Risk Factors of Myopic Shift among Primary School Children in Beijing,China: A Prospective Study

Objective: To evaluate factors associated with myopic shift among primary school children.Methods: In a one-year prospective school-based study, 5052 children from ten schools were enrolled using a multi-stage random cluster approach. The baseline examination included non-cycloplegic auto-refractometry and questionnaire interview. Measurements were repeated at the follow-up.Results: Among 5052 students at baseline investigated, 4292 students (85.0%) returned for the follow-up examination. The mean refractive error (-1.13±1.57 diopters) had changed -0.52±0.73 diopters from the baseline to the follow-up examination. 2170 (51.0%) had a rate of significant myopic shift (significant myopic shift is defined as the change of spherical equivalent of the refraction ≤ -0.50D between the follow-up and baseline measures). We confirmed that common associated factors (older age, parental myopia, lower refractive status at baseline, shorter reading distance and lower frequency of outdoor activities during class recesses) were associated with greater shift towards myopia. After controlling for age, sex, region of habitation, parental myopia and refractive status at baseline, greater shift towards myopia was independently associated with distance from near-work (OR=1.48 , 95% CI=1.26-1.74, P<0.001) and longer time outdoors for leisure (OR=0.87, 95% CI=0.78-0.97, P<0.013).Conclusion: Greater shift towards myopia was independently associated with modifiable factors (distance from near-work and longer time outdoors for leisure) might suggest that encouraging children to go outside for outdoor activities during class recess and after school may be a promising and feasible intervention against myopia development.     

青年近视患者神经纤维层厚度的临床研究

目的 探讨青年近视患者的神经纤维层(RNFL)厚度分布特性及其影响因素.方法 横断面研究.选取准分子激光角膜屈光手术前的青年近视患者162例(162眼),平均年龄(27.0±4.6)岁,等效球镜度-0.75～-11.00 D,平均(-4.98±2.64)D.其中,低度近视组54例,平均等效球镜度为(-2.27±0.64)D;中度近视组55例,平均等效球镜度为(-4.54±0.79)D;高度组53例,平均等效球镜度为(-8.19±1.51)D.采用光学相干断层扫描(OCT)仪检查视盘周围神经纤维层厚度,用偏相关分析RNFL厚度与患者年龄、性别、等效球镜度、眼轴、角膜中央厚度及角膜曲率的相关性.结果 本组入选患者视盘周围平均RNFL厚度:全周为(103.6±9.5)μm,上方为(128.7±16.8)μm,鼻侧为(67.8± 16.5)μm,下方为(125.9± 17.2)μm,颞侧为(91.9±16.9)μm.各RNFL厚度参数与年龄、性别、角膜曲率、中央角膜厚度无相关性,全周、上方、鼻侧、下方的平均RNFL厚度与眼轴呈负相关(r=-0.379、-0.297、-0.180 、-0.291,P＜0.05),颞侧的平均RNFL厚度则与眼轴无相关性,鼻侧、下方的平均RNFL厚度与等效球镜度呈负相关(r=-0.233、-0.163,P＜0.05),颞侧平均RNFL厚度与等效球镜度则呈正相关(r=0.159,P＜0.05).结论 青年近视患者视盘周围平均RNFL厚度上方＞下方＞颞侧＞鼻侧,全周、鼻侧、上方、下方平均RNFL厚度随眼轴的增长而变薄,下方和鼻侧RNFL厚度随等效球镜度增加而变薄,颞侧平均RNFL厚度随着等效球镜度增加而增厚.     

近视眼角膜上皮细胞EGFR、TGF-βRⅠ及IL-1RⅠ的表达

目的 :检测近视患眼角膜上皮细胞表皮生长因子受体 (EGFR)、转化生长因子 βⅠ型受体 (TGF -βRⅠ )和白细胞介素 1Ⅰ型受体 (IL -1RⅠ )的表达。方法 :将PRK术中获取的角膜上皮细胞制成细胞涂片 ,ABC法检测。结果 :EGFR、TGF -βRⅠ和IL -1RⅠ在全部标本表达 ,强度依次为EGFR >IL -1RⅠ >TGF -βRⅠ。结论 :近视患眼角膜上皮细胞表达此三种受体 ,推测PRK术后此三种受体参与角膜创面修复。     

Pegaptanib for myopic choroidal neovascularization in a young patient

Background The treatment of choroidal neovascularization (CNV) due to myopic degeneration can include laser photocoagulation, photodynamic therapy, corticosteroids, and subretinal surgery. We report a case of a young patient with myopic CNV refractive to laser photocoagulation, photodynamic therapy, and intravitreal triamcinolone acetonide treated with intravitreal pegaptanib injections. Methods Interventional case report. The medical chart of a 36-year-old female treated with intravitreal pegaptanib injections was reviewed for changes in visual acuity on the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, CNV leakage on fluorescein angiography, and adverse events reported. Results ETDRS visual acuity improved from counting fingers (CF) to 20/40 in the right eye after five, 6-weekly pegaptanib injections. Conclusions This is the sentinel case of US Food and Drug Administration (FDA) approved pegaptanib usage for non-wet macular degeneration via an Investigational New Drug application (Title 21, Code of Federal Regulations part 132). Pegaptanib appears to be effective in treating myopic CNV refractive to laser photocoagulation, photodynamic therapy, and intravitreal triamcinolone acetonide. The authors have no proprietary interest.     

近视屈光度、眼轴、裸眼视力的检测分析

目的　探讨近视眼患者的屈光不正度数、眼轴与裸眼视力的相互关系。方法　按屈光不正度数共分 3组 , 组 71只眼 ,屈光度 - 1.0 0～ 3.0 0 D; 组 86只眼 ,屈光度 - 3.2 5～ 6 .0 0 D; 组 2 4只眼 ,屈光度 - 6 .2 5～ 8.5 0 D。检测近视屈光度、眼轴、裸眼视力。分组进行 t检验 ,总体进行相关分析。结果　中度近视与低度近视的裸眼视力差别有非常显著性 (P <0 .0 0 1) ;高度近视与中度近视的视力 ,差别无显著性 (P >0 .0 5 )。屈光度数与眼轴各组之间均有非常显著性差别 (P <0 .0 0 1)。总体相关分析屈光不正度数与眼轴、裸眼视力之间有非常显著差别 (P<0 .0 0 1)。结论　眼轴越长 ,屈光不正度数越大。裸眼视力与屈光度两者有相关性 ,但并非绝对并行     

视知觉学习治疗近视性弱视的效果观察及护理

目的探讨视知觉学习治疗近视性弱视的疗效及护理特点。方法选择近视性弱视患儿54例(98眼),全部采用视知觉学习进行视觉训练。按1996年4月全国儿童弱视、斜视防治学组制定的标准进行分类和疗效评价。结果视知觉学习治疗近视性弱视患儿的基本治愈率为52.0%,总有效率为88.7%;轻、中、重度弱视的疗效差异有显著意义,三者的治疗周期差异有显著意义。结论视知觉学习治疗近视性弱视效果明显;有效的护理干预可促使儿童主动配合治疗,提高依从性,缩短疗程,从而提高弱视治愈率。     

Transpupillary thermotherapy for myopic choroidal neovascularization: 1-year follow-up

Purpose To evaluate the use of transpupillary thermotherapy (TTT) for myopic choroidal neovascularization (CNV) retrospectively in a case series. Methods Ten consecutive patients with CNV secondary to high myopia were treated with TTT and followed-up for 18.3 ± 7.1 months (range: 12–30 months). An activity scoring (AS) scheme based on CNV size, central foveal thickness as determined by optical coherence tomography (OCT), amount of subretinal hemorrhage, and fluorescein angiography (FA) staining characteristics was developed to assess the response to treatment. The main outcome measures were AS and visual acuity (VA). Results There was no significant loss or gain in VA, and the lesions stabilized in all eyes. FA revealed late staining typical of CNV scarring, and the amount of central foveal thickness decreased in all eyes, as determined by OCT. The mean AS at 3, 6, and 12 months and at the final visit were significantly lower than the preoperative AS (P < 0.05). No complication occurred during or after treatment. Conclusion A scheme for evaluating overall CNV activity may be useful tool for assessing the response of patients to TTT. TTT seems to stabilize myopic CNVs both clinically and as revealed by angiography, with a significant decrease in the activity of lesions. Longer term results are required to evaluate the stabilizing effect of TTT in myopic CNV.     

准分子激光角膜切削术治疗近视和近视散光的临床研究

目的 为评价准分子激光角膜切削术矫正近视的结果。方法 应用ＳＶＳ ＡＰＥＸ型准分子激光治疗仪对１５０例（２６０只眼）近视患者进行准分子激光角膜切削术，并对随访的患者进行观察。     

近视性屈光参差患者角膜塑形术后视觉相关生活质量及立体视功能的变化

目的评估近视性屈光参差患者行角膜塑形镜矫正前后的视觉相关生活质量及立体视功能。方法回顾性系列病例研究,选取2015年3月至2019年3月因近视性屈光参差于湖州师范学院附属第一医院眼科就诊并行角膜塑形镜矫正的近视患者48例。采用25项美国国家眼科研究所视觉功能问卷调查(NEI-VFQ-25)中文版评估角膜塑形镜矫正前后患者的视觉相关生活质量。通过近立体视检查图本评估近视性屈光参差患者矫正前、矫正3个月后的立体视锐度。数据采用配对样本t检验及χ~2检验进行分析。结果近视性屈光参差患者行角膜塑形镜矫正3个月后的视觉相关生活质量,包括总体视觉情况、精神健康状态、近距离工作、远距离工作、驾驶和周边视野的评分均较配戴前显著提高,差异有统计学意义(P0.01),但眼痛方面评分比矫正前明显降低,差异有统计学意义(P0.01),而在一般健康状态、社交功能、社会角色限制、独立性和色觉方面矫正前后比较,差异均无统计学意义(P0.05)。近视性屈光参差患者行角膜塑形镜矫正3个月后的近立体视功能优于矫正前,差异有统计学意义(χ~2=18.450,P0.01)。结论配戴角膜塑形镜能够改善近视性屈光参差患者的视觉相关生活质量及立体视觉。     

LASEK治疗近视散光的临床疗效观察

目的探讨准分子激光上皮下角膜磨镶术（LASEK）治疗近视散光的安全性和有效性。方法对91人（182眼）近视散光患者进行LASEK手术治疗。随访12个月,观察手术后的视力,屈光度,散光及其散光轴位的变化。结果术后随访12个月,裸眼视力≥术前最佳矫正视力（BCVA）者占61．5％;所有患眼术后散光在±1．00D以内,残留散光平均为-0．24D,散光矫正74．8％,散光轴较术前偏斜23°。术前与术后结果行配对t检验,P〈0．01,二者存在显著差异。结论;隹分子激光上皮下角膜磨镶术（LASEK）治疗近视散光预测性佳,安全可靠。