扎实推进中国儿童青少年屈光发育档案的建立

建立屈光发育档案有助于了解儿童青少年群体近视发生发展规律,开展个体化近视防控。目前,全国各地开展儿童青少年屈光发育档案建立工作的有关单位逐渐增加。我们认为,有效组织、科学管理、不断提升技术含量、提高应用价值是其可持续发展的重要前提,强调要注重构建多部门合作共建机制,加强屈光发育档案的完整性、动态更新与规范化管理,进一步开展近视早期预测、早期干预研究与实践转化,积极推广应用眼视光、公共卫生适宜技术及信息科技前沿技术,不断提升档案内涵、拓展外延,切实助力降低儿童青少年近视发病率。     

儿童单纯近视性屈光参差与屈光结构关系的研究

目的　探讨儿童单纯近视性屈光参差与屈光结构之间的关系。方法　测量 43例单纯近视性屈光参差儿童角膜曲率半径、前房深度、晶状体厚度、玻璃体腔及眼轴长度。结果　近视眼玻璃体腔及眼轴长度均长于正视眼 (P <0 0 5 )。结论　在眼球发育过程中 ,眼轴长度差异是形成单纯近视性屈光参差的主要原因     

儿童屈光不正与各屈光参数关系

目的：研究眼轴、角膜屈光力、晶状体屈光力与儿童屈光不正的关系。

方法：通过睫状肌麻痹检影验光及光学生物测量仪(IOL-Master)获得44例88眼的屈光不正度数、眼轴、角膜屈光力、前房深度等参数,经计算得到晶状体度数。按屈光不正度数分为远视组、正视组、近视组,直线相关与回归比较年龄和屈光不正与各屈光参数之间的关系。

结果：受试者44例88眼,平均年龄9.04±2.39岁,等效球镜(SE)-3.50～+8.75D; 远视组眼轴比近视正视组短(P<0.05),远视组晶状体屈光力明显低于近视正视组(P<0.05),三组间角膜屈光力和前房深度无明显差别。本研究发现年龄与等效球镜(SE)之间成负相关; 眼轴与年龄成正相关; 年龄与晶状体屈光力成正相关; SE与眼轴成负相关; SE与晶状体屈光力有负相关关系。

结论：儿童随年龄增长,SE向近视发展,眼轴变长,晶状体屈光力增强; SE越偏远视,眼轴越短、晶状体屈光力越弱。     

青少年儿童屈光参差临床分析

目的:探讨青少年儿童各类屈光参差分布,及各类屈光参差性弱视的治疗。方法:用阿托品扩瞳1wk后检影验光,两眼屈光参差≥3.00D的青少年儿童120例,年龄3～20(平均8)岁。在扩瞳情况下配镜治疗。结果:单纯远视性屈光参差75例,参差范围 3.00～ 8.50(平均 4.00)D,单纯近视性屈光参差32例,参差范围-3.00～-21.00(平均-6.50)D,远视散光性屈光参差2例,参差范围 3.25～ 4.75(平均 4.00)D,近视散光性屈光参差11例,参差范围-3.00～5.00(平均-4.00)D。结论:青少年儿童屈光参差以单纯远视性屈光参差多见,单纯近视性屈光参差范围较大,在扩瞳情况下,带镜均能接受,弱视治疗有不同程度效果。     

中老年近视患者的角膜屈光手术和晶状体屈光手术的选择

目的：探讨中老年近视患者的角膜屈光手术和晶状体屈光手术的选择。方法：两例５０岁以上双眼近视患者的右眼均行白内障除人工晶状体植入术,两者的左眼先行角膜屈光手术,３年后又行白内障摘除人工晶状体植入术。术后随访最短４个月最长４年,对术后情况进行对比、回顾分析。结果;未经角膜屈光手术的白内障摘除人工晶状体植入术的效果最好。结论：近视患者的屈光矫正手术的术式选择,应根据年龄、晶状体情况,近视程度和单、双眼情     

不同类型高度病理性屈光参差屈光要素分析

目的分析不同类型高度病理性屈光参差同例双眼的屈光要素构成差异,探索影响屈光状态的主要因素、相互关系。方法收集136例等效球镜>3.00D的单纯近视性、远视性屈光参差,复性近视性、远视性屈光参差患者的临床资料,按屈光度数不同分为高屈光眼组和低屈光眼组;按屈光状态不同分为近视性屈光参差组(104例)和远视性屈光参差组(32例)。对所有患者双眼进行角膜地形图检查角膜屈光力,眼部A超检查前房深度、晶状体厚度及眼轴长度,对相关数据进行配对t检验,对各屈光要素与眼球屈光度进行多元线性回归分析。结果角膜屈光力近视性屈光参差组双眼相似率为79.81%,高于远视性屈光参差组的68.75%(P<0.05);前房深度近视性屈光参差组双眼相似率为68.27%,远视性屈光参差组为59.38%,二者差异无统计学意义(P>0.05);晶状体厚度近性视屈光参差组双眼相似率为79.81%,远视性屈光参差组为90.63%,二者差异无统计学意义(P>0.05);眼轴长度近视性屈光参差组双眼相似率为12.50%,远视性屈光参差组为18.75%,相似率均较低(P>0.05)。多元线性回归分析示:近视性屈光参差屈光度数与角膜屈光力、晶状体厚度及眼轴长度呈正相关关系(b=0.836、1.406、2.279,均为P<0.05),与前房深度呈负相关关系(b=-2.051,P<0.05);远视性屈光参差屈光度数与角膜屈光力、晶状体厚度及眼轴长度成负相关关系(b=-0.912、-1.389、-2.318,均为P<0.05),与前房深度无显著相关关系(P>0.05)。结论角膜屈光力及眼轴长度是影响眼球屈光状态的主要因素。前房深度及晶状体厚度在眼纵轴线上的位置对眼球屈光状态的影响不容忽视。     

屈光参差眼的屈光结构分析

目的 探讨屈光参差眼屈光要素的差异程度对屈光参差的形成作用.方法 收集双眼等效球镜度数差＞2.00 D的屈光参差患者91例,按屈光参差类型分为远视性屈光参差和近视性屈光参差2组.用日本Topcon KR.8800自动验光仪测量双眼屈光度数和角膜曲率（CC）.用法国Quantel 0459 A型超声生物测量仪测量双眼前房深度（ACD）、晶状体厚度（LT）、玻璃体腔长度（VCL）及眼轴长度（AL）,将患者的双眼进行自身对照观察,所测数据采用配对t检验进行统计学分析.屈光参差眼各屈光要素与年龄及分组的关系采用多元线性回归进行分析,屈光参差眼的屈光要素与眼轴的关系采用偏相关的方法进行分析.结果 屈光参差者双眼之间只有玻璃体腔长度和眼轴长度存在差异（tVCL=9.506、3.654,P均＜0.01 tAL=12.334、3.447,P均＜0.01）.多元线性回归分析发现：屈光参差者双眼的角膜曲率、前房深度都与年龄无关 近视性屈光参差眼的角膜曲率、前房深度都大于远视性屈光参差眼（tK=4.600,P＜0.01 tACD=2.894,P＜0.01）,而晶状体厚度没有差异 2组屈光参差者双眼的角膜曲率、前房深度都与眼轴长度无关,而晶状体厚度与眼轴相关（r=0.358、0.296,P＜0.01）.玻璃体腔的长度与眼屈光状态和眼轴都相关（r=0.975、0.979,P＜0.01）.结论 玻璃体腔长度的变化是屈光参差发生的内在根本原因.     

色觉在眼屈光发育中的作用

作为视觉重要组成部分的色觉在屈光发育中的作用应引起我们的重视。有研究发现,不同单色光与眼球的增长发育和屈光的变化密切相关,长波长光能促进眼球的增长形成相对近视,短波长光能抑制眼球的增长产生相对远视。研究还发现,短波长蓝光可阻止豚鼠光学离焦性近视进展。色光干预引起屈光发育异常的作用机制除了纵向色像差作用外,还可能存在其他作用机制。作为色觉通路第一站的视锥细胞可能在屈光发育及近视形成过程中发挥重要作用,视色素的代谢产物视黄酸可能是影响屈光发育的重要信号因子。研究色觉在眼屈光发育中的作用有助于进一步探讨近视发病机制,也为近视防治研究提供了新的方向。本文对色觉在眼屈光发育中的作用进行综述。     

3～12岁儿童眼轴长度、晶状体屈光力与屈光不正的关系

目的：探讨3～12岁儿童屈光参数发育特点,分析其与屈光不正的相关性。方法：描述性研究。共纳入2017年12月至2018年12月在重庆医科大学附属儿童医院眼科门诊就诊的3～12岁儿童600例 （1 200眼）,通过睫状肌麻痹检影验光及光学生物量仪（IOL-Master）获得等效球镜度（SE）、眼轴长度、角膜屈光力、前房深度,并计算晶状体屈光力。按年龄分成3组,分别为3～6岁组,7～9岁组和10～12岁组。按SE分成5组,分别为远视组、正视组、轻度近视组、中度近视组和高度近视组。 采用独立样本t检验、单因素方差分析及线性回归分析年龄、屈光与各屈光参数的关系。结果：3～6岁组,7～9岁组和10～12岁组SE（F=131.5,P<0.001）及晶状体屈光力（F=276.4,P<0.001）随年龄增长逐渐变小,眼轴长度（F=235.02,P<0.001）、前房深度（F=228.7,P<0.001）随年龄增长逐渐增大,角膜曲率（F=0.01,P=0.66）变化稳定。3组SE与眼轴长度呈负相关（r=-0.80、-0.85、-0.81,均P<0.001）,与晶状体屈光力呈正相关（r=0.98、0.92、0.91,均P<0.001）。轻度近视组,眼轴长度及晶状体屈光力与SE呈正相关性（r=0.545、0.601,P<0.001）;高度近视组眼轴长度及晶状体屈光力与SE呈正相关性（r=0.675、0.784,P<0.001[1]）。矫正年龄和性别后,眼轴长度解释SE 73.6%的变异,晶状体屈光力可解释SE 86.5%的变异。结论：眼轴长度与晶状体屈光力是影响屈光发育和近视发展的主要因素。     

屈光手术在小儿眼科的应用

屈光不正是弱视发病的重要病因.儿童弱视的传统治疗方法是戴镜和遮盖,对于一些特殊儿童群体,如严重屈光参差无法耐受角膜接触镜患儿、神经行为异常疾病患儿、面部发育异常患儿,戴镜和遮盖治疗效果差,且患儿无法配合传统的戴镜及遮盖.近年来,屈光手术历经数次设备及手术技术的变革,已逐渐成为很多患者熟知的眼科手术.1995年Singh首次将准分子激光角膜切削术(PRK)应用于小儿眼科之后,一些学者陆续开始在此领域进行了探索式临床应用.根据解剖部位不同,屈光手术分为角膜屈光手术和晶状体屈光手术.本文就小儿眼科中不同屈光手术术式治疗儿童重度近视性屈光参差、重度远视性屈光参差及双眼近视进行综述,讨论适应证的选择及术后并发症,对手术进行展望,未来随着麻醉技术、手术材料及设备的革新发展,儿童屈光手术将更安全,预测性更好.     

Refractive index of the crystalline lens in young and aged eyes

Background : When the ageing crystalline lens is modelled on the basis of a constant equivalent lens, the changes in ocular dimensions would lead to an increase in power of the order of two dioptres. A comparable increase in myopia is usually not evident with increasing age and this inconsistency has been referred to as the lens paradox. It has been proposed that this paradox can be resolved if the refractive index is modelled as a gradient refractive index. The purpose of this paper was to study differences in the equivalent, gradient and surface refractive index of the crystalline lens between a young and old age group. Methods : Biometric data was collected for 96 subjects: 48 young adults with an age range 19 to 31 years (mean 22.10 ± 2.93 years) and 48 old adults with an age range 49 to 61 years (mean 53.88 ± 3.88 years). The equivalent refractive index was determined for each subject by paraxial ray tracing and a merit function based on refractive error and Purkinje image height. The refractive index gradient was determined by modelling the crystalline lens as a bi-elliptical iso-indicial structure in a three-surface Gullstrand-Emsley schematic eye and a merit function based on the surface power, the gradient refractive index power and the equivalent power of the lens. The central refractive index of the lens was assumed to be 1.406. Results : The differences between the groups included a decrease in the mean equivalent refractive index from 1.427 ± 0.007 to 1.418 ± 0.006, an increase in surface refractive index from 1.386 ± 0.007 to 1.394 ± 0.006 with a concurrent change in the gradient refractive index profile. The refractive index changes maintained a constant mean lens power in each group. Conclusions : The so-called ‘lens paradox’ whereby an increase in the power of the crystalline lens does not lead to an increase in myopia is resolved by a decrease in the equivalent refractive index of the lens or when modelled as a gradient refractive index structure, by an increase in the surface refractive index and an associated change in gradient for an assumed central refractive index of 1.406.     

Refractive lens exchange

Advances in small incision surgery have enabled cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a procedure refined to yield the best possible postoperative refractive result. As the outcomes of cataract surgery have improved, the use of lens surgery as a refractive modality in patients without cataracts (clear lens extraction) has increased in popularity. The removal of the crystalline lens for refractive purposes, or so-called refractive lens exchange (RLE), offers distinct advantages over corneal refractive surgery in selected cases. Nevertheless, in some middle-aged patients with high refractive errors, corneal refractive surgery can be a safe and effective treatment. In addition, the use of multifocal lenses offers an alternative for the correction of presbyopia. A further advantage of RLE is that it simultaneously eliminates the need for cataract surgery in the future. The keys for success in RLE are effectiveness and consistency in the refractive outcome, providing at the same time surgical and postoperative safety. To achieve these goals, adequate indications following strict risk/benefit criteria and refractive precision based on accurate preoperative protocols for IOL calculation and selection are mandatory, together with an appropriate choice of surgical procedure based on the surgeon's skills, minimizing complications.     

屈光性晶状体置换手术治疗高度近视眼的长期疗效观察

目的:通过对高度近视眼透明晶状体摘除人工晶状体植入手术后长期疗效观察,评价该疗法的远期效果及安全性。方法:利用非随机的系列病例回顾性研究,对在两年间接受高度近视眼透明晶状体摘除人工晶状体植入的67例(125眼)患者进行了长达6a的随访研究。所有患者均接受了以矫正高度近视眼为目的透明晶状体超声乳化摘除及低读数或负度数人工晶状体囊袋内植入手术。在术后第1,3,6a,分别观察其视力、屈光度、角膜内皮、后发性白内障及视网膜并发症等方面的变化情况。结果:所有手术没有医源性事故发生;接受手术时患者的平均年龄为42.8岁;术前平均近视屈光度为-15.65D。术后6a随访,较术前自戴眶架眼镜矫正视力提高的占75.7%,没有变化的占10.4%,低于术前自戴眶架眼镜矫正视力的占12.2%。44%有后发性白内障发生,需行Nd∶YAG激光后囊膜切开或后囊膜切除手术;1.6%分别在术后5mo和16mo发生视网膜脱离。术后1a角膜内皮丢失率为1.9%,3a为3.2%,6a为5.9%。结论:有术前全面细致的眼部检查、评估和娴熟的超声乳化手术技术的掌控,透明晶状体摘除手术治疗高度近视眼是安全和疗效满意的。     

Reprint of “The role of the lens in refractive development of the eye: Animal models of ametropia” [Experimental Eye Research 87 (2008) 3-8]

Research with young mammals and chicks has shown that the visual environment can affect the refractive development of the eye by enhancing or slowing axial eye growth, but the effect on the refractive components of the eye, the lens and cornea, are less clear. A review of the literature indicates that the lens is minimally affected, if at all, and results vary depending on whether the lens is studied in an isolated state or with the accommodative apparatus intact. Research has shown that the development of myopia or hyperopia in young chicks alters lens focal length and magnitude of the accommodative response. However, the result may be indirect or passive due to the effect of the change in size and shape of the globe on the articulation between the ciliary body and lens. Recent research has also investigated the role of the lens in induced refractive error development in a fish, tilapia (Oreochromis niloticus). Translucent goggles were sutured over one eye for 4 weeks to induce form deprivation myopia while the untreated eye served as an untreated contralateral control. In addition to measuring refractive state and intraocular dimensions, a scanning laser system was used to determine the optical quality of excised lenses. All the deprived fish eyes developed significant amounts of myopia and the vitreous and anterior chambers of the treated eye were significantly longer axially than those of the untreated contralateral eyes. No significant change in optical quality was found between lenses of the myopic and non-myopic eyes and the fish recovered completely from the myopia five days after the goggle was removed. The results show that although fish, unlike higher vertebrates, are capable of lifelong growth, the visual environment is an important factor controlling ocular development in this group as well, and eye development is not strictly genetically determined. This review indicates that lens growth and optical development is independent from the refractive development of the whole eye.     

眼内屈光手术研究进展

屈光性手术是当前眼科界发展最快的前沿领域之一。其种类繁多,更新较快,而高度近视的屈光性手术对眼科医师来说一直是个挑战。由于准分子激光角膜原位磨镶术（LASIK）等角膜屈光手术在高度近视上的应用受限,加之近年来有晶状体眼人工晶状体技术和屈光性晶状体置换术的进步,使得眼内屈光手术在矫治高度近视、远视及老视等方面已逐步体现出其独特的优越性。就目前其最新研究进展,包括有晶状体眼人工晶状体的种类、手术并发症及其处理,屈光性晶状体置换术手术技术等进行综述。     

The role of the lens in refractive development of the eye: animal models of ametropia

Research with young mammals and chicks has shown that the visual environment can affect the refractive development of the eye by enhancing or slowing axial eye growth, but the effect on the refractive components of the eye, the lens and cornea, are less clear. A review of the literature indicates that the lens is minimally affected, if at all, and results vary depending on whether the lens is studied in an isolated state or with the accommodative apparatus intact. Research has shown that the development of myopia or hyperopia in young chicks alters lens focal length and magnitude of the accommodative response. However, the result may be indirect or passive due to the effect of the change in size and shape of the globe on the articulation between the ciliary body and lens. Recent research has also investigated the role of the lens in induced refractive error development in a fish, tilapia (Oreochromis niloticus). Translucent goggles were sutured over one eye for 4 weeks to induce form deprivation myopia while the untreated eye served as an untreated contralateral control. In addition to measuring refractive state and intraocular dimensions, a scanning laser system was used to determine the optical quality of excised lenses. All the deprived fish eyes developed significant amounts of myopia and the vitreous and anterior chambers of the treated eye were significantly longer axially than those of the untreated contralateral eyes. No significant change in optical quality was found between lenses of the myopic and non-myopic eyes and the fish recovered completely from the myopia five days after the goggle was removed. The results show that although fish, unlike higher vertebrates, are capable of lifelong growth, the visual environment is an important factor controlling ocular development in this group as well, and eye development is not strictly genetically determined. This review indicates that lens growth and optical development is independent from the refractive development of the whole eye.     

Review of current status of refractive lens exchange and role of dysfunctional lens index as its new indication

Advances in phacodynamics and intraocular lenses (IOLs) has given second life to clear lens extraction (CLE) or refractive lens exchange (RLE) in recent years for the treatment of patients with high degrees of myopia, hyperopia, and astigmatism who are unsuitable for laser surgery. Furthermore, presbyopia treatment with RLE supplemented with multifocal or accommodating IOLs gives the dual benefit of correcting refractive errors with eliminating the need for cataract surgery. RLE should be consistent and effective for a good refractive outcome along with safety during the surgical procedure and in the postoperative period. Therefore, proper patient selection and accurate preoperative protocols for IOL power calculations and selection are important along with an appropriate choice of surgical procedure. Dysfunctional lens index is a new objective tool that helps surgeon to aid in diagnosing, counseling, and educating patients with dysfunctional clear lens. In this article, we give a brief overview about the application of RLE for individuals with presbyopia and refractive errors like myopia, hyperopia, and astigmatism who are not suitable for laser correction.     

眼内屈光手术治疗超高度近视的现状

超高度近视的具体病因尚不清楚,用框架眼镜矫正具有视野狭小、物像畸变、镜片厚重配戴不便等缺点,准分子激光手术因角膜本身条件受限不能进行充分矫正。而近年来晶状体相关的屈光手术矫正超高度近视均获得了较满意的效果,我们就目前各类眼内晶状体相关的屈光手术的优缺点和治疗现状作一综述。     

Effect of hyperbaric oxygen on guinea pig lens optical quality and on the refractive state of the eye

The main objective of this study was to investigate the effect of in vivo hyperbaric oxygen (HBO) treatment of albino guinea pigs on ocular refractive state and optical properties of the lens in vitro, as well as on the integrity of the mitochondria of the lens. The animals were treated 30-35 times (2.5-3 months) or 70 times (6 months) with HBO. An increased level of lens nuclear light scattering was evident by slit-lamp at 30 treatments, and this increased at 70 treatments. After 30-35 HBO treatments a myopic shift in refractive state of the eye was seen in two separate studies with two different refractionists. Also, the average back vertex distance of the lens was significantly shorter after 35 HBO treatments while spherical aberration (focal variability) increased after 70 treatments. No difference in refractive state was noted after 70 HBO treatments (a reversal of the initial myopic effect). The mitochondrial distribution and morphology of the lens epithelium and the superficial cortical fibre cells were normal after both 35 and 70 HBO treatments, highlighting that HBO treatment does not affect the superficial cortex of the lens. The results of the in vitro lens optical analysis carried out in this study correlate with the myopia observed after 30-35 HBO in vivo treatments. A similar reversible myopia and increase in lens nuclear light scattering is known to occur in humans treated with HBO for extended periods and the results suggest that the myopia was caused by a change in the refractive index of the lens. The significant loss of sharp focus after 70 HBO treatments can be correlated with previous reports of biochemical and morphological changes associated with HBO-induced loss of lens nuclear transparency in mature guinea pigs. The guinea pig HBO model may be a useful approach for the study of lens development and refractive error.