233例圆锥角膜的临床特点分析  

Clinical features of 233 cases of keratoconus

作　　者：李绍伟[1] 李赵霞[1] 史伟云[1] 曾庆延[1] 晋秀明[1] 

机构地区：[1]山东省眼科研究所青岛眼科医院,青岛266071

出　　处：《中华眼科杂志》2005年第7期610-613,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨圆锥角膜的临床发病特点。方法对1993年1月至2002年3月在我院接受穿透性角膜移植、表层角膜镜片术和深板层角膜移植圆锥角膜患者病历资料进行回顾性调查;从2000年1月至2002年3月对到我院就诊的山东地区的圆锥角膜患者进行调查。233例圆锥角膜患者在此期间到我院就诊,男性216例,女性17例。了解患者的家族史、全身并发症、发病年龄、屈光状态变化、病程进展、角膜地形图变化特点、眼轴及前房深度等情况。结果患者的临床表现基本遵循近视散光屈光不能矫正瘢痕或急性圆锥的模式。219例患者提供较准确的视力下降发病年龄,出现近视的平均年龄为13.8岁,其中11～15岁者占67.1%(147/219例)。189例患者准确回答从出现近视到框架眼镜不能矫正(视力<0.1)的时间为1～20年,其中85.2%(161/189例)发生在6年内。47例单眼出现急性圆锥,其中4.3%(2/47例)的急性圆锥角膜患者出现角膜穿孔。34例角膜基质发生瘢痕的患者中,32例(94.1%)发生于发病后的8年内。角膜地形图显示角膜锥体有旁中心沿散光最大轴线逐渐向周围扩大最后又沿散光最小轴线扩大,并向中心移动的规律。患者眼轴长度平均为(25.9±1.4)mm,前房深度平均为(4.3±0.3)mm。311只患眼有眼轴长度的A超测量数据,其中279只患眼(89.7%)眼轴>24mm。患者双眼发病早晚和程度均不同。2例患者为Down综合征,2例患者智力障碍。未发现有圆锥角膜家族史的患者。结论圆锥角膜与轴性近视密切相关,潜伏期圆锥角膜患者的前房深度较正常者深。Objective To analyze clinical features of keratoconus. Methods The case history of keratoconus patients who underwent penetrating keratoplasty, epikeratophakia or deep lamellar keratoplasty in our hospital during January 1993 to March 2002 was reviewed, and inquiry form was sent to those who without complete data. Patients were followed during January 2000 to March 2002. Two hundred and thirty three cases of keratoconus were enrolled in this study with 216 males and 17 females. Patient′s family history, systemic complications, refractive status, progress of disease, eye axial length and anterior chamber depth were recorded. Results The clinical natural history of these patients followed the model of “myopia-astigmatism-poor spectacle correction-acute corneal hydrops or stromal scar”. The presenting age of myopia ranged from 6 to 29 years, with a mean age of 13.8 years, 10.1 % (22/219) of the patients were younger than 10 years, 67.1% (147/219) were between 11 and 15 years. The interval time between emerging myopia and poor spectacle correction (best corrected visual acuity less than 20/200) was ranged from 1 to 20 years, of which 85.2% (161/189) were shorter than 6 years. Twenty percent (47/233) of the patients had acute corneal hydrops in one eye at the age of 12 to 31 years, and 4.3% of them(2/47)resulted in corneal perforation. Thirty-four patients had corneal stromal scars 1 to 13 years after keratoconus developed, and 94.1% of them(32/34)were within 8 years. Topography examination demonstrated a tendency of the cone base position progress: first, paracentral-enlargement following dominant astigmatism axis, then, enlargement along smaller astigmatism axis, and finally, the cone base moving centrally. The eye axial length averaged at (25.9±1.4) mm, the depth of anterior chamber (AC) were (4.3±0.3) mm, 89.7% (279/311) eyes had an axial length longer than 24 mm. All cases had an asymmetry clinical progress course. Two cases had Down syndrome, 2 with intelligence defect. No family history was noted in thi

关 键 词：临床特点分析 穿透性角膜移植 深板层角膜移植 表层角膜镜片术 DOWN综合征 2002年 角膜地形图 前房深度 急性圆锥角膜 中华眼科杂志 发病年龄 眼轴长度 1993年 回顾性调查 2000年 全身并发症 发病特点 病历资料 山东地区 

分 类 号：R772.21[医药卫生—眼科]