正常角膜及圆锥角膜的生物力学特性比较研究

Objective To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. Methods It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (≥3.00 D) and low-to-moderate corneal astigmatism (<3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage Ⅰ), moderate (stage Ⅱ) and severe (stage Ⅲ/Ⅳ). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. Results The mean CH and CRF were (7.1±1.6) mm Hg and (6.3±1.5) mm Hg in keratoconic eyes compared with (10.1±1.3) mm Hg and (10.5±1.6) mm Hg in normal eyes. The difference were statistically significant(t=-11.813, -14.943 ;P<0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to- moderate corneal astigmatism (t=0.373,0.095; P>0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r=-0.627, P<0.001) and the same relationship was found between CRF and the keratoconus grade (r=-0.587, P<0.001). In multiple linear regression analysis, CH was correlated with central corneal thickness (CCT) and corneal curvature (r=0.320, -0.375;P<0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r=-0.441 ,P<0.01), while they were only correlated with CCT in normal eyes (r=0.367,0.459;P<0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z=20.462,38.305 ;P<0.0001), the difference between them was significant (Z =7.134,P=0.008). Conclusions The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.     

角膜塑型术后眼波前像差变化

目的 探讨角膜塑型术后眼波前像差变化及其影响因素，了解第3代角膜塑型术对视觉质量的影响。方法 对进行角膜塑型术的21例（42眼）进行了前瞻性临床研究，将角膜塑型术术前及术后达最佳裸眼视力时的眼波前像差情况作测量与比较。检查结果通过Matlab软件分析．直接获取35项Zemike系数及每阶Zemike系数的RMS值。结果 角膜矫型术后总像差，第3、第4、第5、第7阶RMS值较术前增加，且差异有显著性（P〈0．05）。第2、第6阶RMS值较术前增加，但差异无显著性（P〉0．05）。结论 角膜塑型术后眼的像差增加，降低了视觉质量。角膜光学区直径的缩小以及偏离、角膜表面的非规则性增加，角膜非生理形态的改变等是导致像差增加的原因。     

应该大力加强对“医学验光”的研究与实施

本文重申"医学验光"在我国推广的实际意义及规范。强调进行系统研究是保证其科学应用的基础。     

阅读障碍与颜色滤光镜

阅读障碍在儿童中发病率很高,占5%～10%,严重影响儿童的阅读能力、学习水平以及心理健康.有关阅读障碍的机制很多,其中大细胞系统功能缺陷与视觉压力是造成阅读障碍的重要机制.目前关于阅读障碍尚缺乏有效的治疗手段.近年来大量的研究表明颜色滤光镜能够提高阅读障碍患者的视觉表现,从而提高阅读能力.视觉大细胞系统功能缺陷理论与皮层超兴奋引起的视觉压力是颜色滤光镜提高患者视功能的主要理论基础.     

正常角膜及圆锥角膜的生物力学特性比较研究

Objective To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. Methods It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (≥3.00 D) and low-to-moderate corneal astigmatism (<3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage Ⅰ), moderate (stage Ⅱ) and severe (stage Ⅲ/Ⅳ). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. Results The mean CH and CRF were (7.1±1.6) mm Hg and (6.3±1.5) mm Hg in keratoconic eyes compared with (10.1±1.3) mm Hg and (10.5±1.6) mm Hg in normal eyes. The difference were statistically significant(t=-11.813, -14.943 ;P<0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to- moderate corneal astigmatism (t=0.373,0.095; P>0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r=-0.627, P<0.001) and the same relationship was found between CRF and the keratoconus grade (r=-0.587, P<0.001). In multiple linear regression analysis, CH was correlated with central corneal thickness (CCT) and corneal curvature (r=0.320, -0.375;P<0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r=-0.441 ,P<0.01), while they were only correlated with CCT in normal eyes (r=0.367,0.459;P<0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z=20.462,38.305 ;P<0.0001), the difference between them was significant (Z =7.134,P=0.008). Conclusions The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.     

黄芪用于急性出血性结膜炎疗效探讨

黄芪用于急性出血性结膜炎疗效探讨上海医科大学眼耳鼻喉科医院眼科陈荣家，瞿小妹，郭维群上海医科大学眼耳鼻喉科医院眼病毒室周忆平１９９０年夏季，ＡＨＣ病例又有小流行趋势，临床特征，表现有眼发红，疼痛眼睑肿胀，结膜高度充血，并伴有结膜下出血，ＡＨＣ眼病，由...     

学龄期儿童青少年电子屏幕用眼健康管理专家指导意见

我国未成年人使用各类电子产品、数字化设备呈普遍化、低龄化发展趋势。长时间使用智能手机、笔记本电脑、平板电脑等进行在线学习、网络社交、网上娱乐,会显著增加学龄期儿童青少年近距离用眼负荷,挤占正常的社会交往、体育活动与户外自然光暴露时间。家长及监护人对儿童青少年使用电子屏幕的管理缺位,儿童青少年易养成不健康的屏幕用眼习惯与行为,对学龄期儿童青少年的生理、心理以及屈光发育可能带来不良影响。为促进学龄期儿童青少年养成屏幕用眼的良好习惯,使他们健康科学地使用各类电子显示屏幕,减缓儿童青少年近视的发病与进展,基于循证医学证据、行业标准规范及临床经验制订《学龄期儿童青少年电子屏幕用眼健康管理专家指导意见》至关重要。     

不同晶状体屈光力计算公式在儿童屈光发育档案中的应用比较

目的比较在缺乏晶状体厚度时,不同晶状体屈光力计算公式的一致性,寻找简化晶状体屈光力流行病学调查的计算公式。方法横断面研究。晶状体屈光力通过3种不同的公式计算得出。计算公式包括需要晶状体厚度值的Bennett公式,以及不需要晶状体厚度值的修正Stenström公式及Bennett-Rabbetts公式。共189名（378眼）7～14岁正视青少年纳入研究,将测量所得的生物学数据代入上述各公式中,以Bennett公式计算所得的晶状体屈光力（PL,Bennett）作为基础值,比较另2种公式计算值（PL,Sten、PL,BR）的准确性。对相关数据进行配对符号检验、Wilcoxon秩和检验及Pearson相关分析。结果分别应用Gullstrand-Emsley与Bennett-Rabbetts模型眼计算,发现PL,Sten[（0.46±0.35）D]较PL,Bennett[（0.29±0.35）D]低,差异有显著统计学意义（Z=-159.5、-120.0,P<0.01）。PL,BR[（0.27±0.35）D]较PL,Bennett[（0.09±0.34）D]低（Z=-112.5、-42.0,P<0.01）。通过修正c常数使PL,BR与PL,Bennett之间差异无统计学意义（Z=5.0,P＞0.05）,两者之间的最大差异仅为1.35 D,同时85.4%的PL,BR与PL,Bennett的误差小于0.50 D。将不同年龄组PL,Bennett与PL,BR（修正c常数后）的差值进行多组Wilcoxon秩和检验（χ²=314.53,P<0.01）,2种公式计算值之间的差异在7～12岁之间逐渐减小,12岁之后差异增大。2种方法所计算得出的晶状体屈光力之间的差值与年龄呈显著负相关（r=-0.36,P<0.01）。结论通过c常数的修正,Bennett-Rabbetts公式与Bennett公式所得晶状体计算值在正视青少年中表现出较好的一致性。     

非球面角膜塑形镜矫正近视的有效性和安全性

目的：评价非球面角膜塑形镜矫正近视的临床有效性和安全性。方法：前瞻性随机对照研究。选取年龄≥8岁的双眼近视患者,通过中央随机系统随机分配至试验组和对照组,试验组配戴NOR型非球面角膜塑形镜,对照组配戴欧几里德夜戴型角膜塑形镜。配戴后1 d、1周、2周、1个月、3个月、 6个月、9个月、1年进行随访,评估裸眼远视力、屈光度、角膜K值、裂隙灯显微镜检查结果、镜片情况、角膜内皮细胞计数、角膜厚度、眼压。采用独立样本t检验、Wilcoxon秩和检验、卡方检验等方法进行数据分析。结果：共291例受试者完成初次配戴,试验组143例,对照组148例。配戴后各随访时间点,2组左、右眼LogMAR裸眼远视力、屈光度及其相对于基线期变化值的差异均无统计学 意义（P>0.05）;2组左、右眼角膜平坦K值及右眼角膜陡峭K值相对于基线变化值差异均无统计学意 义（P>0.05）。除配戴后1 d、9个月以外,其余随访时间点,2组左眼角膜陡峭K值相对于基线变化值 差异均无统计学意义（P>0.05）。配戴后6个月、1年时,2组左、右眼角膜厚度、角膜内皮细胞计数、 眼压及其相对于基线期变化值的差异均无统计学意义（P>0.05）。各随访时间点,2组受试者均未出现严重并发症,并发症发生率的组间差异均无统计学意义（P>0.05）。配戴后1年时,2组角膜塑形镜 配适状态和镜片状态均良好且组间比较差异无统计学意义（P>0.05）。结论：NOR型非球面角膜塑形镜与夜戴型角膜塑形镜矫正近视的有效性和安全性良好,2种角膜塑形镜疗效一致且均具有较高的安全性。     

圆锥角膜早期的角膜地形图改变

目的　揭示早期圆锥角膜角膜地形图的特征,为早期诊断此病提供参考。方法　收集了本院门诊拟诊为早期圆锥角膜的患者27例52眼。所有患者均行TMS-1角膜地形图测定。结果　80.77%眼角膜最高屈光度部位在正下方或颞下方,最高屈光度在45D以上,散光在2D以上,所有眼平均最高屈光度在47.56D±5.80D,平均散光5.47D±3.80D;角膜非对称性指数(SAI)及角膜规则性指数(SRI)值大于0.5者分别为94%、98%,SAI值平均为2.6±1.9,SRI值平均为1.67±0.94。结论　早期圆锥角膜的测定须兼顾上述综合参数,SAI及SRI值的变化更敏感。