中青年近视人群全眼散光、角膜散光和眼内散光的分布特征及相关性  

The Distribution and Correlation of Refractive Astigmatism,Corneal Astigmatism and Internal Astigmatism in Young and Middle-Aged Myopic Individuals

作　　者：谭诗敏 张亚荣 王馨笛 蔡艳[1] 范依萌 刘钊[1] 康前雁[1] 裴澄[1] 米生健 Shimin Tan;Yarong Zhang;Xindi Wang;Yan Cai;Yimeng Fan;Zhao Liu;Qianyan Kang;Cheng Pei;Shengjian Mi(Department of Ophthalmology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Ophthalmology,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,China)

机构地区：[1]西安交通大学第一附属医院眼科,西安710061 [2]安康市中医医院眼科,安康725000

出　　处：《中华眼视光学与视觉科学杂志》2024年第12期881-887,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：陕西省重点研发计划(2023-YBSF-568);陕西省自然科学基金(2024JC-YBQN-0962);中央高校基本业务费项目(XZY012022117);西安交通大学医学基础-临床融合创新项目(YXJLRH2022037)

摘　　要：目的:观察并探讨中青年近视人群的全眼散光(RA)、角膜散光(CA)和眼内散光(IA)的分布特征及相关性。方法:系列病例研究。连续纳入2020年4月至2021年4月在西安交通大学第一附属医院眼科屈光手术中心就诊的所有近视患者881例(881眼,均为右眼),年龄18~51岁。收集显然验光得到的RA、Sirius眼前节三维成像分析系统测量的CA和角膜前表面散光(ACA),并根据Thibos矢量方法计算IA和眼内残余散光(ORA)。采用Wilcoxon符号秩和法检验|IA|和|ORA|间差异。引入补偿因子(CF)衡量IA对CA的补偿作用。使用Spearman秩相关分析研究3种散光矢量分解值的相关性。结果:所有近视患者|RA|值为(0.79±0.67)D,|CA|值为(0.92±0.60)D,|IA|值为(0.47±0.26)D。|ORA|值高于|IA|,二者差异有统计学意义(Z=-11.02,P<0.001)。RA、CA和IA大小≥0.75 D者的占比分别为50.7%、52.7%和15.7%。RA和CA以顺规散光为主,IA以逆规散光为主。相较于|RA|>1.0 D,当|RA|≤1.0 D时,IA对RA的贡献更大。无论是J_(0)还是J_(45),RA与CA的相关性均强于RA与IA(J_(0):r_(RA-CA)=0.81,P<0.001;r_(RA-IA)=-0.43,P<0.001。J_(45):r_(RA-CA)=0.64,P<0.001;r_(RA-IA)=-0.59,P<0.001)。进一步分析发现,CF0和CF_(45)表现为补偿关系(0.1≤CF<2)的占比分别为62.82%和63.92%。CF0以补偿不足最多(43.96%),CF_(45)以完全补偿最多(32.94%)。结论:在中青年近视人群中,人眼散光成分以CA为主。RA越小,IA对RA的贡献越大。无论是在J_(0)分量还是J_(45)分量上,RA均与CA呈正相关。IA对CA主要起补偿作用,在J_(0)分量上以补偿不足为主,在J_(45)分量上,以完全补偿为主。Objective:To investigate the distribution and correlation of refractive(RA),corneal(CA)and internal astigmatism(IA)in a young and middle-aged myopic population.Methods:We conducted a serial case study,consecutively enrolling 881 myopic patients(811 right eyes)who presented at the Ophthalmology Refractive Surgery Center of the First Affiliated Hospital of Xi'an Jiaotong University from April 2020 to April 2021.RA were obtained from manifest refraction.CA and anterior corneal astigmatism(ACA)were measured with 3D ocular anterior segment analyzer Sirius.IA and ocular residual astigmatism(ORA)were derived from Thibos vector analysis.The Wilcoxon signed rank-sum test was employed to compare the difference between|IA|and|ORA|.The compensation factor(CF)was introduced to assess the compensatory effect of IA on CA.The Spearman's rank correlation coefficient test was employed to investigate the correlation among the 3 types of astigmatism vector decomposition values.Results:The values of|RA|,|CA|and|IA|in myopic patients were(0.79±0.67)D,(0.92±0.60)D,and(0.47±0.26)D,respectively.The value of ORA was significantly higher than that of IA(Z=-11.02,P<0.001).The percentages of eyes with RA,CA and IA≥0.75 D were 50.7%,52.7%,and 15.7%,respectively.RA and CA were mainly with-the-rule,while IA was primarily against-the-rule.Compared to cases where|RA|>1.0 D,contribution of IA to RA was higher when|RA|≤1.0 D.The correlation between RA and CA was stronger than that between RA and IA for both J_(0) and J_(45)(J_(0):r_(RA-CA)=0.81,P<0.001;r_(RA-IA)=-0.43,P<0.001.J_(45):r_(RA-CA)=0.64,P<0.001;r_(RA-IA)=-0.59,P<0.001).Further analysis revealed that the proportions of compensatory effect(0.1≤CF<2)were 62.82%and 63.92%for CF 0 and CF_(45) respectively.For CF 0,the majority of CF values were under compensation(43.96%).For CF_(45),the full compensation(32.94%)was the most common category.Conclusions:In the young and middle-aged myopic population,CA was the most significant contributor among all components of astigmatism.The smaller

关 键 词：近视 散光 全眼散光 角膜散光 眼内散光 

分 类 号：R778[医药卫生—眼科]