the Q values difference between the nasal-temporal region was found as the SE increased. Pearson analysis showed the relationship between them was statistically significant (r=-0.42, P<0.001). Conclusion: The anterior corneal Q values of different regions of school-aged children's eyes were different. The nasal Q values, inferior Q values and the Q values difference between the nasal-temporal region were all significantly different among the different refracive groups and correlated with SE. It's critically important to considere the anterior corneal Q values of different regions when correctting refraction for different refractive children.

    角膜Q值区域学龄期儿童屈光不正

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    学龄期儿童青少年近视患者生存质量研究

    王媛媛耿鑫钟佳杰沈婷...
    447-453页
    查看更多>>摘要：目的： 研究学龄期儿童青少年近视患者及其父母的生存质量并分析其相关影响因素。 方法： 病例对照研究。运用中小学生视力相关生存质量量表和家长生存质量调查表对335例近视患者及其家长（近视组）和110例视力正常者及其家长（对照组）进行问卷调查，同时记录患者视力、近视度数等眼部信息及个体和家庭信息。采用独立样本t检验、单因素方差分析、多元线性回归分析等分析儿童青少年近视患者的量表得分及个体家庭因素和近视情况对生存质量的影响。 结果： 近视组儿童青少年视力相关生存质量量表得分为95.90±8.37，明显低于对照组（104.59±5.25），差异有统计学意义（t=5.73，P<0.001）。近视组家长生存质量调查表得分为46.85±13.61，对照组得分为60.59±6.57，2组差异有统计学意义（t=6.32，P<0.001）。近视戴镜的儿童青少年生存质量在生理功能维度和情感功能维度得分明显低于近视不戴镜者（t=2.17，P=0.034；t=2.31，P=0.024）。近视戴镜患者的家长生存质量调查表得分明显低于近视不戴镜患者的家长（t=2.56，P=0.013）。多元回归分析显示家庭年总收入是影响儿童青少年近视患者生存质量总量表得分的主要因素（b=2.91，t=2.16，P=0.035），家庭年总收入、课外艺术类课时是影响儿童青少年近视患者情感能力维度的主要因素（b=1.66，t=3.39，P=0.001；b=-3.19，t=-2.46，P=0.018），课外文化类课时是影响儿童青少年近视患者视功能和身体机能维度得分的主要因素（b=-0.84，t=-2.05，P=0.045）。 结论： 儿童青少年近视患者及其家长的生存质量明显差于视力正常者，尤其是配戴屈光矫正眼镜者。家庭经济状况是影响儿童青少年近视患者生存质量的主要因素。关注患儿生存质量可能改善其屈光矫正的合作程度。 Objective: To evaluate the quality of life of school-age children and adolescents with myopia as well as that of their parents, and to investigate its determining factors. Methods: This is a perspective case control study. Three hundred thirty-five children and adolescents with myopia (myopic group) and 110 age-matched children with normal vision (control group) were enrolled to evaluate their quality of life using the QOL questionnaire about vision for primary and middle school students (QVSS). The quality of life of their parents was assessed using the Pedeyes Q questionnaire. Ocular history, such as visual acuity and degree of myopia as well as social demographic information were recorded. An independent samples t-test, one-way ANOVA analysis and multiple linear regression analysis were performed to analyze the variables studied. Results: The mean score of the QVSS was 95.90±8.37 in the myopic group, which was significantly lower than that in the control group which was 104.59±5.25 (t=5.73, P<0.001). Parents of children in the myopic group had lower scores on the Pedeyes Q questionnaire (46.85±13.61) than those in the control group (60.59±6.57), and the difference was statistically significant (t=6.32, P<0.001). Children with myopia who wore corrective glasses had a significantly lower score in the Physiological function subscale and Emotional function subscale than those who did not wear corrective glasses (t=2.17, P=0.034 t=2.31, P=0.024). Parents of children with myopia who wore corrective glasses had a lower Pedeyes Q score than those who did not (t=2.56, P=0.013). The results of multiple regression analysis suggested that family income was the main factor correlated with the total score of the scale (b=2.91, t=2.16, P=0.035), while the results of the Emotional subscale for children with myopia was mainly affected by family income and time spent in extracurricular art class (b=1.66, t=3.39, P=0.001 b=-3.19, t=-2.46, P=0.018). Time spent in extra-curricular cultural classes dominated the visual function and physical function dimensions score (b=-0.84, t=-2.05, P=0.045). Conclusions: Children and adolescents with myopia as well as their parents had a lower quality of life than those with emmetropia. Family economic status was a predominant factor influencing quality of life in children with myopia. Paying attention to quality of life may improve the cooperation of refractive correction.

    生存质量近视量表

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    特发性黄斑前膜的组织病理学特征

    项振扬金琴辉罗华荣甘梅富...
    454-463页
    查看更多>>摘要：目的： 观察各期特发性黄斑前膜（IMEM）的病理结构特征，分析黄斑前膜病理组织学特点及其发展规律。 方法： 前瞻性临床研究。选取2016年2月至2018年9月在台州医院路桥院区进行玻璃体切割联合内界膜-黄斑前膜剥除术治疗的IMEM患者60例（62眼），根据OCT图像4期分期方案分为1期IMEM组、2期IMEM组、3期IMEM组及4期IMEM组。将术中剥除的带内界膜的IMEM标本HE染色后进行膜平铺及切片观察，并进一步行SMA、GFAP、S-100、CD34、CD68等免疫组织化学染色及弹力纤维染色、Masson染色等特殊染色检查。记录各组膜组织类型、病理组织学结构特征、主要细胞和纤维成分及免疫组织化学的阳性率。采用χ2检验进行各组膜组织类型分布及免疫组织化学阳性率比较，Kruskal-Wallis H检验进行组间细胞密度比较。 结果： 将膜组织类型分为致密型及稀疏型，4组膜组织类型分布差异有统计学意义(χ2=11.44，P=0.006)。切片观察组织病理学特点发现：从1期到4期组织的细胞聚集度降低，细胞的胞质减少，组织内胶原纤维由致密变得疏松。4组间细胞密度总体比差异有统计学意义（H=13.73，P=0.003），多重比较分析发现2期与4期的细胞密度差异有统计学意义（H=3.69，P=0.001）。免疫组织化学染色显示CD34均阴性表达，GFAP均阳性表达，部分膜组织表达SMA、S-100、CD68，但各组间SMA、S-100、CD68阳性率比较差异均无统计学意义。弹力纤维染色及Masson染色提示各组的IMEM纤维成分均为胶原纤维，从1期到4期纤维逐渐扩张增厚。 结论： IMEM属于非血管性纤维增生组织，其主要细胞成分为胶质细胞及成纤维细胞，各期细胞成分相似，纤维成分为胶原纤维。在疾病发展后期细胞密度下降，整个过程纤维呈逐渐扩张状态。 Objective: To observe the histopathological structure characteristics and cellular fiber components of the idiopathic epimacular membrane (IMEM) in each stage, thus to study the pathologic development of IMEM. Methods: This is a prospective clinical study. A total of sixty patients (62 eyes) with IMEM who underwent vitrectomy combined with internal limiting membrane and IMEM peeling treatment in Luqiao Branch of Taizhou Hospital from February 2016 to September 2018 were selected. The patients were then divided into 4 groups based on OCT images (stage 1 group to stage 4 group). The IMEM tissues were collected and stained with HE. Further immunohistochemical staining was performed for SMA, GFAP, S-100, CD34 and CD68. And Elastic and Masson staining were conducted as well. The types of IMEM, pathological structural characteristics, cell density, fiber components, and immunohistochemical positive rates were recorded. The Chi-square test was applied to analyze the proportion of IMEM types and immunohistochemical positive rates, while the Kruskal-Wallis H test was utilized to compare cell density. Results: The IMEM could be divided into two types: dense membrane and sparse membrane.The proportion of the two types was statistically different among the groups (χ2=11.44, P=0.006). Under the microscope, it was found that the cell numbers and cell cytoplasm decreased from stage 1 to stage 4, and the collagen fibers in the tissue changed from dense to sparse. The cell density of IMEM in the four groups was also statistically different (H=13.73, P=0.003). Post-hoc analyses found there was a statistical difference in cell density between stage 2 and stage 4 (H=3.69, P=0.001). Immunohistochemical staining showed that CD3 was negative, GFAP was positive, and some membrane tissues expressed SMA, S-100, and C68, however, there was no significant difference in the positive rates among groups. Elastic fiber staining and Masson staining showed that the IMEM fibers were collagen fibers, and the fibers gradually expanded and thickened from stage 1 to stage 4. Conclusion: IMEM was a kind of non-vascular fibroproliferative tissue. Its major cell components were glial cells and fibroblasts. The cell components in each stage were similar, and the fibers were composed of collagen. The cell density decreased and the fibers gradually expanded as the disease developed.

    黄斑前膜组织病理学检查免疫组织化学

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    双元件可调节人工晶状体设计

    周晓红王良玉杨朋千吴昔昔...
    464-471页
    查看更多>>摘要：目的： 设计一种新的双元件可调节人工晶状体，并对其成像质量进行评估。 方法： 通过光学设计软件Zemax，建立新设计的双元件可调节人工晶状体和人眼模型，模拟仿真其在不同视距下（L=6 m、L=70 cm、L=40 cm以及L=25 cm）的成像结果，得到空间频率为100 cycles/mm时的调制传递函数（MTF）值。与Simonov等研究结果进行对比分析，同时分析仿真结果是否满足人工晶状体植入光学特性和测试标准。 结果： 通过光学设计软件模拟仿真新设计的双元件可调节人工晶状体眼模型，其结果显示无论α=0°还是α=5°，瞳孔大小为3 mm时，单色光（λ=0.546 μm）空间频率100 cycles/mm对应的MTF值均大于0.43，满足人工晶状体植入光学特性和测试标准。在α=0°时，仿真结果相较于Simonov等研究结果有较大提升；在α=5°时，无明显提升。 结论： 本研究设计的双元件可调节人工晶状体仿真结果满足人工晶状体植入光学特性和测试标准要求，相较于Simonov的研究结果，其整体性能有所提升。 Objective: To evaluate the imaging quality of the dual-element accommodative intraocular lens proposed by the author. Methods: Getting the results by modelling and simulating the eye with IOL, and comparing with the existing research results. The dual-element accommodative intraocular lens proposed by the author were simulated with the optical design software Zemax, and the imaging results at different viewing distances (L=6 m, L=70 cm, L=40 cm and L=25 cm) were simulated, obtaining the MTF value when the spatial frequency is 100 cycles/mm. Comparing with the results of Simonov's research and analyzing, checking whether the simulation results meet standard of the optical properties and testing methods of intraocular lens implantation. Results: The dual-element accommodative intraocular lens proposed by the author was simulated with the optical design software. The results showed that no matter α=0°or α=5° when the pupil size is 3 mm and the wavelength λ = 0.546 μm, the modulation transfer function (MTF) values ​​corresponding to the frequency of 100 cycles/mm are all greater than 0.43, which meets standard of the optical properties and testing methods of intraocular lens implantation. When α=0°, the simulation results are greatly improved compared with Simonov's research results when α=5°, there is no significant improvement. Conclusion: The simulation results of the dual-element accommodative intraocular lens proposed by the author meet the requirements of the optical properties and testing methods of intraocular lens implantation compared with Simonov's research results, the results are generally improved.

    人工晶状体可调节焦距光学系统

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