基于体检中心的中小学生“小瞳检影筛查近视+后续佩戴角膜塑形镜”流程效果分析  

Effect of“noncycloplegic retinoscopy for screening myopia+subsequent wearing orthokeratology lens”process for primary and secondary school students based on physical examination center

作　　者：郭萍[1] 张懿[2] 李敏敏[1] 王剑超 田澍蔚 GUO Ping;ZHANG Yi;LI Minmin;WANG Jianchao;TIAN Shuwei(Department of Health Management,the Second Affiated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710015,P.R.China;Shaanxi Key Laboratory of Ophthalmology,the First Hospital of Xi'an,Xi'an,Shaanxi 710002,P.R.China;Department of Ophthalmology.the Second Affiliated Hospital of Xi'an liaotong University,Xi'an,Shaanxi 710004,P.R.China)

机构地区：[1]西安交通大学第二附属医院健康管理部,西安710015 [2]西安市第一医院眼科/陕西省眼科学重点实验室,西安710002 [3]西安交通大学第二附属医院眼科,西安710004

出　　处：《华西医学》2020年第12期1484-1489,共6页West China Medical Journal

摘　　要：目的探讨基于体检中心的中小学生"小瞳检影筛查近视+后续佩戴角膜塑形镜"流程的效果。方法将2017年1月—2018年12月于西安交通大学第二附属医院健康管理部(即体检中心)进行视力检查的172例中小学生作为研究对象,受试者首先于健康管理部接受小瞳检影,随后于眼科接受散瞳检影,比较2种检影结果的一致性。将小瞳检影及散瞳检影均诊断为近视的93例随机分为对照组46例及试验组47例,分别配戴框架眼镜和角膜塑形镜,比较两组配镜前的屈光度、眼轴长度、角膜曲率及玻璃体腔深度,以及配镜后3、6、12个月时的屈光度增量、眼轴长度增量、角膜曲率及玻璃体腔深度,并比较两组并发症的发生情况。结果以散瞳检影为金标准,小瞳检影的阳性预测值为88.6%,灵敏度为96.9%,特异度为84.2%,与散瞳检影存在一致性(kappa=0.821,P<0.001)。配镜前,两组双眼的屈光度、眼轴长度、角膜曲率及玻璃体腔深度差异均无统计学意义(P>0.05);配镜后3、6、12个月时,试验组左眼屈光度增量分别为(0.48±0.07)、(0.69±0.13)、(0.88±0.11)D,左眼眼轴长度增量分别为(0.18±0.05)、(0.22±0.04)、(0.27±0.05)mm,右眼屈光度增量分别为(0.46±0.10)、(0.71±0.12)、(0.90±0.10)D,右眼眼轴长度增量分别为(0.17±0.04)、(0.23±0.04)、(0.26±0.05)mm,对照组上述指标分别为(0.73±0.08)、(1.04±0.11)、(1.13±0.11)D,(0.26±0.04)、(0.36±0.04)、(0.40±0.05)mm,(0.73±0.09)、(1.04±0.10)、(1.17±0.11)D,(0.24±0.04)、(0.37±0.04)、(0.42±0.05)mm,组间差异均有统计学意义(P<0.05)。试验组配镜后3、6、12个月时双眼角膜曲率及玻璃体腔深度的变化趋势与对照组不同(P交互<0.05),其各时点双眼角膜曲率均低于配镜前且均低于对照组,差异均有统计学意义(P<0.05),其各时点双眼的玻璃体腔深度与配镜前比较差异均无统计学意义(P>0.05)但均低于对照组(P<0.05)。两组常见并发症的发生�Objective To investigate the effect of"noncycloplegic retinoscopy for screening myopia+subsequent wearing orthokeratology lens"process for primary and secondary school students based on physical examination center.Methods A total of 172 primary and secondary school students undergoing vision examination in the Health Management Department(i.e.physical examination center)of the Second Affiliated Hospital of Xi’an Jiaotong University between January 2017 and December 2018 were selected as the research objects.After examination by noncycloplegic retinoscopy in the health management department,they were examined by mydriatic retinoscopy in the ophthalmology department,and then the consistency of the results of the two methods was analyzed.Then 93 students with myopia diagnosed by both methods were randomly divided into control group(n=46)and trial group(n=47),wearing frame glasses and orthokeratology lenses respectively.The diopter,eye axial length,corneal curvature and vitreous cavity depth before wearing glasses,as well as the increment of the above indicators at 3,6 and 12 months after wearing glasses/lenses were compared between the two groups,and the incidence of complications of the two groups were compared.Results Compared with mydriatic retinoscopy,the positive predictive value of noncycloplegic retinoscopy was 88.6%,the sensitivity was 96.9%and the specificity was 84.2%,and the consistency kappa coefficient was 0.821(P<0.001).Before wearing glasses/lenses,there was no significant difference in diopter,eye axial length,corneal curvature or vitreous cavity depth of both eyes between the two groups(P>0.05);at 3,6 and 12 months after wearing glasses/lenses,the diopter increment and eye axial increment of both eyes of the trial group were less than those of the control group[left eye diopter increment:(0.48±0.07)vs.(0.73±0.08)D,(0.69±0.13)vs.(1.04±0.11)D,(0.88±0.11)vs.(1.13±0.11)D;left eye axial increment:(0.18±0.05)vs.(0.26±0.04)mm,(0.22±0.04)vs.(0.36±0.04)mm,(0.27±0.05)vs.(0.40±0.05)mm;right eye d

关 键 词：小瞳检影 散瞳检影 角膜塑形镜 近视 

分 类 号：R179[医药卫生—妇幼卫生保健]