Ocular injuries secondary to motor vehicle accidents

PURPOSE: Ocular trauma is one of the main causes of visual reduction or loss, particularly in the younger population. METHODS: In this prospective study the authors included 67 consecutive patients with ocular trauma secondary to motor vehicle accidents who were hospitalized in the Athens University Eye Clinic from September 1993 to December 1996. The mean follow-up time was 31 months, the mean age was 31.7 years, and the ratio between men and women was 2.7:1. RESULTS: Thirty-two of the accidents (47.76%) took place in populated areas. Among the 67 injured persons, 58 (86.56%) were car passengers, 8 (11.95%) were on motorcycles, and 1 (1.49%) was a pedestrian. Only 3 (5.2%) of the 58 persons injured inside automobiles used safety belts and none of the motorcyclists used crash helmets during the accidents. Fifty-three (79.1%) ocular traumas were penetrating in nature, with glass fragments being the main cause in 36 of them (67.9%). Among the 53 injured persons experiencing penetrating ocular trauma, 49 had a follow-up time of more than 6 months. Twenty of them (40.8%) underwent one surgical procedure, 22 (44.9%) were submitted to two surgical procedures, and the remaining 7 persons (14.3%) needed three or more operations. Eighteen (36.7%) of the 49 patients with penetrating ocular trauma and with 6 months follow-up had a final visual acuity of less than 1/20, 21 (42.9%) had a visual acuity of more than 5/10, and 3 (6.1%) underwent enucleation. Among the 67 patients, 61 had a follow-up time of more than 6 months, regardless of their history of penetrating ocular trauma. Eighteen of them (29.5%) had a final visual acuity of less than 1/20, 8 (13.1%) had a visual acuity between 2/10 and 4/10, and 22 (52.5%) had a visual acuity of more than 5/10. CONCLUSIONS: Because motor vehicle accidents can cause severe ocular trauma, it would be helpful for drivers to be more careful and aware of motor vehicle regulations. There seems to be a great need of enforcement of seatbelt laws in Greece.     

Shedding light on night myopia

First described during the 18th century, the cause of night myopia remains a controversial topic. Whereas several explanations have been suggested in the literature, particularly related with accommodation or chromatic shift in scotopic light conditions, no definitive explanation for its aetiology has been provided. We describe an experiment in which ocular refractive state was objectively and subjectively measured while viewing two kind of stimulus: letters on a bright background and a punctual source of light in a dark background. We found that under photopic conditions the optimum refractive state of the accommodating eye is significantly more myopic when maximizing perceived quality of a point source on a dark background compared to a conventional letter chart with black letters on a white background. Optical modeling suggested this difference in refractive state is due to spherical aberration. Since isolated point sources are more likely encountered at night, whereas extended objects are more likely encountered in the daytime, our results suggest that a significant part of the night myopia phenomenon is determined by the nature of the visual stimulus and the visual task used to assess ocular refractive state.     

LASIK术前瞳孔大小与术后夜间眩光的关系

目的探讨行双眼准分子激光原位角膜磨镶术(LASIK)者术前瞳孔大小与术后夜间眩光的关系。方法将240例(480眼)按近视屈光度分为2组:组Ⅰ(低、中度近视组)-1.00D~-6.00D;组Ⅱ(高度近视组)-6.25D~-12.50D。以TOPCON Auto Kerato_Refractometer KR-8100测定240例(480眼)近视眼术前暗环境中的瞳孔大小,分析所得数据。记录术前、术后的屈光度和最佳矫正视力(BCVA)。术后3月随访时,患者填写一份术后夜间眩光的问卷。结果双眼平均BCVA手术前后差异无统计学意义(P>0.05)。低、中度近视组平均暗视瞳孔直径(6.24±0.72)mm;高度近视组平均(7.33±0.41)mm,两组差异有统计学意义(P<0.01)。术后夜间眩光与术前暗环境中大的瞳孔明显相关(P<0.01)。术后夜间眩光与性别亦有显著相关性(P<0.05),男性术后夜间眩光发生率大于女性。结论LASIK术前暗环境中大的瞳孔与术后夜间眩光有关联。因此对行LASIK手术的近视患者应进行术前瞳孔大小的评估。     

高度近视与原发性开角型青光眼

目的:从流行病学、临床特征及诊断、遗传学说及机制等方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述。方法:仔细分析了28篇原文,总结出高度近视与原发性开角型青光眼的可能机理。结果:高度近视与原发性开角型青光眼密切相关,其可能的机制有:①升压基因学说。②胶原基因学说。结论:高度近视与原发性开角型青光眼密切相关,根据TIGR基因理论和胶原基因理论,高度近视与原发性开角型青光眼都与TIGR基因突变和胶原疾病有关。     

光照与近视发生发展的关系

光是视觉信号产生的基础。不良的光照现象对眼屈光状态的发育有重要影响。随着近视眼的低龄化发病趋势,视觉环境中光的因素已经成为近视发生和发展的重要环节。光照强度、频率、周期节律变化以及不同光波长均与近视的发生和发展有着密切关系。本文就光照的上述基本属性参数与近视关系的研究进行综述。     

近视屈光度与非接触眼压关系的临床研究

目的:观察近视度数与非接触眼压测量值之间的关系。方法:选择我院门诊就诊及体健的近视患者127例254眼,年龄12～45(平均32.2±7.7)岁。测量非接触眼压及验光检查近视屈光度。按照等效球镜(spherical equivalent,SE)的度数分为低度近视组(LM)(-3.00D-0.25D,n=46)作为无近视组(NM)。应用SPSS11.5统计软件用方差分析比较4组眼压的差别,应用相关直线回归分析方法分析近视眼眼压与近视度数之间的关系,应用χ2检验对近视以及非近视组的高眼压患者所占比率进行统计分析。结果:眼压测量值非近视组(15.32±3.07)mmHg明显低于低度近视组(16.46±2.85)mmHg,P=0.032和中度近视组(17.90±3.37)mmHg,P<0.01,差异有统计学意义;与高度近视组(16.12±2.54)mmHg,差异无统计学意义P=0.295,中度近视组眼压高于其他3组,差异有统计学意义,P值分别为0.002,0.013,<0.01,所有近视患者近视度数与眼压之间无明显相关性,P=0.543,近视患者高眼压(眼压>21mmHg)患者(18眼)占8.6%,对照组非近视患者中高眼压患者占2.5%,差异有统计学意义,P<0.01。结论:利用非接触眼压仪测量眼压,近视患者会比非近视患者更容易出现高眼压,中度近视患者眼压最高,高度近视患者测量值同无近视患者相比无差异,其原因有待于进一步研究。     

近视眼患者379例角膜曲率的多因素分析

目的:探讨近视眼患者角膜曲率及其相关影响因素。方法:近视眼患者379例746眼,分别做角膜地形图检查获取角膜曲率、测量近视屈光度、中央角膜厚度和非接触眼压,将所得结果进行统计分析。结果:近视眼患者角膜曲率(轻度43.0±1.3D,中度43.3±1.6D,高度44.1±1.2D)比较有明显统计学意义(F=30.90,P=0.000);角膜厚度(轻度546±41μm,中度541±32μm,高度535±30μm)轻度与高度近视组差别有统计学意义(P=0.002);眼压(轻度14.3±2.6mmHg,中度14.0±2.4mmHg,高度14.0±2.2mmHg)3组间比较差别无统计学意义。男、女之间角膜曲率(男43.1±1.3D,女44.0±1.5D)、中央角膜厚度(男546±34μm,女534±32μm)、眼压(男14.7±2.5mmHg,女13.4±2.1mmHg)等比较差别均有明显统计学意义(均P=0.000)。角膜曲率(Y)与近视屈光度(X1)、角膜厚度(X2)、眼压(X3)之间均有高度相关性(Y=46.462+0.114X1-0.0051X2-0.0597X3)。近视屈光度与角膜厚度、眼压之间无相关性;而角膜厚度(X)与眼压(Y)之间有高度相关性(Y=0.036X-5.437)。结论:近视眼患者角膜曲率与性别、近视屈光度、角膜厚度和眼压等因素均存在显著相关性。     

Simulation of night myopia in pseudophakic eyes

PURPOSE: Eyes with an intraocular lens (IOL) implanted that have no accommodative ability are likely to have night myopia caused by Purkinje's shift and chromatic aberration. We evaluated the changes in retinal images caused by night myopia in various IOL-implanted eyes by simulation using model eyes. METHODS: A polymethylmethacrylate (PMMA) IOL, soft acrylic IOLs, and high-refractive-index silicone IOLs were prepared, and inserted into the model eye. The image plane of the model eye was determined as the line image at which a slit light of 560 nm was best focused, which was regarded as emmetropic condition under photopic vision. A slit light of 505 nm was then directed into the model eye. Its line image on the image plane was blurred, which was regarded as myopic condition under scotopic vision. Under each condition, the modulation transfer functions (MTF) were calculated and the line images were photographed. RESULTS: The degree of reduction of MTF and blurring of the line image under the night myopic condition was in the order of PMMA < soft acrylic < high refractive index silicone IOL. CONCLUSION: Eyes with a soft acrylic or high-refractive-index silicone IOL may have more intense night myopia caused by chromatic aberration.     

病理性近视与LAMA1基因相关性的研究

目的:探讨病理性近视与LAMA1基因之间的相关性。方法:收集汉族病理性近视患者及正常人外周静脉血,提取全基因组DNA,采用聚合酶链反应-单链构象多态性方法,对标本中LAMA1基因第27外显子、第36外显子的基因序列进行扩增及直接测序分析,应用SHEsis软件检验两组样本是否符合哈迪-温伯格平衡(Hardy Weinberg Equilibrium,HWE),通过Fisher确切概率检验病理性近视与LAMA1基因的相关性。结果:本研究中LAMA1基因第27外显子、第36外显子未发现有意义的突变。结论:LAMAl是否可被确认为病理性近视的致病基因尚需更深入的探究。     

眼正负相对调节力比值变化与近视眼发病关系的研究

目的 选择同年龄段、同等学历的大学生测量不同屈光组眼正、负相对调节力及其比值等调节参数,分析其与近视眼的发病的关系.方法 同意被检查入校新生292人,平均年龄( 18.76±0.80)岁.正视组29人,低、中、高度近视组分别为118、82、37人;26人远视及屈光参差者被排除.被检者在电脑验光基础上,使用综合验光仪进行主觉验光,并测其调节幅度、正负相对调节力.结果 正视组正相对调节力(PRA)均值(-.4.87±1.47)D,低、中、高度近视组正相对调节力均值分别为(-2.36±1.21)D、(-2.92±1.40)D、(-2.86±1.81)D,不同近视组PRA比正视组均有显著降低(F=24.54,p=0.00);正视组负相对调节力(NRA)均值(+2.09±0.46)D,低、中、高度近视组负相对调节力均值分别为(+1.99±0.51)D、(+1.95±0.45)D、(+1.99±0.47)D,各组比较差异无统计学意义(F=0.58,P=0.63);正视组PRA/NRA的比值均值为2.35±0.51,低、中、高度近视组PRA/NRA的比值均值分别为1.21±0.66、1.53±0.76、1.49±0.95,不同近视组PRA/NRA的比值比正视组均有显著降低(F =19.06,P=0.00).结论 同年龄段、同等学历大学生近视组的正负相对调节力比值、正相对调节力明显低于正视组.近视眼的正负相对调节力比值及正相对调节力下降是近视眼发病的共同特征.     

近视眼中央前房深度的多因素分析

目的探讨近视眼患者中央前房深度及其相关影响因素。方法用OrbscanⅡz眼前节分析诊断系统对63例（125只眼）近视眼患者中央前房深度（ACD）、角膜横径（WTW）、瞳孔直径进行测量,并测量等效球镜度（SE）、角膜屈光力、中央角膜厚度（CCT）和非接触眼压,对结果进行统计分析。结果平均ACD（3.18&#177;0.21）mm,男性平均ACD（3.24&#177;0.22）mm,女性平均ACD（3.10&#177;0.18）mm,两者比较差异有统计学意义（P=0.05）,ACD深度与WTW、瞳孔直径相关系数分别为r=0.611、0.229,P=0.000、0.01,ACD与SE、CCT、眼压相关系数分别为r=0.043、0.047、0.087,P=0.633、0.605、0.334,ACD与年龄、角膜中央平均K值相关系数分别为r=-0.351、-0.275,P=0.000、0.002。结论ACD与WTW、瞳孔直径正相关,与年龄、角膜中央平均K值呈负相关,与SE、CCT、眼压无相关性。     

Pupil size and night vision disturbances after LASIK for myopia

PURPOSE: To examine whether standardized, preoperative evaluation of pupil sizes can predict the risk of night vision visual disturbances after bilateral laser in situ keratomileusis (LASIK) for myopia. METHODS: A prospective study was carried out involving 46 patients who underwent bilateral LASIK for myopia. Pupil sizes were measured before surgery using an infrared pupillometer under standardized settings. Pre- and postoperative refraction and best spectacle-corrected visual acuity (BSCVA) were registered. At the 3-month follow-up visit, the patients completed a questionnaire regarding night vision pre- and postoperatively. RESULTS: The mean bilateral, spherical equivalent refraction (SE) was - 8.76 D (range 6.32 to - 12.0 D) preoperatively, and - 1.69 D (range 0 to - 4.38 D) postoperatively. The mean bilateral BSCVA was not changed by the operations. We found a significant correlation between large scotopic pupil sizes and the impression of worsened night vision (p < 0.01). A significant correlation between gender (males) and subjectively reduced night vision postoperatively was also found (p < 0.05). CONCLUSION: Large pupil size measured preoperatively is correlated with an increased frequency of subjectively experienced post-LASIK visual disturbances during scotopic conditions. We recommend preoperative evaluation of pupil size in all patients prior to LASIK surgery.     

青少年近视患者视网膜厚度与屈光度的关系研究

目的：探讨青少年近视患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度与等效球镜数(spherical equivalent,SE)以及眼轴长度(axial length,AL)的关系。

方法：本研究纳入对象为2015-12/2017-12于我院诊断的100例200眼青少年近视患者,按SE<-3.00D、-3.00D≤SE≤-6.00D、SE>-6.00D设为低、中、高度近视组,分别为34例68眼、36例72眼、30例60眼,选择30例60眼正常视力青少年设为对照组。光学相干断层成像术(optical coherence tomography,OCT)测量所有待检者上、下、鼻、颞4个象限RNFL厚度以及视盘全周平均RNFL厚度,采用A超测量AL,并通过Pearson相关分析法对视盘全周平均RNFL厚度与SE绝对值、AL的相关性进行分析。

结果：低度组、中度组、高度组的上、下、鼻、颞4个象限RNFL厚度以及视盘全周平均RNFL厚度均显著低于对照组,差异有统计学意义(P<0.05),低度组、中度组、高度组RNFL厚度逐渐降低,组间比较差异有统计学意义(P<0.05); 低度组、中度组、高度组SE逐渐降升高,组间比较差异有统计学意义(P<0.05),均显著高于对照组,差异有统计学意义(P<0.05); 对照组、低度组、中度组、高度组AL逐渐升高,组间比较差异有统计学意义(P<0.05); 视盘全周平均RNFL厚度与SE绝对值呈负相关(r=-0.564,P<0.001),与AL呈负相关(r=-0.423,P<0.001)。

结论：RNFL厚度与SE和AL呈负相关关系,提示RNFL厚度越薄青少年近视患者近视越严重。     

近视患者晶状体参数与眼部解剖特征参数的关系

目的：了解行有晶状体眼后房型人工晶状体植入术的近视患者晶状体参数与其眼部解剖特征参数的关系。

方法：回顾性研究。收集2022-06/2023-06在无锡华厦眼科医院行有晶状体眼后房型人工晶状体植入术的近视患者46例46眼。术前评估眼部解剖特征参数包括角膜中央厚度(CCT)、前房深度(ACD)、眼轴长度(AL)等前后径,水平角膜直径(WTW)、水平沟到沟直径(STS_H)、水平角到角直径(ATA_H)等水平径,以及垂直沟到沟直径(STS_V)、垂直角到角直径(ATA_V)等垂直径,晶状体参数包括水平晶状体矢高(CLR_H)、垂直晶状体矢高(CLR_V)、水平晶状体厚度(LT_H)、垂直晶状体厚度(LT_V),并分析上述参数的差异性、一致性及相关性。

结果：除WTW与STS_V、STS_H与ATA_V无显著差异(均P>0.05)外,其余水平径与垂直径眼部解剖特征参数均有差异(P<0.05); CLR_H与CLR_V有显著差异(P<0.01),但LT_H与LT_V无差异(P>0.05)。Bland-Altman一致性分析结果显示,水平径、垂直径眼部解剖特征参数一致性较差; CLR_H与CLR_V一致性较差; LT_H与LT_V一致性较好,其差值的95%一致性界限(LoA)为-0.21-0.28 mm,95% LoA线外点比例为4.35%。Pearson相关性分析结果显示,水平径与垂直径眼部解剖特征参数间均有相关性(P<0.01),前后径参数均无相关性(P>0.05); 除CLR_H与LT_H、LT_V无相关性外,其余晶状体参数均有相关性(P<0.05); AL与水平径和垂直径眼部解剖特征参数均具有相关性(P<0.05),但与晶状体参数均无相关性(P>0.05)。多元线性回归分析显示,LT=0.419+0.017×年龄-0.548×ACD+0.371×ATA_H+0.884×CLR_V,CLR_H=-0.443+0.809×CLR_V,CLR_V=-0.092-0.200×ATA_H+0.560×CLR_H(校正R²=0.458、0.482、0.589)。

结论：水平径、垂直径眼部解剖特征参数不可互相替代; CLR_H、CLR_V不可互相替代,而LT_H、LT_V可互相替代。部分晶状体参数、WTW、STS、ATA与ACD相关,而年龄、ACD、ATA_H、CLR_V是LT的影响因素。     

近视患者LASIK术后夜间眩光的相关因素

目的:探讨近视患者LASIK术后发生夜间眩光的术前相关因素。方法:将665例(1257眼)近视患者按屈光度分为两组:组Ⅰ(低、中度近视)-1.00～-6.00D;组Ⅱ(高度近视)-6.25～-14.25D。以ObscanⅡ眼前节分析系统测量术前暗光下瞳孔直径,所有手术均为标准的LASIK手术,术后3mo调查患者夜间眩光情况。结果:低、中度近视组术前暗光下瞳孔直径6.81±0.50mm,高度近视组6.98±0.57mm,两组差异有显著性(P=0.001)。低、中度近视组58眼(7.9%)发生夜间眩光,高度近视组为137眼(26.2%),两组差异有显著性(P=0.000)。低、中度近视组发生眩光眼和无眩光眼在术前暗光下瞳孔直径上差异有显著性(P=0.000),拟矫正屈光度上差异无显著性(P=0.104);高度近视组在暗光下瞳孔直径和拟矫正屈光度上差异均具有显著性(P=0.001,0.002)。结论:LASIK术后夜间眩光与术前暗光下瞳孔直径有关,高度近视患者也与拟矫正屈光度有关。     

高度近视眼黄斑区视网膜厚度与视力损害的关系

背景部分高度近视患者在出现眼部并发症的形态改变之前就可表现为视功能的改变,黄斑区视网膜厚度的改变与其是否相关尚不清楚。目的探讨高度近视眼视网膜厚度与视力损害的关系。方法采用连续病例观察研究设计。选取2011年1月至2012年1月在北京同仁医院眼科中心接受准分子激光角膜原位磨镶术（LASIK）的高度近视患者132例245眼,近视等效球镜为一6．00—一20．00D。所有患者均接受最佳矫正视力（BCVA）和傅里叶域光学相干断层扫描仪（FD—OCT）检查,扫描模式为黄斑MM6。所有受检眼根据矫正视力的不同分为矫正视力≥0．9组和矫正视力≤O．8组;根据有无后巩膜葡萄肿将人选眼亚分为无后巩膜葡萄肿组及后巩膜葡萄肿组,后巩膜葡萄肿组再根据OCT图像上后巩膜葡萄肿的形态亚分为黄斑对称组及黄斑倾斜组。利用OCT随机软件生成的视网膜厚度图获取各组患者黄斑区不同象限视网膜厚度的平均值,比较不同视力组间和不同形态后巩膜葡萄肿间黄斑区视网膜厚度的差异。结果不同视力组间和各亚组间受检者的人口基线特征匹配。矫正视力≥0．9组BCVA为1．02±0．16,矫正视力≤0．8组为0．62~0．08,差异有统计学意义（t=3．233,P=0．001）;矫正视力≥0．9组黄斑中心凹区视网膜厚度为（256．28±13．19）斗m,明显较矫正视力≤0．8组的（231．17±10．96）斗m厚,差异有统计学意义（t=2．134,P=0．031）。无后巩膜葡萄肿组及后巩膜葡萄肿I组、Ⅱ组间BCVA分别为1．00~0．27、0．78±O．21和0．90~0．13,3个组间差异有统计学意义（F=15．760,P=0．015）,无后巩膜葡萄肿组及后巩膜葡萄肿Ⅱ组患者BCVA均高于后巩膜葡萄肿I组,差异均有统计学意义（q=16．131,P=0．006;q=一10．831,P=0．008）;3个组间黄斑中心凹区平均视网膜厚度值的差异有统计学意义（F=2．316,P=0．025）,后巩膜葡萄肿I组患者视网膜厚度为（234．21±15．69）Ixm,明显低于无后巩膜葡萄肿组的（252．25±15．31）斗m,差异有统计学意义（q=12．977,P=0．023）;3个组黄斑旁中心凹区视网膜厚度值的差异无统计学意义（F=0．318,P=0．078）;3个组间黄斑周边区视网膜厚度的差异有统计学意义（F=1．925,P=0．013）,后巩膜葡萄肿Ⅱ组视网膜厚度值为（273．26±16．37）斗m,与后巩膜葡萄肿I组患者的（289．11±19．30）txm及无后巩膜葡萄肿组的（290．33±17．12）斗m比较明显下降,差异均有统计学意义（g=一8．305,P=0．023;g=-7．011,P=0．012）。结论高度近视眼黄斑中心凹区视网膜厚度的改变与BCVA损害有关,后巩膜葡萄肿的后顶点对应处视网膜变薄累及黄斑中心凹时会导致视力下降。     

Role of vergence accommodation in correcting for night myopia

Although the dark-focus or resting position of accommodation provides a parsimonious interpretation of the anomalous myopias, in correcting for night myopia the role of vergence accommodation must be considered. Both contrast sensitivity (CS) and accommodation were determined for monocular and binocular observation without and with optical corrections based on the individual dark-focus. The data suggest that the availability of a stimulus for vergence accommodation may modify the magnitude of an optical correction for night myopia.