温州地区近视儿童骨龄的研究

目的：分析温州地区近视儿童的骨龄、年龄、身高、体质量、眼生物学参数之间的关系。

方法：收集温州地区近视儿童410例820眼,年龄5～11岁,测量每位儿童身高、体质量、骨龄、眼轴长度(AL)、计算体质量指数(BMI)。快速散瞳后医学验光测得屈光度数,并将其换算为等效球镜度数(SE)。对每个年龄段的儿童按骨龄差(生物年龄-生活年龄)进行分组,分别统计各个组别的近视占比,并比较不同骨龄差组间近视占比。将近视儿童按骨龄差进行分组,统计每个组别内男、女性别的占比,并比较男童、女童间的近视占比。

结果：5～11岁近视儿童的年龄与身高、体质量、BMI、SE、眼轴有一定相关性(r_s=0.853、0.776、0.291、-0.274、0.312,均P<0.05),与骨龄差无相关性(r_s =0.045,P>0.05)。在5～11岁的近视儿童中,40.5%儿童骨龄超前,40.2%儿童骨龄差在正常范围,19.3%儿童骨龄落后(χ²=21.576,P<0.05)。在5～11岁的近视儿童中,男童占46.3%,女童占53.7%(χ²=17.322,P<0.01),其中在骨龄超前的儿童中,女童的比例高于男童。

结论：温州地区5～11岁近视儿童的年龄与身高、体质量、BMI、SE、眼轴有一定相关性。低龄近视儿童中有较多儿童骨龄超前,尤其是女童。     

儿童原发性近视眼

目的　分析儿童原发性近视眼的特点。方法　①对象流行病学调查发现的50例(3～7岁)及临床就诊的39例(1～12岁),静态屈光均为近视眼。②观察指标远视力、近视力、屈光(用1%阿托品)、眼底、角膜曲率、眼轴。结果　儿童近视眼多数为原发性(82例),继发于其它疾病的有7例,无明显性别差异。儿童原发性近视眼为先天性,眼轴多明显延长,长度与屈光度成正相关,角膜屈折力无明显病理意义。屈光度进行性发展,随年龄增加而加深,是日后成年期变性近视眼的主要组成。结论　儿童近视眼可分为原发性和继发性。其中主要为原发性变性近视眼。     

阿托品联合双焦镜控制青少年轻中度近视疗效分析

Objective To evaluate the efficacy and safety of topical atropine and bifocal lens in slowing the progression of myopia and ocular axial elongation in children with slight to moderate myopia. Methods This trial included 62 children with slight to moderate myopia. They were all being treated in the Second Hospital of the Zhengzhou of Henan. Forty-two children were treated with 1% atropine ointment once daily before sleep for 1 year, and were demanded to wear bifocal lens at the same time. The other children were assigned to control group. Baseline and last assessments of refractive errors by cycloplegic autorefiaction and of axial length were done by ultrasound biometry. Intraocular pressure and corneal curvature were also recorded. The results were compared with data of control subjects. Results The visual acuity of 38 eyes (36.84%) in the treated group cutted down, compared with 80% in the control group. After 1 year, the mean progression of myopia and of axial elongation in the control group was -1.19±1.48D and 0.70± 0.63mm respectively. In the atropine-treated eyes, the mean progression of myopia was only±0.06± 0.79D and of axial elongation was 0.09± 0.19mm. Five children were forced to stop treatment because of photophobia and anaphylactic conjunctivitis. No other major adverse effects related to the treatment were noted. Conclusions 1% Atropine ointment and bifocal lens are safe and effective treatment for retarding myopic progression in slight to moderate myopia.This treatment is well tolerated by most children.     

阿托品联合双焦镜控制青少年轻中度近视疗效分析

Objective To evaluate the efficacy and safety of topical atropine and bifocal lens in slowing the progression of myopia and ocular axial elongation in children with slight to moderate myopia. Methods This trial included 62 children with slight to moderate myopia. They were all being treated in the Second Hospital of the Zhengzhou of Henan. Forty-two children were treated with 1% atropine ointment once daily before sleep for 1 year, and were demanded to wear bifocal lens at the same time. The other children were assigned to control group. Baseline and last assessments of refractive errors by cycloplegic autorefiaction and of axial length were done by ultrasound biometry. Intraocular pressure and corneal curvature were also recorded. The results were compared with data of control subjects. Results The visual acuity of 38 eyes (36.84%) in the treated group cutted down, compared with 80% in the control group. After 1 year, the mean progression of myopia and of axial elongation in the control group was -1.19±1.48D and 0.70± 0.63mm respectively. In the atropine-treated eyes, the mean progression of myopia was only±0.06± 0.79D and of axial elongation was 0.09± 0.19mm. Five children were forced to stop treatment because of photophobia and anaphylactic conjunctivitis. No other major adverse effects related to the treatment were noted. Conclusions 1% Atropine ointment and bifocal lens are safe and effective treatment for retarding myopic progression in slight to moderate myopia.This treatment is well tolerated by most children.     

阿托品联合双焦镜控制青少年轻中度近视疗效分析

目的 探讨长期滴用1%阿托品凝胶并联合应用双焦镜对治疗青少年轻中度近视的有效性及安全性.方法 选取2008年1月至2009年3月于眼科门诊就诊的62例轻中度近视患者,将其按2:1比例随机分为治疗组42例和对照组20例.治疗组给予1%阿托品凝胶每晚睡前一次滴眼,连续使用一年,同时联合应用双焦镜;对照组则根据视力和症状给予常规验光配镜,局部及全身均不使用任何药物.所有患者在受试前均接受全面的眼科检查作为基线标准,一年试验结束后检查视力、屈光度(散瞳验光)、眼轴、眼压及角膜曲率,将两组结果进行对比分析.结果 治疗组视力下降率为36.84%,而对照组为80%,明显高于治疗组.治疗起始时治疗组的屈光度(SEQ)为(-2.18±1.05)D,对照组为(-2.12±1.33)D,1 年后治疗组的屈光度平均改变(+0.06±0.79)D,而对照组为(-1.19±1.48)D,对照组屈光度下降程度明显高于治疗组,两组比较有显著性差异.治疗组1年后眼轴平均增长(0.09±0.19)mm,对照组眼轴增长(0.70±0.63)mm,治疗组眼轴较起始无明显改变而对照组明显增长.所有观察对象均未出现眼压升高.两组间角膜曲率在治疗前及治疗后均无明显差异.对照组无人中途退出,治疗组42例中有5例(11.9%)因畏光及过敏性结膜炎而退出试验.结论 阿托品联合双焦镜能够有效控制并延缓近视发展,长期使用1年未发现明显的不良反应,患者能够耐受该治疗.     

Photodynamic therapy of subfoveal choroidal neovascularization in high myopia in a clinical setting: visual outcome in relation to age at treatment

PURPOSE: To evaluate the visual outcome of patients with myopic subfoveal choroidal neovascularization (CNV) given photodynamic therapy (PDT) in a clinical setting, and to identify potential relation between the visual outcome and the age at treatment. DESIGN: Interventional case series. METHODS: Retrospective comparative study. SETTING: Outpatient ophthalmology clinic. PATIENTS: Twenty-nine consecutive patients (30 eyes) with subfoveal CNV caused by pathologic myopia who were treated with verteporfin PDT from January 2000 to May 2003. INTERVENTION: All the patients received verteporfin PDT and were followed clinically and with fluorescein angiography (FA). Review of the medical records and angiograms was performed. Patients were divided into two groups by age, using the median age (60 years) as the cutoff. MAIN OUTCOME MEASURES: Visual acuity (VA) at the end of follow-up in the older-patient group compared with the younger-patient group. RESULTS: The mean age was 63.1 years. Mean follow-up was 11.5 months. Patients received a mean of 3.48 treatments. Mean VA improved in the younger group from 0.63 to 0.39 logMAR (P = .02, paired t test) and deteriorated in the older group from 0.71 to 0.99 logMAR (P = .03, paired t test). In the whole cohort, 33% of eyes lost 3 or more lines of Snellen best-corrected VA; in the older age group, 50% of eyes lost 3 or more lines, whereas in the younger age group, only 8% of eyes did so (P = .024, Fisher's exact test). CONCLUSIONS: In our consecutive case series, visual prognosis of myopic CNV after PDT was found to be influenced by age at treatment.     

Prevention of myopia in children

Eye diseases rank third in the structure of morbidity among children aged 0 to 17 years. Acquired myopathy is the leading abnormality in the structure of morbidity, with diminished vision being in 28% of preschool children and in every two school graduates. Myopia is attended by the signs of systemic connective tissue dysplasia and impaired circulation due to autonomic dysfunction. Early diagnosis and correction of autonomic dysfunction is the basic line of the prevention and treatment of school myopia. Treatment of children can be organized in the medical room of a school. Along with general health-improving measures, physiotherapetic procedures, such as lens exercises, curative gymnastics, massage, and gentle manual therapy procedures should be used in the multimodality treatment of children with myopia. Autonomic tone can be regulated through the visual analyzer by pulse photostimulation on a spectral ophthalmologic apparatus (an up-to-date ACO-05 software model ("DEST", Cheboksary). Moreover, circulation improves, eye muscles become stronger, visual reflexes restore, and vision improves. A school oculist's room may be used as a new health-improving form in children with myopia. It should be set up in every school since the high efficiency of treatment for accommodation spasm is an important argument of the prevention of myopia, promotes a greater coverage of children with early myopia by means of therapeutic measures, as well as timely and contemporary prevention of progressive myopathy.     

Prevalence of lattice degeneration and its relation to axial length in severe myopia

We studied 436 eyes of 218 patients with myopia of -6.00 diopters or more in both eyes. Of 218 patients, 72 (33.0%) had lattice degeneration of the retina. Among these 72 patients, lattice lesions were uniocular in 39 (54.2%) and binocular in 33 (45.8%). Of 105 males, 33 (31.4%) had lattice degeneration; of 113 females, 39 (34.5%) had lattice degeneration. Contrary to previously published data, we found an inverse relationship between axial length and the prevalence of lattice degeneration in severely myopic eyes. The greatest prevalence of lattice degeneration (63 of 154 eyes, 40.9%) was found in eyes with an axial length of 26.0 to 26.9 mm (-6.00 to -8.70 diopters), and the least prevalence of lattice degeneration (five of 71 eyes, 7.0%) was found in eyes with an axial length of 32.0 mm (-24.00 diopters) or greater. This may explain the observation that retinal detachment after cataract surgery has been noted more commonly among patients with moderate than severe myopia.     

Carbogen therapy in high myopia in children

Forty-eight patients, aged 7 to 15, with the diagnosis of high developed myopia complicated by chorioretinal peripheral dystrophy were investigated. A total of 1500 examinations were made. The patients were shared between the main and control groups. Sex, age and the clinical pattern were compatible. The main-group patients received the carbogene therapy and routine neurotrophic treatment, while the controls received only the latter. The treatment course lasted for as long as 10 days (10 inhalations). There were no any complications during and after the carbogene inhalations. The conclusion, based on the data obtained, can be that the carbogene inhalations, when added to the neurotrophic treatment scheme, enhance the therapy efficiency in case of high, complicated and developed myopia in children.