摘要
目的:探讨单眼近视性屈光参差对少年儿童眼部屈光参数的影响，分析眼轴变化与屈光度变化相关性。方法:收集2017年7月至2020年5月于首都医科大学附属北京同仁医院眼科中心就诊的单眼近视性屈光参差少年儿童患者70例(140只眼)。其中，男性28例(56只眼)，女性42例(84只眼)，年龄8~15岁，平均(11.0±1.9)岁。全部患者均测量眼轴长度、角膜曲率平坦K值、角膜曲率陡峭K值、角膜平坦E值及角膜陡峭E值；散瞳验光并计算等效球镜屈光度。患者的年龄、眼轴长度、等效球镜屈光度、眼轴长度差值、屈光度差值、角膜曲率平坦K值、角膜曲率陡峭K值、角膜平坦E值及角膜陡峭E值均符合正态性分布，采用(±s)进行描述。健眼和患眼各生物学参数的比较采用配对t检验；按年龄段分为8~10岁组和11~15岁组，采用Pearson相关系数和线性回归分析双眼眼轴长度差值和屈光度差值的相关性。结果:70例(140只眼)患者中，男性28例(56只眼)，占40%；女性42例(84只眼)，占60%。右眼近视患者51例(51只眼)，占72.86%；左眼近视患者19例(19只眼)，占27.14%。患眼的眼轴长度为(24.49±0.84)mm，健眼的眼轴长度为(23.54±0.73)mm，两组之间差异具有统计学意义(t＝15.626，P<0.05)；患眼等效球镜度为(－2.39±1.05)D，健眼等效球镜度为(－0.07±0.32)D，双眼差异具有统计学意义(t＝－18.214，P<0.05)；患眼角膜曲率平坦K值为(42.74±1.28)，健眼角膜曲率平坦K值为(42.75±1.29)，双眼差异无统计学意义(t＝0.344，P>0.05)；患眼角膜曲率陡峭K值为(44.03±1.44)，健眼角膜曲率陡峭K值为(43.92±1.38)，双眼差异具有统计学意义(t＝－3.392，P<0.05)；患眼角膜平坦E值为(0.64±0.09)，健眼角膜平坦E值为(0.66±0.11)，双眼差异具有统计学意义(t＝2.672，P<0.05)，患眼角膜陡峭E值为(0.50±0.20)，健眼角膜陡峭E值为(0.53±0.20)，双眼差异无统计学意义(t＝1.226，P>0.05)。总体、8~10岁组及11~15岁组患者双眼眼轴长度的差值分别为(0.94±0.50)mm、(0.78±0.43)mm及(1.07±0.52)mm，屈光度的差值分为(－2.30±1.05)D、(－2.01±1.05)D及(－2.66±1.00)D，各组双眼眼轴长度差值与屈光度差值之间的相关性具有统计学意义(r＝－0.850，－0.835，－0.792，P<0.05)；使用双眼眼轴长度差值与屈光度差值构建一元线性回归方程，分别为ŷ＝－1.788x－0.624、ŷ＝－2.054x－0.421及ŷ＝－1.53x－1.024。8~15岁总体患者眼轴长度差值每增加1 mm，近视屈光度差值则增加－1.79 D；8~10岁患者眼轴长度差值每增大1 mm，近视屈光度差值则增加－2.05 D；11~15岁患者眼轴长度差值每增加1 mm；近视屈光度差值则增加－1.53 D。结论:屈光参差影响眼轴长度、角膜曲率陡峭K值及角膜平坦E值等屈光参数，眼轴长度增长与近视屈光度增长紧密相关，8~15岁少年儿童眼轴长度差值每增加1 mm，近视屈光度差值增加－1.79 D。
Abstract
Objective:The aim of this study was to assess the impact of monocular myopic anisometropia on the refractive parameters of children′s eyes and analyze the correlation between axial changes and refractive changes.Methods:From July 2017 to May 2020, 70 cases (140 eyes) of children with monocular myopic anisometropia were collected from the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University. Among them, there were 28 males (56 eyes) and 42 females (84 eyes), aged 8 to 15 years with an average age of (11.0±1.9) years. All patients were measured for axial length, corneal curvature flatness K value, corneal curvature steepness K value, corneal flatness E value, and corneal steepness E value. Astigmatic refraction and calculation of equivalent spherical diopter were performed. The patients′ age, axial length, equivalent spherical refractive index, D-value of axial length, D-value of refractive index, corneal curvature flatness K value, steep K value, corneal flatness E value, and steep E value conformed to a normal distribution, and were described by ±s. The biological parameters between healthy and affected eyes was compared using paired t testing. According to age range, they were divided into 8 to 10 years old group and 11 to 15 years old group. The correlation between D-value of binocular axial length and D-value of refractive index were performed Pearson correlation coefficient and linear regression analysis.Results:Among 70 patients (140 eyes), there were 28 males (56 eyes), accounting for 40%, and 42 females (84 eyes), accounting for 60%. There were 51 patients (51 eyes) with right myopia, accounting for 72.86%, and 19 patients (19 eyes) with left myopia, accounting for 27.14%. The axial length of the affected eye was (24.49±0.84) mm, while the axial length of the healthy eye was (23.54±0.73) mm. There were statistically significant differences between the two groups (t=15.626, P<0.05). The equivalent spherical diopter of the affected eye and the healthy eye was (-2.39±1.05) D and (-0.07±0.32) D, respectively. The difference between the two eyes was statistically significant (t=-18.214, P<0.05). The K value of corneal curvature flatness in the affected eye was (42.74±1.28), while the K value of corneal curvature flatness in the healthy eye was (42.75±1.29). There was no statistically significant difference between the two eyes (t=0.344, P>0.05). The K value of corneal curvature in the affected eye was (44.03±1.44), while the K value of corneal curvature in the healthy eye was (43.92±1.38). The difference between the two eyes was statistically significant (t=-3.392, P<0.05). The E value of corneal flatness in the affected eye was (0.64±0.09), while the E value of corneal flatness in the healthy eye was (0.66±0.11). The difference between the two eyes was statistically significant (t=2.672, P<0.05). The E value of corneal steepness in the affected eye was (0.50±0.20), while the E value of corneal steepness in the healthy eye was (0.53±0.20). There was no statistically significant difference between the two eyes (t=1.226, P>0.05). The differences in binocular axial length among patients in the overall, 8 to10 year old group, and 11 to15 year old group were (0.94±0.50) mm, (0.78±0.43) mm, and (1.07±0.52) mm, respectively. The differences in refractive power were divided into (-2.30±1.05) D, (-2.01±1.05) D, and (-2.66±1.00) D. The correlation between the differences in binocular axial length and refractive power in each group was statistically significant (r=-0.850, -0.835, -0.792; P<0.05). A univariate linear regression equation using the difference in binocular axial length and diopter was constructed, denoted by ŷ=- 1.788x-0.624, ŷ=- 2.054x-0.421, ŷ=- 1.53x-1.024, which suggesting that D-value of the myopia diopter would increase by -1.79 D if D-value of the axial length increased for every 1 mm in children aged 8 to 15 year old; D-value of the myopia diopter would increase by -2.05 D if D-value of the axial length increased for every 1 mm in children aged 8 to 10 year old; D-value of the myopia diopter would increase by -1.53 D if D-value of the axial length increased for every 1 mm in children aged 11 to 15 year old.Conclusions:Anisometropia affects refractive parameters such as axial length, corneal curvature steepness K value, and corneal flatness E value. Axial growth is closely related to the growth of myopia. Every 1 mm increase in axial difference will cause 1.79 D refractive error change within the children aged between 8 to 15 years old.
基金项目
首都卫生发展科研专项项目(2022-1G-4083)
万方数据