高度远视性屈光不正患儿首诊原因及临床特点分析  

Analysis of the causes and clinical characteristics of initial diagnosis in children with highly hyperopic refractive errors

作　　者：张永强 艾咏归 刘晓慧 杨孝颖 何娇 Zhang Yong-qiang;Ai Yong-gui;Liu Xiao-hui(Department of Ophthalmology,Beijing Children's Hospital East Branch,Beijing 100022,China)

机构地区：[1]北京东区儿童医院眼科,100022

出　　处：《中国斜视与小儿眼科杂志》2024年第1期31-34,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的 探讨高度远视患儿首诊原因及临床特点,为其临床矫正及屈光性弱视的早期防治提供指导.方法 收集2016年1月至2023年11月高度远视性屈光不正患儿临床资料,研究对象为首次睫状肌麻痹剂检影验光确诊为高度远视(任意一眼SE≥+5.00D)的患儿.对其首诊原因、首次散瞳月龄、屈光状态、视力、眼位及眼部生物测量等进行分析.结果 (1)共收集高度远视患儿临床资料35例,其中男性19例,女性16例.首诊原因:医疗机构常规体检发现屈光异常者15例(42.9%);幼儿园体检视力低下,来医院就诊者4例(11.4%);发现眼斜、对眼、歪头视物等异常症状而就诊者11例(31.4%);因其他眼病就诊,屈光检查异常者5例(14.3%).首次睫状肌麻痹检影验光确诊月龄11~53个月,平均36.54±10.96月.(2)35例(70眼)患者双眼屈光状态均为远视,其中高度远视(SE≥+5.00D)57眼;单眼高度远视者13例(13眼),双眼均为高度远视者22例(44眼).屈光参差21例(60%,21/35),均为复性远视性屈光参差,其中轻度屈光参差12例,高度屈光参差9例.(3)首次散瞳检查时能配合视力检查者23例(SE≥+5.00D者38眼),其中裸眼远视力低下者34眼(89.5%,34/38),仅有4眼(10.5%,4/38)裸眼远视力达标;最佳矫正视力达标者22眼(57.9%,22/38),16眼(42.1%,16/38)最佳矫正视力为低下状态.(4)首次散瞳检查时能配合眼部生物学测量者25例,SE≥+5.00D者39眼,大多表现为轴性远视,平均AL长度20.42±0.69mm.相关分析显示,SE与AL呈明显负相关(r=-0.520,P<0.001),而与平均角膜曲率无明显相关性(r=-0.179,P=0.275).(5)35例高度远视患儿,合并斜视12例,其中调节性内斜视9例,先天性内斜视1例,共同性外斜视2例.结论 婴幼儿高度远视对视力影响明显,主要为轴性远视,可仅表现为单眼或双眼同时发生;患儿易合并复性远视性屈光参差;部分合并调节性内斜视.加强婴幼儿早期屈光筛查,发现异常症状并及时就诊,有利于屈光Objective To explore the causes and clinical characteristics of initial diagnosis in children with high hyperopia,providing guidance for their clinical correction and early prevention and treatment of refractive amblyopia.Methods Collect clinical data of children with highly hyperopic refractive errors from January 2016 to November 2023.The study subjects were children diagnosed with high hyperopia(SE≥+5.OOD in any eye)through the first ciliary muscle paralysis examination.Analyze the reasons for the first diagnosis,the age of the first dilated pupil,refractive status,visual acuity,eye position,and ocular biometric measurements.Results A total of 35 cases of highly hyperopic children were collected,including 19 males and 16 females.Reason for initial diagnosis:15 cases(42.9%)of refractive abnormalities were found during routine medical examinations in medical institutions;4 cases(11.4%)of kindergarten physical examination showed low vision and came to the hospital fortreatment;11 cases(31.4%)were diagnosed with abnormal symptoms such as eye deviation,eye alignment,and crooked head vision;Due to other eye diseases,5 cases(14.3%)had abnormal refractive tests.The first diagnosis of ciliary muscle paralysis was confirmed by retinoscopy and optometry at an age of 11~53 months(36.54±10.96).35 cases(70 eyes)of patients had hyperopia in both eyes,with 57 eyes showing high hyperopia(SE≥+5.00D);13 cases(13 eyes)had high hyperopia in one eye,and 22 cases(44 eyes)had high hyperopia in both eyes.21 cases(60%,21/35)of anisometropia were all compound hyperopia,including 12 cases of mild anisometropia and 9 cases of high anisometropia.23 cases(38 eyes with SE≥+5.00D)were able to cooperate with visual acuity examination during the first dilated pupil examination.Among them,34 eyes(89.5%,34/38)had low naked eye far vision,and only 4 eyes(10.5%,4/38)had good naked eye far vision;22 eyes(57.9%,22/38)achieved the best corrected visual acuity standard,while 16 eyes(42.1%,16/38)had the best corrected visual acuity in a low state

关 键 词：高度远视 屈光不正 临床特点 

分 类 号：R778.1[医药卫生—眼科]