早产儿和足月儿屈光不正的分布和临床特点

目的:观察和分析儿童眼科门诊就诊的屈光不正3～7岁患儿,有早产史和足月产史的患儿的屈光不正的特点和差异.方法:屈光不正179例(358眼),分为2组:早产史者51人,足月产者128人.1%阿托品眼膏散瞳进行视网膜带状光剪影验光.结果:足月儿的屈光不正患儿中,以远视多见,占157/256眼(61.3%),对比有早产儿屈光不正的远视发病25/102(24.5%),差异有统计学意义(P<0.05).有早产儿屈光不正中,以散光发病为主,占81/102眼(79.4%),尤以高度散光、混合散光多见,相对与足月儿,其散光发病,高度散光发病和混合散光发病眼数的差异均有显著性(P<0.05).结论:散光,尤其是高度散光、复杂的混合散光是有早产儿童视力低下的重要原因.临床上散光与弱视的形成关系密切相关,因此不能忽略早产儿童视力发育.最早可提前到2岁即可进行屈光筛查.     

对10岁早产儿和足月儿屈光状态的人口统计学研究

目的：评估10岁早产儿和足月儿的屈光状态。     

早产儿视网膜病变的屈光状态

自发性退化早产儿视网膜病变（ROP）的屈光不正发生率较普通人群高,其近视发生率和近视度数随ROP严重程度上升而上升。行激光光凝治疗和冷冻治疗的ROP患眼近视发生率和度数均增加,但激光光凝治疗比冷冻治疗后的屈光状态好;保留晶状体的玻璃体切割手术后,患眼近视度数降低,视功能改善;巩膜扣带手术后,患眼可出现高度近视。随着年龄增加,ROP患儿的近视和散光发生率增加。ROP患眼屈光不正的发生率大,发生屈光不正性弱视、斜视等异常视觉症状的危险性高,需要定期检查,及时治疗需要干预的屈光不正。     

早产儿视网膜病变干预治疗后屈光状态研究进展

早产儿视网膜病变是一种发生于早产儿的未成熟视网膜血管的异常增生性疾病,是目前全球婴幼儿致盲的主要原因之一。目前该疾病常用的治疗方式有激光光凝术、玻璃体内注射抗血管内皮生长因子、冷冻疗法、玻璃体切割术等。不同治疗方法对患者屈光状态发展影响有差异。因此,本文旨在对早产儿视网膜病变治疗后患儿的屈光状态研究进展进行综述。     

早产儿与足月儿屈光发育特点的比较

目的比较0～2岁早产儿与足月儿屈光发育特点,为早产儿早期开展视力筛查工作提供理论依据。方法选取2009年12月至2010年12月在我院健康体检的早产儿264例(528眼),按矫正月龄分为6月龄、9月龄、12月龄、18月龄、24月龄共5组,各年龄段同期随机选取50名(100眼)足月儿作为对照组,使用Suresight视力筛查仪测量双眼屈光度,分析早产儿与足月儿屈光状态,描绘屈光发育曲线。结果早产儿与足月儿在0～2岁期间屈光发育曲线走势基本一致,球镜值和柱镜值均随年龄增长而呈下降趋势。屈光状态以远视为主者,早产儿412眼,占78.0%,足月儿428眼,占85.6%;近视发生率早产儿高达2.7%(14/528),足月儿仅为0.8%(4/500);混合散光发生率早产儿为17.0%(90/528),足月儿为10.6%(53/500),差异均有统计学意义(均为P<0.05)。结论早产儿存在近视和散光的高风险。对早产儿应早期开展眼保健工作,定期连续进行视力筛查,及时发现屈光状态异常并矫治。     

不同屈光状态学龄期儿童角膜前表面区域Q值的研究

目的：应用Pentacam眼前节分析仪测量我国学龄期儿童角膜形态,通过正切曲率半径计算各区域 角膜前表面Q值,分析不同屈光状态下各区域角膜前表面Q值的特点。方法：系列病例研究。选取 2018年9月至2019年10月在温州医科大学附属第二医院育英儿童医院眼科门诊就诊的学龄期儿童 192例,以右眼作为研究对象,按右眼等效球镜度（SE）分成中度近视组、低度近视组、正视组、低 度远视组、中度远视组这5组。应用Pentacam眼前节分析仪测量其角膜形态,通过正切曲率半径计 算鼻侧（315°-45°）、上方（45°-135°）、颞侧（135°-225°）、下方（225°-315°）这4个区 域角膜前表面Q值。采用方差分析比较各区域角膜Q值差异和各区域角膜Q值在不同屈光组间的差 异;采用Pearson相关分析SE和角膜Q值的相关性。结果：鼻、上、颞、下4个区域角膜前表面Q值 分别为-0.50±0.13、-0.62±0.15、-0.31±0.10、-0.42±0.18,4个区域角膜Q值差异有统计学意义 （F=215.19,P<0.001）,颞、下、鼻、上4个区域角膜前表面变平坦趋势依次增快。不同屈光组间仅鼻侧、 下方角膜前表面Q值存在差异（F=6.00,P<0.001;F=2.95,P=0.022）。随着SE的增加,鼻侧、下方角 膜Q值变小,呈负相关（r=-0.38,P<0.001;r=-0.16,P=0.031）。不同屈光组在上方和颞侧2个区域 角膜前表面Q值差异均无统计学意义。不同屈光组的鼻颞侧Q值差值差异存在统计学意义（F=10.40, P<0.001）,且随SE的增加,鼻颞侧Q值差异增大,二者有相关性（r=-0.42,P<0.001）。结论：学龄期 儿童各区域的角膜前表面Q值存在差异,不同屈光状态的鼻侧及下方角膜Q值、鼻颞侧差值均存在 差异,且均与SE存在相关性,提示不同屈光度的儿童矫正屈光不正时需考虑各区域角膜Q值,以提 高成像质量。     

早产儿视网膜病变冷凝术后视功能及屈光状态

目的 探讨早产儿视网膜病变冷凝术后视功能恢复情况和屈光状态.方法 对在我院接受冷凝术后患儿16例(32眼),进行远期(>3.5a)视功能和屈光状态分析.结果 矫正视力<0.05者2眼.0.05～0.10者4眼,0.1～0.3者5眼,0.3～0.5者10眼,≥0.5者11眼.屈光状态3～5D者2眼,0～3D者2眼,-3～0D者2眼,-3～-6D者16眼,≤-6D者8眼.2眼因后极部视网膜脱离测不到屈光度.结论 冷凝术治疗影响视网膜病变患儿视功能恢复,可使近视、散光等屈光不正发生率增加.     

正常早产儿与足月儿视网膜电图特征分析

目的了解正常早产儿与足月儿视网膜功能发育的特点。方法选取健康无眼病出生孕周小于37周的早产儿组63例(126只眼),其中孕周小于34周(含34周)早产儿1组28例(56只眼)和出生孕周大于34周早产儿2组35例(70只眼),足月组30例(60只眼)在出生后4～6周进行闪光视网膜电图(ERG)检测,记录视杆细胞反应、视锥细胞反应及最大混合反应。对比分析三组婴儿的ERG的a、b波反应的潜伏期、振幅。结果与足月组婴儿比较,早产组在视杆反应、最大混合反应、视锥反应中b波的潜伏期延长,幅值降低,差异有统计学意义(P=0.044,P=0.030,P=0.001,P=0.025,P=0.040,P=0.024),而a波除了在混合反应中的幅值差异有统计学意义外(P=0.012),其余潜伏期与幅值在视杆反应、最大混合反应、视锥反应中差异均无统计学意义(P=0.100,P=0.186,P=0.379,P=0.861,P=0.059)。而2组早产儿之间,早产1组视杆细胞反应、最大混合反应、视锥细胞反应a波、b波潜伏期较早产儿2组轻度延长,幅值轻度降低,但差异均无统计学意义(P=0.637,P=0.619,P=0.706,P=0.141,P=0.098,P=0.782;(P=0.635,P=0.059,P=0.125,P=0.606,P=0.348,P=0.634)。结论确定了正常足月儿和早产儿1个月龄时F-ERG的3个标准反应的正常值,并比较了各反应值与孕周的关系,发现早产儿视网膜发育程度较足月产婴儿稍低,且出生孕周越低,视网膜的发育程度越差。     

屈光不正儿童眼屈光状态变化规律探讨

目的 :了解屈光不正儿童屈光发育变化的规律。方法 :眼科初诊病例 ,经常规检查 ,无眼部器质性病变或显斜者 ,用 1%阿托品眼膏进行睫状肌麻痹视网膜检影验光后 ,选择 3～ 10岁屈光不正儿童进行 3年追踪观察。每年验光一次。结果 :3年来的主要表现为远视等效球镜值增加 ,球镜度减少 ,远视散光明显增多P <0 0 1。结论 :屈光不正的儿童 ,其屈光度及屈光状态不是一成不变的 ,为了确保儿童斜视弱视的治疗 ,在对屈光不正儿童处方配镜时 ,要重视追踪管理 ,散光和屈光参差的不稳定性必须给以考虑 ,不能像成人那样多年使用一付眼镜     

早产儿屈光状态和视力的调查研究

目的:观察和分析早产儿的屈光状态和视力发育情况。方法:对4～6岁早产儿156例312眼门诊进行视力和静态屈光检查并记录结果。结果:4～6岁早产儿156例312眼远视238眼(76.3%),近视15眼(4.8%),散光28眼(9.0%),正视眼31眼(9.9%),生理性远视所占的比例最大,各年龄远视比例有所不同,但都随着年龄的增长远视比例下降,正视和近视比例逐渐增加,视力正常率明显提高。结论:4～6岁早产儿屈光状态和视力发育与正常儿接近,随着年龄的增长,屈光状态有由远视向正视和近视发展的趋势。     

早产儿眼球发育及屈光状态变化

目的:观察早产儿眼球生物学指标及屈光状态随年龄变化的规律。方法:早产儿218例、足月儿76例分别在出生后1,4,8和12mo进行A超检查,记录眼轴长度、前房深度、晶状体厚度、玻璃体腔长度;并在8和12mo进行睫状肌麻痹检影验光,记录球镜度;分析眼球生物学指标及屈光状态随年龄变化规律。结果:随年龄增长,无论早产儿及足月儿前房深度、玻璃体腔长度、眼轴长度均逐渐增大;晶状体厚度逐渐减小。出生初期,早产儿较正常儿前房深度浅,玻璃体腔长度及眼轴长度短。出生后随年龄增长,早产儿玻璃体腔长度和眼轴长度生长较足月儿快;但前房深度和晶状体厚度改变无明显差异。结论:出生时早产儿较正常儿眼球各项生物学指数发育差,随年龄增长,早产儿正视化较足月儿快,与眼轴生长有关。     

0~6岁早产儿和正常儿童屈光状态的比较研究

目的：探讨0~6岁早产儿和正常儿童的屈光发育情况。方法病例对照研究。回访自2011年9月至2012年9月在武汉大学人民医院进行早产儿视网膜病变(ROP)筛查的无视网膜病变的早产儿1164例,其中纳入研究1088例（2176只眼）,按矫正胎龄分组：<0.5岁（150例）,≥0.5岁且<1.0岁（118例）,≥1.0岁且<1.5岁（155例）,≥1.5岁且<2.0岁（137例）,≥2.0岁且<2.5岁（153例）,≥2.5岁且<3.0岁（95例）,≥3.0岁且<4.0岁（103例）,≥4.0岁且<5.0岁（89例）,≥5.0岁（88例）。同时收集来武汉大学人民医院门诊体检的正常足月儿1191例,纳入同龄随机对照组足月儿1102例（2204只眼）。所有儿童行睫状肌麻痹检影验光确定屈光状态。其中3~6岁早产儿采用相干光生物测量仪（IOL Master）测量眼轴和角膜曲率。定量资料组间差异使用t检验,定性资料组间差异采用卡方检验。相关性使用多元线性回归分析。结果0～6岁早产儿平均近视患病率为9.1%,足月儿为4.4%;0～6岁早产儿平均散光患病率为35.4%,足月儿为18.9%。2～6岁早产儿平均球镜度数为（1.15±0.87）D,平均柱镜度数为（0.84±0.71）D,平均等效球镜度数为（1.47±0.28）D,球镜、等效球镜度数以及柱镜均随年龄的增大而呈现下降趋势。3～6岁早产儿等效球镜度数与眼轴、角膜曲率、胎龄、出生体重及年龄相关（r=-0.232,0.112,0.117,0.254,-0.215;P=0.000,0.009,0.008,0.000,0.001）。结论早产儿近视及散光患病率高于足月儿;早产儿正视化过程要早于足月儿。（中华眼科杂志,2015,51：505-509）     

The evolution of refractive status in Chinese infants during the first year of life and its affected factors

AIM: To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS: A total of 1258 babies (2516 eyes) aged 32wk gestational age to 1y participated in the study, including 766 premature and 492 full-term infants. First, each baby received an orthoptic examination, slit-lamp checking and fundus imaging. Patients with diseases which might affect refractive status were excluded from the cohort. The cycloplegia retinoscopy was performed. Their neonatal histories were reviewed. Each measurement contained the refractive status and calculation of the spherical equivalent (SE). RESULTS: Refractive state showed an average hyperopia of +0.94±1.63 D at early ages, followed by a trend toward more hyperopia. The refractive state reached the top (+2.43±1.46 D) at the age of one to two months. Then gliding till one year old when the refractive state reached +0.59±1.41 D. The prevalence of astigmatism was 42.17% in the study, being 2.82% myopic astigmatism and 39.35% hyperopic astigmatism. The 94.1% of hyperopic astigmatism was with-the-rule astigmatism and 71.83% of myopic astigmatism was with-the-rule astigmatism. Refractive state between boys and girls was different. The mean SE of boys was +1.97±1.57 D, while that of girls was +1.79±1.46 D, and the difference was significant. CONCLUSION: Before one year old, the change of refractive status is associated with checking age and sex. At the age of one to two months, the degree of hyperopia reaches the top. Boys have more hyperopic degree than girls, and with-the-rule astigmatism is predominant. Excluding premature infants with advanced retinopathy of prematurity, premature and full-term children have same refraction status.     

矫正年龄6个月内无早产儿视网膜病变的早产儿眼部生物学参数分析

目的 探讨矫正年龄(PMA)6个月内的无早产儿视网膜病变(ROP)早产儿眼部生物学参数分布及与出生体重(BW)和PMA的关系。方法 纳入490例接受ROP筛查的早产儿并研究。根据PMA分为7组：0个月组(矫正胎龄40周±3 d)、1个月组、2个月组、3个月组、4个月组、5个月组和6个月组。采用RETCAM3检查眼底并排除ROP,角膜测厚仪测量中央角膜厚度(CCT),A超测量眼轴长度(AL)、前房深度(ACD)、晶状体厚度(LT)和玻璃体长度(VL)。利用自动屈光测量仪测量患儿PMA 3个月至6个月非睫状肌麻痹的屈光状态。采用t检验数据正态性,单因素方差分析患儿性别、眼别及组间眼部生物学参数差异性,多因素线性回归模型分析AL、ACD、LT、VL和CCT与BW和PMA的关系。结果 入组患儿的出生胎龄为(32.71±2.26)周,BW为(1802.46±480.83)g, ACD、LT、VL、AL、和CCT分别为(2.26±0.30)mm、(4.04±0.24)mm、(11.84±0.84)mm、(18.14±1.11)mm和(535.01±37.63)μm。PMA 3个月至6个月球镜度、柱...     

Analysis of the clinical characteristics and refraction state in premature infants: a 10-year retrospective analysis

AIM: To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity (ROP) who were or not treated. METHODS: The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed. RESULTS: A total of 562 screened premature infants (all Chinese, 1124 eyes), were recruited with a 378:184 male-to-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55% (93/562 cases). The incidences in boys and girls were 16.14% (33/378 cases) and 17.39% (32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP (stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP (30.99%, 172/555 cases), and myopic refraction (including myopia and myopia combined with astigmatism) was more common in premature infants with ROP (48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction (including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment (63.63%, 7/11 cases). CONCLUSION: The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.     

学龄期儿童近视初诊时屈光状态分布与生物学参数的相关性研究

目的:研究学龄期儿童初发并确诊为近视时的年龄、屈光分布的特点及其与眼轴、角膜散光的相关性。方法:采用简单随机抽样法选取2020-05/09于我院眼科门诊因视力下降就诊,并第一次诊断为近视的学龄期儿童196例391眼,排除患其它引起视力下降眼病的病例。按年龄分为6~8、9~10、11~12岁三组,按屈光度分为SE≤-1.00D、-1.00-3.00D四组。所有儿童均接受视力、眼压、裂隙灯显微镜、IOL Master、验光及眼底检查并记录结果,分析屈光度、年龄分布及与各屈光参数关系。结果:纳入病例中6~8、9~10、11~12岁年龄组分别有128眼(32.7%)、155眼(39.6%)、108眼(27.6%)。平均年龄9.29±1.64岁。各年龄组间等效球镜(SE)和眼轴(AL)均有差异(P<0.01)。SE≤-1.00D、-1.00-3.00D屈光度组分别有134眼(34.3%)、162眼(41.4%)、74眼(18.9%)、21眼(5.4%)。平均SE为-1.54±0.89D。各屈光度组AL有差异(P<0.01)。SE与AL间呈线性回归关系,回归方程为Y=12.373-0.577X,R²=0.286,β=-0.577,P<0.001。散光度与角膜散光间呈线性回归关系,回归方程为Y=0.084-0.502X,R²=0.389,β=-0.502,P<0.001。结论:6~12岁的学龄期儿童初次确诊近视性屈光不正的年龄集中在9~10岁,屈光度以低度近视为主。AL增长与年龄、SE相关,儿童散光性屈光不正与角膜散光相关。     

The prevalence of uncorrected refractive error in urban, suburban, exurban and rural primary school children in Indonesian population

Uncorrected refractive error (URE) is a major health problem among school children. This study was aimed to determine the frequency and patterns of URE across 4 gradients of residential densities (urban, exurban, suburban and rural). This was a cross-sectional study of school children from 3 districts in Yogyakarta and 1 district near Yogyakarta, Indonesia. The information regarding age, sex, school and school grader were recorded. The Snellen’s chart was used to measure the visual acuity and to perform the subjective refraction. The district was then divided into urban, suburban, exurban and rural area based on their location and population. In total, 410 school children were included in the analyses (urban=79, exurban=73, suburban=160 and rural=98 school children). Urban school children revealed the worst visual acuity (P<0.001) and it was significant when compared with exurban and rural. The proportion of URE among urban, suburban, exurban and rural area were 10.1%, 12.3%, 3.8%, and 1%, respectively, and it was significant when compared to the proportion of ametropia and corrected refractive error across residential densities (P=0.003). The risk of URE development in urban, suburban, exurban, and rural were 2.218 (95%CI: 0.914-5.385), 3.019 (95%CI: 1.266-7.197), 0.502 (95%CI: 0.195-1.293), and 0.130 (95%CI:0.017-0.972), respectively. Urban school children showed the worst visual acuity. The school children in urban and suburban residential area had 2 and 3 times higher risk of developing the URE.     

应用Suresight对1-3岁婴幼儿屈光状态的筛查与分析研究

目的　应用Ｓｕｒｅｓｉｇｈｔ手持式自动视力筛查仪对１～３岁婴幼儿的屈光状态进行检测,了解婴幼儿视觉系统屈光状态及分布规律。方法　选取２０１３年８月至２０１４年２月于郑州市儿童医院眼科门诊进行视力体检的１～３岁婴幼儿２３９名,按年龄分成４组:１２～１７个月龄组、１８～２３个月龄组、２４～２９个月龄组、３０～３６个月龄组,利用Ｓｕｒｅｓｉｇｈｔ手持式自动视力筛查仪进行屈光检测,并对结果进行统计分析。结果　在２３９名被检测幼儿中,有１８名幼儿未检测出其屈光状态,其总检测率为９２.５％,其中近视状态２例。１２～１７个月龄组、１８～２３个月龄组、２４～２９个月龄组、３０～３６个月龄组屈光球镜值分别为（＋１.９３±０．６３）Ｄ、（＋１．７９±０．５５）Ｄ、（＋１．５０±０．６５）Ｄ、（＋１．５４±０．７１）Ｄ,各组间差异有显著统计学意义（Ｆ＝７．０６２,Ｐ＝０.０００）,屈光柱镜值分别为（０．８２±０．４０）Ｄ、（０．７８±０．４６）Ｄ、（０．６９±０．４９）Ｄ、（０．７２±０．４３）Ｄ,各组间差异无统计学意义（Ｆ＝１．１２５,Ｐ＝０．３３９）。相关及回归分析显示,１～３岁婴幼儿月龄与其屈光球镜值之间存在负相关关系（ｒ＝－０.４１１,Ｐ＝０．０００）,即１～３岁婴幼儿屈光球镜值随年龄增长而降低;１～３岁婴幼儿月龄与其屈光柱镜值之间存在负相关关系（ｒ＝－０．１０５,Ｐ＝０.０３５）,即１～３岁婴幼儿屈光柱镜值随年龄增长而降低,但其相关性较低。结论　建议婴幼儿应从出生后６个月起至少每半年进行一次视力及屈光检查,密切观察屈光及视力的发育状态,保证视力健康发育。     

高中各年级动态眼屈光状况的横断面流行病学调查

目的:对在校中学生眼健康状况中的动态屈光基本情况进行横断面调查,为青少年眼保健提供基础资料。方法:采用前瞻性调查设计,对西安市城区重点中学2002/2004年度高中学生1385人2770眼动态屈光状态等指标进行采集,输入编辑的专项应用程序,用SPSS11.0软件行统计分析。结果:高中学生(年龄16～18岁)在正常动态情况下,近视眼的发病率为94%,其中41.7%的低度近视,40.0%的中度近视,12.3%的高度近视;正视眼仅占3.8%,尚有2.2%为远视眼;3个年级组各屈光构成比相比,高度近视、远视组在3a间基本稳定,而高三年级在低度近视组、正视组明显下降的同时,中度近视组明显升高。高中平均屈光度(-3.39±2.34)D,其中低度近视平均(-1.83±0.75)D,中度近视平均(-4.38±0.85)D,高度近视平均(-7.49±1.28)D。3个年级平均屈光度为:高一(-3.29±2.49)D,高二(-3.09±2.31)D,高三(-3.57±2.25)D,组间和总体均有显著性差异(P<0.01)。女生组平均屈光度(-3.46±2.35)D,大于男生组(-3.31±2.32)D(P=0.093);其他屈光度组间在性别中无显著性差异。眼别中右眼平均屈光度(-3.51±2.25)D大于左眼(-3.27±2.42)D(P=0.008)。女生右眼平均屈光度大于左眼(P=0.030)。远视组右眼平均屈光度小于左眼(P=0.004)。结论:高中学生屈光状态趋于平稳的同时,近视眼的构成比中在高三年级继续有低度近视向中度近视发展变化,致使高中总体屈光状态呈平缓近视化趋势;女生在近视化进展期早于男生,女生右眼在高中屈光近视化进展期早于左眼,应针对高中年级学生这一人群的用眼状态采取综合、简易的手段,对其近视度数进行医疗干预。