20岁以下学生高度近视眼底改变自然病程转归的观察  

The natural course of high myopic fundus degenerative appearances in Chinese teenagers of 20 years old age

作　　者：石一宁[1] 方严[2] 王云[2] 

机构地区：[1]陕西省人民医院眼科,西安710068 [2]安徽省淮南市第一人民医院安徽眼科研究所

出　　处：《临床眼科杂志》2010年第1期1-6,共6页Journal of Clinical Ophthalmology

基　　金：安徽省卫生科技立项项目(编号2008B086)

摘　　要：目的对国人高度近视眼形成初期眼底退行性病变自然病程观察,即20岁年龄组屈光度、眼轴、眼球形态下的眼底改变演化趋势。方法入选学生包括:20岁以下、屈光度-6 D(10岁以下-4 D)、眼轴25 mm(10岁以下24 mm)。并将年龄分为3组:～10岁组,～15岁组,～20岁组。对门诊查体和就诊学生76只眼进行眼底照相、A/B超、验光等相关眼科检查,记录并归纳整理。SPSS10.0统计。根据眼底镜、眼底照相、Heidelberg HRA2激光扫描眼底荧光造影系统进行荧光/吲哚青绿血管造影检查,将眼底形态分为4组:无变化、黄斑局限病灶、豹纹状眼底、后极广泛病灶或混合(即病理性近视)。A/B超仪测量眼轴,并将眼球形态分为无变化、均匀扩张、后巩膜葡萄肿3组。复方托比卡胺散瞳,主观检影验光测定眼屈光度。结果 76例中,眼底改变82%为非病理性改变,病理性改变相对在较稳定的低构成15.8%。(1)～10岁组平均近视度-5.71 D,平均眼轴25.5 mm。但眼轴微小改变(1 mm)时眼底呈现明显改变:-4.5 D(-4.58±2.78),25 mm(25.10±0.71)时可无眼底表现,-8.3 D(-8.33±1.26)、26 mm(25.99±0.99)时即可呈现病理性改变,而-5.5 D(-5.50±1.12)、26 mm(25.99±1.54)时眼底也可呈豹纹状改变。(2)～15岁组眼轴的增长、近视度的增加和年龄的增长与眼底演变呈较陡的线性关系,平均近视度-7.89 D,平均眼轴27 mm;但度数-6 D(可到-8 D,-5.25±3.46)、眼轴26 mm(大到29 mm,25.81±2.09)可以无眼底改变,且波动范围较大;-15 D(-15.13±3.01)、29 mm(29.10±1.87)可呈现病理性改变,发展至-8.75 D(-8.75±4.09)、28 mm(28.08±1.48)眼底仅呈现豹纹状改变。(3)～20岁组,平均近视度在高度近视-9.68 D,平均眼轴27.5 mm。但发展至-8 D(-6.73±1.78)、26 mm(24.84±1.40)时仍可以无眼底改变,-15D(-14.42±6.37)、30 mm(30.69±1.11)可呈现病理性改变,-10 D(-9.68±4.03)、28 mm(27.53±1.29)眼底仅呈现豹纹状改变。(4)3组间,～15岁组无眼Objective To observe the natural course of fundus appearances in the high myopia eye in initial period, including the fundus changes development followed with refraction error, axis of eye, shape of eye ball in Chinese teenagers of 20 years old age. Methods The enrolled included younger than 20 year old school kids, their refraction error were over -6 D（ -4 D below lO-year-old） , and the eyeball axis were over 26mm（24mm below 10-year-dd）. They were divid- ed 3 groups： - 10 year- old, - 15 year-old, and -20 year-old. The fundus appearances were divided into 4 groups among 76 school students, negative, focal lesions, tessellation, and pathologic changes , according to the KOWA fundus camera and Heidelberg HRA2 fluoreceine angiophotography. At the meantime, myopic severity was over - 6 Dchecked with cycloplegic objective refraction by NIKON SPEEDY-K automatic optometry and retinoscopy, ocular axis and shape of eye ball were measured and recorded by BVI A/B-scan. Of Topcon CT60 The collected data were analyzed statistically. Results The There were 82% cases with the non-pathologic appearances in 76 high myopic teenagers, while diffused pathologic myopias were relatively low in 15.8%. （ 1 ） The average refraction was -5.71 D, the axis 25.5 mm when they were younger than 10-year-old, but 1 mm＇ longitude of eyeball will show significant fundus changes. The eyes with -4.5 D（ -4.58 ±2.78） ,25 mm （25.10 ± 0.71 ） may show no change in fundus, while with -8.3 D（ -8.33 ±1.26） ,26 mm（25.99 ±0.99） have already appeared pathologically, With -5.5 D（ -5. 50 ±1.12 ） ,26 mm（ 25.99±1.54 ） , the hindus may show tessellation change only. （ 2 ） In - 15-year-old group, there was steep linear development among the fundus appearance and eyeball axis, refraction error. The average was -7.89D and 27ram. There may not appear any changes even when refraction reached to -8 D（ -5.25 ±3.46） , axis 28 mm（25. 81 ±2.09）, and may mean the eye can tolerate the axis＇ change in longer interv

关 键 词：20岁在校学生 高度近视 视网膜退行性病变 屈光度 眼轴 A/B超 荧光素眼底血管造影 吲哚青绿眼底血管造影 

分 类 号：R778[医药卫生—眼科]