盐酸环喷托酯对儿童睫状肌麻痹效果的观察

目的:探讨盐酸环喷托酯滴眼液对屈光不正儿童验光睫状肌麻痹的效果。方法:对6～12岁屈光不正儿童60例120眼随机分为3组,分别用盐酸环喷托酯滴眼液、复方托吡卡胺滴眼液及阿托品眼膏滴眼。在用药前及用药后不同时间点对3组患者分别在电脑验光仪上进行客观验光并测量瞳孔直径,在综合验光仪上进行主观验光并用移近法测量调节力和剩余调节力。结果:盐酸环喷托酯滴眼液最大睫状肌麻痹时间是60min,在最大睫状肌麻痹状态下盐酸环喷托酯组剩余调节力较复方托吡卡胺组小(P<0.05),与阿托品组相近(P>0.05)。结论:用盐酸环喷托酯代替阿托品对6～12岁屈光不正非斜视儿童进行散瞳验光是可行的。     

NIDEK手持自动电脑验光仪在儿童屈光不正中的应用

目的:了解手持自动电脑验光仪的准确性及在儿童屈光不正中的应用价值。方法:对27例4～16岁儿童用10g/L阿托品眼膏3次/d,连续3d,睫状肌麻痹前后,分别进行视网膜检影、NIDEKAUTOREF/KERATOMEARK-30手持自动电脑验光仪验光和综合验光仪主观验光。结果:睫状肌麻痹后,手持自动电脑验光仪与视网膜检影结果间相关系数为0.980,差值均数±标准差为-0.37±0.52,95%可信区间为-0.51～-0.23;手持自动电脑验光仪与综合验光仪主观验光结果间相关系数为0.982,差值均数±标准差为-0.37±0.49,95%可信区间为-0.51～-0.24,以上两组配对t检验均P=0.000,均差异显著。表明在95%的测量中,结果差异均在0.50D以内。不同屈光状态下,在95%可信区间内,屈光度相差范围为远视<0.75D,近视<0.50D。结果均为手持自动电脑验光仪比视网膜检影、综合验光仪主观验光偏负值。睫状肌麻痹前由于调节的影响3种检查结果相差较大,远视结果相差比近视结果相差大。结论:睫状肌麻痹后,手持自动电脑验光仪验光和视网膜检影、综合验光仪主观验光有极高的一致性,在儿童屈光不正检查中是一种很有价值的、方便的、可靠的屈光检查工具。     

环戊通与阿托品睫状肌麻痹效果的差异性评价

背景 为获得准确的屈光不正度数,需要对初诊的屈光不正儿童进行充分的睫状肌麻痹验光,但是如何选择睫状肌麻痹剂存在争议. 目的 观察环戊通和阿托品对屈光不正低龄儿童睫状肌麻痹效果是否存在差异,为研究临床上环戊通是否可以替代阿托品进行部分低龄儿童的睫状肌麻痹验光提供参考依据.方法 前瞻性临床研究.采用自身配对设计的方法,在检查对象监护人的知情同意和配合下,对80例160眼、年龄4～9周岁的屈光不正儿童进行睫状肌麻痹验光,先使用质量分数1％硫酸环戊通滴眼液点眼,每5分钟1次,共3次,末次点眼45 min后行验光检查;3d后再使用质量分数1％硫酸阿托品眼用凝胶点眼,每天点眼3次,连续3d,于第4天复查验光;比较两种药物散瞳后电脑验光、检影验光及残余调节的屈光度值差异.结果 散瞳前和应用1％硫酸阿托品眼用凝胶后的电脑验光值分别为(0.55±3.52)D和(2.22±3.52)D,差值为(1.66±1.62)D,差异有统计学意义(t=13.02,P=0.00);应用1％硫酸环戊通滴眼液后电脑验光值为(1.74±3.46)D,与应用1％阿托品后的电脑验光值相比差值为(0.48±0.46)D,差异有统计学意义(t=13.08,P=0.00).两种药物散瞳后的电脑验光值之间呈明显的阳性相关(R2=0.98,P=0.00).利用红外线验光仪测量残余调节,1％环戊通滴眼液和1％阿托品凝胶散瞳后测量的残余调节值分别为(0.32±0.44)D和(0.05±0.41)D,差值为(0.27±0.55)D,差异有统计学意义(t=4.56,P=0.00).按屈光类型分为近视组、低中度远视组和高度远视组,两种药物散瞳后电脑验光的差值近视组为(0.31±0.37)D,低中度远视组为(0.56±0.48)D,高度远视组为(0.59±0.50)D;近视组明显低于低中度远视组,差异有统计学意义(t=-3.14,P=0.00).4～6岁组两种药物散瞳后电脑验光的差值为(0.61±0.53)D,7～9岁组差值为(0.49±0.39)D,两组间差异无统计学意义(t=1.21,P=0.23).因“调节”隐藏的屈光度值与两种药物散瞳后电脑验光的差值呈弱相关(r=0.43,P=0.00). 结论 1％硫酸环戊通滴眼液点眼和1％硫酸阿托品眼用凝胶点眼对低龄儿童均能起到使调节放松的作用,两种药物的差值主要表现在远视儿童中.因此临床上对于远视儿童的散瞳验光最好应用1％硫酸阿托品眼用凝胶.     

Wavescan波前像差仪测量屈光不正的准确性研究

目的:评价Wavescan波前像差仪测量近视眼屈光不正的准确性。方法:对33例66眼行屈光不正矫正术的患者分别用电脑验光(睫状肌麻痹和非睫状肌麻痹下)、显然验光、Wavescan波前像差仪法测量眼屈光不正,并将患者按屈光不正度数分为3组:低度近视组(-0.50～-3.00D)17眼,中度近视组(-3.00～-6.00D)27眼,高度近视组(-6.00～D)22眼。对测量的结果进行两两比较,采用配对t检验分析。结果:四种验光方法测量的验光结果(球镜、柱镜、等效球镜)显示,低度近视及高度近视组,显然验光与Wavescan波前像差仪验光球镜及柱镜度数比较没有统计学差异(P=0.289,P=0.814,P=0.057,P=0.246),睫状肌麻痹状态下验光与Wavescan波前像差仪验光在中高度近视组,球镜度数及柱镜度数之间的比较差异没有统计学意义(P=0.052,P=0.111,P=0.539,P=0.154),并且结果不随屈光状态的不同而不同,而等效球镜度数之间的差异具有统计学意义。Wavescan波前像差仪和显然验光及睫状肌麻痹状态下验光测量,结果比较,随屈光不正度数增加,球镜相符率降低,柱镜相符率升高。结论:Wavescan波前像差仪测量屈光不正有较高的准确性,可以很好地用于VISXSTARS4准分子激光治疗系统个体化切削治疗使用,但与显然验光和睫状肌麻痹状态下验光比较仍有差异,可以作为以上两种验光方法的参考和补充。     

Zywave波前像差仪测量屈光不正的准确性研究

目的评价Zywave波前像差仪测量近视眼屈光不正的准确性。方法对56例行屈光不正矫正术的怠者（106只限）分别用电脑验光（睫状肌麻痹和非睫状肌麻痹下）、显然验光、Zywave波前像差仪法测量眼屈光不正，并将患者按屈光不正度数分为三组：低度近视组（-0．50～-3．00D），中度近视组（-3．25--6．00D），高度近视组（-6．25D-）。对测量的结果进行单因素方差分析（ANOVA）。结果四种验光方法测量的验光结果（球镜、拄镜、等效球镜）除低度近视组电脑验光和睫状肌麻痹状态下验光的球镜度数（P=0．029）及等效球镜度数之间的比较差异有显著性（P=0．024）外，余在低度近视组、中度近视组及高度近视组两两之间比较差异均无显著性（ANOVA，P〉0．05）。Zywave波前像差仪和显然验光及睫状肌麻痹状态下验光测量结果比较，随屈光不正度数增加，球镜相符率降低，柱镜相符率升高。结论Zywave波前像差仪测量屈光不正有较高的准确性，可以很好地用于Zyoptix系统个体化切削治疗使用，但与显然验光和睫状肌麻痹状态下验光比较仍有差异，可以作为以上两种验光方法的参考和补充。     

便携式电脑验光仪筛查屈光不正的可行性探讨

目的 探讨便携式电脑验光仪的准确性及用其筛查屈光不正的可行性.设计诊断试验.研究对象2008年6月至9月南通大学附属医院眼科就诊的屈光不正患者65例（130眼）.方法 对所有病例分别行SHIN-NIPPON SRH-2000便携式电脑验光仪验光及视网膜检影.主要指标屈光值（球镜度数、柱镜度数及轴向）的差异性检验、相关分析及受试者工作特征（ROC）曲线分析.结果 以视网膜检影为金标准,电脑验光的球镜度数轻度偏正,其中睫状肌麻痹后电脑验光与检影的差值为（＋0.33±0.56）D,呈高度正相关（r=0.98,P〈0.01）,差异有统计学意义（t=6.87,P〈0.01） 电脑验光的柱镜度数轻度偏负,其中睫状肌麻痹后电脑验光与检影的差值为（-0.23±0.45）D,呈中度正相关（r=0.81,P〈0.01）,差异有统计学意义（t=-5.85,P〈0.01）.电脑验光在睫状肌麻痹前后比较无统计学差异（球镜度数t=1.31,P=0.26 柱镜度数t=-0.28,P=0.78）.电脑验光对散光的检出率高,但主要是≤0.75D的低度散光,且与视网膜检影的轴向差值多数≤150.以视网膜检影的等效球镜为参考指标,电脑验光的ROC曲线下面积〉0.95（睫状肌麻痹后为0.984,睫状肌麻痹前为0.979）.结论 便携式电脑验光仪筛查屈光不正的准确性与视网膜检影一致,可用在群体眼病流行病学调查中筛查屈光不正.     

PR-2000型自动验光仪在儿童屈光筛查中的价值

目的探讨PR-2000型自动验光仪应用于儿童屈光检查中的准确性及特点。方法对260例（520眼）屈光不正患者,用PR-2000型自动验光仪,分别在非睫状肌麻痹状态和睫状肌麻痹状态下验光,并分别与视网膜检影法的验光结果进行比较。结果球镜度数：非睫状肌麻痹状态下和使用阿托品后,PR-2000型自动验光仪验出的结果与阿托品散瞳检影法验出的结果均呈高度正相关（r=0．922,r=0．946）。柱镜度数：非睫状肌麻痹状态下和使用阿托品后,PR-2000型自动验光仪验出的结果与阿托品散瞳检影法验出的结果呈高度正相关（r=0．888,r=0．890）。对于≤0．75D的低度散光,自动验光仪比检影验光法的检出率高。结论PR-2000自动验光仪用于婴幼儿屈光筛查较为可靠实用,也可用于大面积屈光普查和流行病学调查。     

睫状肌麻痹前后综合验光仪与常规验光比较分析

目的 对比分析睫状肌麻痹前后综合验光仪主觉验光和常规主觉插片屈光度的差异变化,探讨科学规范的验光方法.方法 选取2009年8月行屈光检查的近视患者108例,年龄17～28岁,睫状肌麻痹前后用电脑验光仪或检影镜进行客观验光,然后在此基础上进行综合验光仪主觉验光和常规主觉插片.将检测结果用统计软件SPSS11.0进行统计学分析.结果 综合验光仪主觉验光球镜和柱镜度数在睫状肌麻痹前后变化不大,差异无统计学意义(P＞0.05).而常规验光球镜度数睫状肌麻痹前后差异有统计学意义(P＜0.01).柱镜度数散瞳前后差异无统计学意义(P＞0.05).结论 对于成人屈光不正患者,规范科学的综合验光仪主觉验光无需散瞳松弛睫状肌即可获得准确的屈光不正度数,是一种简便准确可靠的验光方法.     

复方托吡卡胺滴眼液在青少年近视患者散瞳验光中的临床客观评价

目的:了解复方托吡卡胺滴眼液在青少年散瞳验光中麻痹睫状肌的临床效果,客观地对其评价以指导临床工作。方法:随机抽取2008-12/2009-02期间的40例80眼近视患者,年龄12～18岁,利用国产复方托吡卡胺滴眼液滴眼散瞳先后对其进行散瞳3次,45min以后,对其进行检影验光,并利用综合验光仪测定其残余调节量,7h以后进行复验及试戴评估,应用SPSS15.0统计软件对结果进行统计学分析。结果:残余调节量最大值+3.00D,最小值+0.25D,平均值+1.57±0.47D,残余调节量≤1.00D仅为6眼(8%),检影验光的结果与复验结果存在统计学差异(P<0.05)。结论:临床上对于青少年近视患者的屈光检查,复方托吡卡胺滴眼液是一种有效的睫状肌麻痹剂,但因注意到其麻痹睫状肌及放松调节的有限性,应灵活结合其他放松调节的方法获取最终的配镜处方。     

盐酸环喷托酯滴眼液和复方托品卡胺睫状肌麻痹效果比较

目的:了解盐酸环喷托酯滴眼液和复方托品卡胺滴眼液在散瞳验光中麻痹睫状肌的临床效果,客观地对其评价以指导临床工作。 方法:随机抽取2010-12/2011-03期间的60例120眼屈光不正（近视和远视各占50%）患者,年龄12～40岁,利用国产复方托品卡胺滴眼液滴眼散瞳先后对其进行散瞳4次, 45min以后,对其进行检影验光,并利用综合验光仪测定其残余调节量,第2d用盐酸环喷托酯眼液进行复验。 结果:远视组盐酸环喷托酯滴眼液和复方托品卡胺两者验光结果差异较大（P＜0.01）;近视组两者验光差异较小（P＜0.05）,但是仍然具有统计学差异。 结论:临床上对于屈光不正患者的屈光检查,复方托品卡胺滴眼液是一种有效的睫状肌麻痹剂,但因注意到其麻痹睫状肌及放松调节的有限性,特别在远视患者应灵活结合其他放松调节如盐酸环喷托酯眼液的方法获取最终的配镜处方。     

初发近视儿童非睫状肌麻痹主觉验光的准确性评估

目的：观察9～13 岁初发近视儿童睫状肌麻痹前后主觉验光是否存在差异并分析相关影响因素,为临床上近视儿童的验光方法的选择提供参考依据。方法：前瞻性临床研究。收集2017 年5-9 月在温州医科大学附属眼视光医院就诊的近视儿童90 例,所有受检者行非睫状肌麻痹主觉验光,然后测量并记录其隐斜量、正负相对调节力、调节反应值。之后用1%盐酸环喷托酯滴眼液点眼3次,45 min后测量电脑验光并复测主觉验光。均取右眼数据用于统计,采用方差分析和多元线性回归进行统计学分析。结果：非睫状肌麻痹主觉验光屈光度为（-1.09±0.30）D,睫状肌麻痹后电脑验光屈光度为（-1.27±0.40）D,睫状肌麻痹后主觉验光屈光度为（-1.09±0.33）D,睫状肌麻痹前、后主觉验光差异无统计学意义（P>0.05）。睫状肌麻痹后电脑验光柱镜度高于主觉验光（P<0.001）,而球镜度差异无统计学意义（P>0.05）。多元线性回归分析发现睫状肌麻痹前、后屈光度差值不受年龄（β=0.044,P=0.699）、屈光度（β=0.091,P=0.430）、隐斜（β=-0.059,P=0.599）、调节滞后量（β=-0.064,P=0.576）、正相对调节能力（β=0.043,P=0.709）等因素影响。结论：在排除调节或集合功能异常的情况下,大部分9～13岁初发性近视儿童可采用非睫状肌麻痹主觉验光获得比较准确的屈光度。     

利用残余调节客观测量方法研究美多丽P对近视儿童睫状肌麻痹的效果

目的通过客观法测量眼残余调节（RA）量,评估美多丽P（质量分数0.5%托品酰胺＋质量分数0.5%苯肾上腺素）在近视儿童中的睫状肌麻痹效果。方法 85例近视儿童,年龄6～14岁;主觉等效球镜-0.75～-5.75D。受试者双眼点用美多丽P滴眼液3次,每次1滴,间隔5min;第3次点用30min后,应用开放视野的红外自动验光仪分别测量单眼注视4m与33cm处0.2SnellenE视标的调节反应。远距离与近距离的调节反应均值之差为RA量。结果平均RA量右眼为（0.22±0.27）D（95%CI：0.16～0.28）,左眼为（0.24±0.27）D（95%CI：0.18～0.30）。RA量在左右眼间（t=-0.84,P=0.41）和不同性别的同眼别间差异均无统计学意义（右眼：t=0.02,P=0.98;左眼：t=-0.82,P=0.41）;应用美多丽P滴眼液后左右眼的RA量呈正相关（r=0.49,P=0.00）;应用美多丽P滴眼液后眼RA量与年龄、近视度数之间均无相关性（r=0.10,P=0.39;r=-0.15,P=0.17）。结论大多数受试者低度的RA量表明,美多丽P滴眼液在近视儿童中是一种有效的睫状肌麻痹剂。     

Measurement of refractive errors in young myopes using the COAS Shack-Hartmann aberrometer.

PURPOSE: To evaluate the Complete Ophthalmic Analysis System (COAS; WaveFront Science) for accuracy, repeatability, and instrument myopia when measuring myopic refractive errors. METHODS: We measured the refractive errors of 20 myopic subjects (+0.25 to -10 D sphere; 0 to -1.75 D cylinder) with a COAS, a phoropter, and a Nidek ARK-2000 autorefractor. Measurements were made for right and left eyes, with and without cycloplegia, and data were analyzed for large and small pupils. We used the phoropter refraction as our estimate of the true refractive error, so accuracy was defined as the difference between phoropter refraction and that of the COAS and autorefractor. Differences and means were computed using power vectors, and accuracy was summarized in terms of mean vector and mean spherocylindrical power errors. To assess repeatability, we computed the mean vector deviation for each of five measurements from the mean power vector and computed a coefficient of repeatability. Instrument myopia was defined as the difference between cycloplegic and noncycloplegic refractions for the same eyes. RESULTS: Without cycloplegia, both the COAS and autorefractor had mean power vector errors of 0.3 to 0.4 D. Cycloplegia improved autorefractor accuracy by 0.1 D, but COAS accuracy remained the same. For large pupils, COAS accuracy was best when Zernike mode Z4(0) (primary spherical aberration) was included in the computation of sphere power. COAS repeatability was slightly better than autorefraction repeatability. Mean instrument myopia for the COAS was not significantly different from zero. CONCLUSIONS: When measuring myopes, COAS accuracy, repeatability, and instrument myopia were similar to those of the autorefractor. Error margins for both were better than the accuracy of subjective refraction. We conclude that in addition to its capability to measure higher-order aberrations, the COAS can be used as a reliable, accurate autorefractor.     

电脑验光仪和综合验光仪联合应用的临床评价

目的：评价电脑自动验光与综合验光仪主动验光联合应用的临床价值。方法：根据扩瞳与否按年龄段分A，B组，A组3－16岁100例，小瞳和扩瞳后分别行电脑验光，B组17－55岁96例，仅行小瞳电脑验光，所有患者均在综合验光仪进行主觉验光。结果：A组小瞳和扩瞳电脑验光球镜度数有显著性差异（P＜0．05），扩瞳电脑验光与综合验光仪主觉验光球镜度数差异无显著意义（P＞0．05），符合率为86％，B组电脑验光与综合验光仪主觉验光的球镜度数无显著性差异（P＞0．05），小瞳验光与综合验光仪散光轴位的差异无显著意义（P＞0．05），符合率为91．6％，结论：电脑自动验光和综合验光仪联合验光是一种准确可靠的验光方法。     

Autorefractometry after laser in situ keratomileusis

PURPOSE: To correlate cycloplegic subjective refraction with cycloplegic autorefractometry in eyes that have had laser in situ keratomileusis (LASIK). SETTING: Vlemma Eye Institute, Athens, Greece. METHODS: Subjective refraction and autorefractometry under cycloplegia were performed in 73 eyes of 46 patients 1, 6, and 12 months after LASIK to correct myopia or myopic astigmatism. The preoperative subjective refraction and autorefractometry under cycloplegia in the same eyes served as controls. RESULTS: A statistically significant difference between subjective refraction and autorefraction was found in the sphere and cylinder at all postoperative times. No statistically significant difference was found in the axis. There was no statistically significant difference in the control eyes. CONCLUSIONS: Automated refractometry in eyes that had had LASIK was reliable in the axis only. Retreatments after LASIK should always be based on subjective refraction.     

A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children

PURPOSE: To evaluate the accuracy of autorefraction using three autorefractors comparing to subjective refraction in diagnosing refractive error in children. DESIGN: A cross-sectional study. METHODS: setting: Community based study. study population: 117 children sampled from primary schools. procedures: All subjects underwent autorefraction using three auto refractors and subjective refraction with and without cycloplegia. main outcome measures: Spherical power, cylindrical power, and spherical equivalence (SE). RESULTS: Without cycloplegia, the mean SE were significantly different for Retinomax K plus 2 (-1.55 diopters, SD 2.37 diopters; 95% CI -1.98 to -1.12; P < .0001) and Canon RF10 (-1.11 diopters; SD 2.61 diopters; 95% CI -1.59 to -0.64; P = .0023) compared with monocular subjective refraction (-0.80 diopters; SD 2.25 diopters; 95% CI -1.21 to -0.35). Mean SE was significantly different for Grand Seiko WR5100K (-0.79 diopters; SD 2.40 diopters; 95% CI -1.23 to -0.35; P = .0002) compared with binocular subjective refraction (-0.62 diopters; SD 2.51 diopters; 95% CI -1.07 to -0.16). With cycloplegia, there was no significant difference in mean SE between refraction methods. Sensitivity and specificity results for the diagnosis of myopia: Without cycloplegia: Retinomax K plus 2 (sensitivity 1.0, specificity 0.51); Canon RF10 (sensitivity 0.92, specificity 0.81); and Grand Seiko WR5100K (sensitivity 0.91, specificity 0.98). With cycloplegia: Retinomax K plus 2 (sensitivity 0.97, specificity 0.99); Canon RF10 (sensitivity 0.97, specificity 0.96); and Grand Seiko WR5100K (sensitivity 1.0, specificity 0.97). CONCLUSIONS: Under noncycloplegic conditions, all three autorefractors have a tendency towards minus over correction in children resulting in over diagnosis of myopia. However autorefractors were accurate under cycloplegic conditions.     

Validity of noncycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study

Purpose: To determine the sensitivity and specificity of noncycloplegic autorefraction for determining refractive status compared to cycloplegic autorefraction. Methods: The target population was noninstitutionalized citizens of all ages, residing in Tehran in 2002, selected through stratified cluster sampling. From 6497 eligible residents, 70.3% participated in the study, from August to November 2002. Here, we report data on 3501 people over the age of 5 years who had autorefraction with and without cycloplegia (two drops of cyclopentolate 1.0% 5 min apart, with autorefraction 25 min after the second drop). Results: Overall, the sensitivity of noncycloplegic autorefraction for myopia was 99%, but the specificity was only 80.4%. In contrast, the sensitivity for hyperopia was only 47.9%, but the specificity was 99.4%. At all ages, noncycloplegic autorefraction overestimated myopia and underestimated hyperopia. Overestimation of myopia was highest in the 21–30 and 31–40 year groups. Underestimation of hyperopia was high up to the age of 50 (20–40%), but decreased with age, to about 8% after the age of 50, down to almost 0% after 70. The difference in mean spherical equivalent with and without cycloplegia fell from 0.71 dioptres (D) in the 5–10 age group to 0.14D in those over 70. Conclusion: Use of noncycloplegic autorefraction in epidemiological studies leads to considerable errors relative to cycloplegic measurements, except in those over 50–60. The difference between cycloplegic and noncycloplegic measurements varies with age and cycloplegic refractive category, and there is considerable individual variation, ruling out adjusting noncycloplegic measurements to obtain accurate cycloplegic refractions.