成年超高度近视眼患者黄斑区巩膜厚度及其相关影响因素

目的观察成年超高度近视(等效球镜度≥-9.00 D)患者黄斑区巩膜厚度的改变,并分析巩膜厚度与年龄、眼轴长度、屈光度数及最佳矫正视力的关系。 方法纳入2016年6月至2018年5月就诊于广州爱尔眼科医院的超高度近视患者112例(195只眼)为研究对象。其中,男性50例(84只眼),女性62例(111只眼);年龄18~67岁,平均(33.10±13.27)岁。采用扫频光学相干断层扫描测量黄斑中心凹处及由中心凹向鼻侧、颞侧各500 μm、1000 μm及1500 μm的巩膜厚度值,共测量7个点位。采用单因素方差分析比较超高度近视眼黄斑区不同部位的巩膜厚度有无差异,当差异有统计学意义时,再用最小显著性差异法进行两两比较,计算相关系数并采用多元回归分析法黄斑中心凹处巩膜厚度和眼轴长度、年龄、屈光度数及最佳矫正视力的关系。 结果本研究纳入的患者平均最佳矫正视力(0.68±0.31),区间为0.01~1.00;平均屈光度数(-14.68±4.31)D,区间为-9.00~-25.25 D;平均眼轴长度(29.14±2.06)mm,区间为25.20~36.00 mm。中心凹颞侧1500 μm处的巩膜厚度均值最小,为(281.17±93.84)μm;中心凹处巩膜厚度均值最大,为(318.13±87.49)μm。颞侧1500 μm处的巩膜厚度与颞侧500 μm、中心凹处和鼻侧相比较薄,差异有统计学意义(t＝-2.78,-3.90,-3.37,-2.85,-3.07;P<0.05);颞侧1000 μm处的巩膜厚度与中心凹处、鼻侧500 μm和鼻侧1500 μm处相比较薄,差异有统计学意义(t＝-2.87,-2.35,-2.05;P<0.05)。中心凹处巩膜厚度与年龄呈轻度负相关(r＝-0.371,P<0.05);与眼轴长度呈中度负相关(r＝-0.573,P<0.05);与屈光度数和最佳矫正视力呈中度正相关(r＝0.469,0.414;P<0.05)。多元线性回归分析表明,眼轴长度和年龄是影响中心凹处巩膜厚度的独立相关因素(β＝-18.436,-1.347;P<0.05)。 结论扫频光学相干断层扫描测量成年超高度近视眼患者黄斑区巩膜全层图像的方法,是无创、实用且简单易行的。本研究结果提示巩膜的病理变化,可能在超高度近视眼并发症的发生与发展过程中发挥作用。测量高度近视眼患者黄斑区巩膜厚度,可作为后巩膜葡萄肿观察的重要指标之一,从而为高度近视眼的防控提供客观依据。     

影响近视患者屈光度的相关因素分析

目的:探讨近视眼患者屈光度与眼轴长度、角膜屈光力、眼压及角膜厚度的相关关系及各因素对近视屈光度的影响。方法:随机抽取行LASIK手术的近视患者430例,分为3组:低度近视组140例(≤-3.00D);中度近视组177例(>-3.00D,≤-6.00D),高度近视组113例(>-6.00D)。测量患者眼的屈光度、眼压、角膜厚度、角膜屈光力及眼轴。结果:低度、中度、高度近视组眼轴长度分别为:24.33±0.86mm,25.45±0.78mm,26.12±1.05mm。各近视组之间比较差异具有统计学意义(P<0.05);各组屈光力分别为:42.96±1.40D,44.09±1.32D,43.59±1.33D。中、高度近视组与低度近视组比较差异具有统计学意义(r=0.096,0.0062,P<0.05);各组眼压分别为:15.71±2.51mmHg,16.04±2.48mmHg,16.89±2.31mmHg。眼压与屈光度呈正相关关系(r=0.185,0.192,P<0.05);各组角膜厚度分别为:604.66±51.47μm,531.17±37.06μm,533.03±35.61μm。中度、高度近视的角膜厚度与低度近视的角膜厚度有显著差异(r=0.506,0.613,P<0.05)。结论:在近视性屈光不正的影响因素中,眼轴长度是影响近视程度的主要因素,随屈光度的增加,眼轴长度增加;眼压也是近视发生、发展过程中不可忽视的因素,眼压随眼轴长度和屈光度增加而增加;中、高度近视除眼轴增长外,角膜屈光力也是重要影响因素,而对在低度近视的作用甚微。角膜厚度与屈光度有直接相关关系,还与长期配戴角膜接触镜等因素有关。     

后巩膜加固术治疗儿童进行性高度近视的疗效观察

目的探讨对进行性高度近视患儿施行改良型Snyder-Thompson式后巩膜加固术的疗效。方法对<14岁28例(52眼)进行性高度近视患儿手术前后采用IOLMaster测定眼轴长度,散瞳验光屈光度矫正视力和眼底检查,应用配对t检验进行比较分析。结果眼轴长度术前为(28.47±2.36)mm,术后为(28.77±2.44)mm,差异有统计学意义(t=6.28,P<0.05)。术后与术前相比,平均眼轴增长(0.31±0.35)mm。矫正视力术前为0.45±0.25,术后为0.61±0.26,差异有统计学意义(t=12.61,P<0.05)。术后眼底未见1例并发症。结论改良型后巩膜加固术有可能延缓儿童高度近视眼轴的增长。     

高度近视眼底病变研究进展（二）

(二)高度近视眼底病变与视功能改变的关系得以研究 Tokoro等研究发现;屈光度超过—17D或眼轴长度大于29mm时,矫正视力都低于0.8。在眼轴超过30mm的320只眼中,视野异常者占51.9％.色觉缺陷的发生率不随眼轴延长而增加,但色觉异常眼中,半数有眼底后极部病变.他还发现高度近视视觉电生理与眼轴长度、眼底病变有关:EOR比值与眼轴长度有效呈负相关(P<0.001);ERGb波辐度与眼轴长度呈负相关(P<0.01):小波辐ERG b波于眼底改变早期出现,故推测高度近视眼底早期病变可能在视网膜色素     

青少年近视眼屈光度与眼轴长度及眼内压的相关性分析

目的:探讨青少年近视眼屈光度、眼轴长度、眼内压的关系,并评估遗传及环境因素对近视发展的影响。方法:对青少年近视患者166例329眼,分别精确测量其屈光度、眼轴长度、眼内压,并按照屈光度分为正视眼组、轻度近视组、中度近视组和高度近视组;分别测量不同年龄段患者父母的屈光度及眼轴长度,对各组数据采用SPSS13.0软件处理并进行相关分析。结果:各组间屈光度与眼轴长度比较,中、高度近视组差异有显著性(P(0.05);相关分析显示组内屈光度、眼轴长度明显正相关;屈光度与眼内压在中高度近视组表现出明显的相关性(r=0.817,P=0.031),且患者与其父母的屈光度存在显著相关性。结论:青少年近视屈光度与眼轴长度、眼内压有密切关系,眼轴长度增加是青少年近视形成的主要原因之一,遗传与环境因素在青少年近视的发生发展中发挥着重要作用。     

硬性透氧性角膜接触镜对儿童高度近视的矫治效果

目的:评价硬性透氧性角膜接触镜(rigid gas permeable contact lens,RGPCL)对儿童高度近视的矫治作用。方法:对20例40眼14岁以下高度近视的儿童验配RG-PCL,同时将20例40眼戴框架眼镜高度近视的儿童作为对照组,1a内定期复查其眼的屈光度、角膜屈折力及眼轴长度。结果:RGPCL组矫正视力明显优于框架眼镜组,两组差异有显著性意义;1a后的近视屈光度平均增加,RGPCL组为0.59±0.42D,框架眼镜组1.07±0.53D,两者差异有显著性意义(P<0.05);角膜屈折力平均减少,RGPCL组为0.22±0.19D,框架镜组为0.02±0.10D,两组间差异有显著性意义(P<0.05);眼轴平均增长,RGPCL组为0.29±0.20mm,框架眼镜组为0.49±0.25mm,两者差异有显著性意义(P<0.05)。结论:RGPCL可能由于提供了更好的视觉质量及更好地矫正了散光,在一程度上使角膜变平且减缓眼轴增长,从而起到阻止高度近视快速发展的作用。     

青少年单纯性近视眼屈光度与角膜曲率及眼轴的相关性

目的探讨青少年单纯性近视眼屈光度与角膜曲率及眼轴的关系。方法对单纯性近视277例536只眼,测量其角膜水平及垂直曲率,并按年龄、屈光度分组,对各组角膜曲率及眼轴长度进行统计学分析。结果各组角膜水平及垂直曲率比较,差异有显著性(P<0.05)。不同年龄两组间的角膜曲率和眼轴长度比较,差异无显著性(P>0.05)。不同屈光度两组比较,角膜曲率差异有显著性(P<0.05),眼轴长度差异有非常显著性(P<0.01)。多元线性回归和相关分析显示眼球轴长增加是单纯性近视眼形成的主要因素。角膜水平曲率与垂直曲率呈正相关,角膜曲率与眼轴长度呈负相关。结论青少年单纯性近视的屈光度与角膜曲率及眼轴长度密切相关,且眼轴长度是单纯性近视眼形成的主要因素。     

光学相干断层扫描与眼底造影对高度近视黄斑变性患者的诊断价值

目的：探讨光学相干断层扫描( optical coherence tomography, OCT )、眼底荧光素血管造影( fundus fluorescein angiography, FFA)对高度近视黄斑变性患者的诊断价值。
　　方法：选取我院眼底病科2014-01/2015-09收集的62例104眼,均符合FFA及OCT分型的高度近视黄斑变性患者的特点。
　　结果：高度近视黄斑变性患者FFA分型、OCT分型存在显著的相关性(r=0.599,P<0.001);高度近视黄斑变性患者OCT分型中,患者的最佳矫正视力( best corrected visual acuity,BCVA)、屈光度、眼轴长度、中心凹厚度测定值差异均具有统计学意义(P<0.05),OCT分型越高,患者的BCVA越低,中心凹厚度、屈光度值越小,眼轴长度越长。高度近视黄斑变性患者 FFA 分型中,患者的BCVA、屈光度、眼轴长度测定值差异均具有统计学意义(P<0.05),中心凹厚度差异无统计学意义(P>0.05);FFA分型越高,患者的屈光度、BCVA值越小,眼轴长度越长;FFA分型患者的中心凹厚度测定值差异无统计学意义(P>0.05)。
　　结论：高度近视黄斑变性患者OCT、FFA检查结果具有一定程度的相关性,同时二者联合应用对进一步诊断疾病性质有积极作用,对于患者的诊治具有一定的价值。     

眼轴对高度近视白内障术后屈光度误差的影响

目的 研究眼轴对高度近视眼合并白内障超声乳化联合囊袋内人工晶状体(IOL)植入术,术后屈光度的影响.方法 对26例28只眼正常眼轴白内障眼及24例(眼)轴性高度近视(眼轴＞26mm),合并白内障的患者行白内障超声乳化联合囊袋内折叠式人工晶状体植入术,测量术前1d、术后1周的眼轴长度、角膜屈光力、术后屈光度,并将结果进行统计学分析.结果 高度近视合并白内障超声乳化术后眼轴长度较术前明显增加(P＜0.05);两组比较高度近视组较正常眼轴组增加明显;高度近视组术后屈光度误差＞1.5 D者占62.5%,眼轴均增加0.5mm以上.高度近视组超声乳化术后眼轴增加值与术后屈光度的绝对误差呈高度正相关(P＜0.05,r=0.918).正常眼轴白内障眼及轴性高度近视,合并白内障眼术后屈光度与术前预留屈光度的差值与术前眼轴测量值呈负相关(P＜0.05 r=-0.763).结论 眼轴增加是产生高度近视眼,合并白内障超声乳化联合囊袋内人工晶体植入术,术后屈光度误差的主要因素;提高高度近视合并白内障眼的眼轴测量准确性,是减少术后屈光度误差的关键.     

高度近视黄斑病变的OCT和FFA形态学分类的对比分析

目的：探讨高度近视黄斑病变的光学相干断层扫描(OCT)和眼底荧光血管造影(FFA)的形态学特征、分类和对比分析。

方法：对入选的高度近视黄斑病变患者61例101眼均行标准对数视力表检查,验光确定屈光度及最佳矫正视力(BCVA),并用IOL-Master测量眼轴长度。入选者需在同一天内行散瞳眼底检查、OCT及FFA检查,必要时行眼底联合造影(FFA&ICGA)。分析不同类型的OCT及FFA形态学特征之间的相互联系,并探讨其与屈光度、最佳矫正视力、眼轴长度及中心凹厚度之间的关系。

结果：FFA分类的漆样裂纹型在OCT分类的1型中所占比例为57.14%,显著高于新生血管型和黄斑萎缩型(21.43%),差异有统计学意义(P<0.05)。FFA分类的黄斑萎缩型在OCT分类的2型中所占的比例为67.80%,显著高于漆样裂纹型(18.64%)和新生血管型(13.56%),差异有统计学意义(P<0.05)。OCT 3型均属于FFA分类的黄斑萎缩型。OCT 1型的屈光度、眼轴长度明显低于2型和3型,而最佳矫正视力和中心凹厚度则明显高于2型和3型。FFA的漆样裂纹型与新生血管型在屈光度及眼轴长度上虽无明显差异,但后者的BCVA及中心凹厚度显著低于前者(P<0.05)。漆样裂纹型及新生血管型的屈光度、眼轴长度均显著低于黄斑萎缩型,最佳矫正视力则明显高于黄斑萎缩型(P<0.05)。

结论：高度近视黄斑病变的OCT和FFA形态学特征密切相关,结合OCT和FFA的图像特征对高度近视黄斑病变形态学改变进行对比分析,不仅有助于明确病变的性质,提高我们对疾病发病机制及预后转归的认识,更为临床诊疗提供了有力的支持。     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

Refractive error in children in a rural population in India

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. METHODS: Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in seven clusters. RESULTS: A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. CONCLUSIONS: Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.     

Vitrectomy in traumatic cataracts and in the complications of surgery in congenital cataract in children

Vitrectomies were carried out in 35 children with traumatic cataracts and complications of surgery for cataracts, caused by injury to the posterior lenticular capsule and incorporation of its fragments to the vitreous. Complete removal of lenticular rudiments rapidly eliminated phacogenic iridocyclitis and improved visual acuity. Improvement of visual functions was attained in 66.6% cases; in 33.4% cases visual acuity did not change. Hemorrhages to the vitreous cavity occurred in 4 cases with pronounced iridocyclitis; therefore, a corneal approach is preferable for cases with pronounced iridocyclitis.     

Refractive error in children in an urban population in New Delhi

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in an urban population in New Delhi, India. METHODS: Random selection of geographically defined clusters was used to identify a sample of children 5 to 15 years of age. From December 2000 through March 2001, children in 22 selected clusters were enumerated through a door-to-door survey and examined at a local facility. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in four of the clusters. RESULTS: A total of 7008 children from 3426 households were enumerated, and 6447 (92.0%) examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 6.4%, 4.9%, and 0.81%, respectively. Refractive error was the cause in 81.7% of eyes with vision impairment, amblyopia in 4.4%, retinal disorders in 4.7%, other causes in 3.3%, and unexplained causes in the remaining 5.9%. There was an age-related shift in refractive error from hyperopia in young children (15.6% in 5-year-olds) toward myopia in older children (10.8% in 15-year-olds). Overall, hyperopia was present in 7.7% of children and myopia in 7.4%. Hyperopia was associated with female gender. Myopia was more common in children of fathers with higher levels of education. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a major public health problem in urban school-aged children in India. Cost-effective strategies are needed to eliminate this easily treated cause of vision impairment.