不同程度近视性屈光参差患者双眼间调节参数的差异性分析

目的：探讨近视性屈光参差患者双眼间调节力差异与屈光参差程度间的关系。方法：横断面研究。收集2019年11月至2021年6月在山东第一医科大学附属青岛眼科医院就诊的近视患者123例（246眼），年龄8~21岁。根据双眼间等效球镜度（SE）差值分为屈光不正组（SE差值≤0.25D）29例、低度屈光参差组（1.00D≤SE差值<2.50D）62例及高度屈光参差组（SE差值≥2.50D）32例3组。所有患者符合双眼最佳矫正视力（BCVA）≥0.8且各项原始数据较为完善。使用综合验光仪测量3组患者的单眼调节幅度（AMP）、单、双眼负相对调节（NRA）、正相对调节（PRA）、调节反应（AR）及调节灵活度（AF）在睫状肌麻痹下验光后确定双眼间屈光度数，分析3组间双眼调节相关参数及单眼调节参数差差值（双眼间调节参数差值＝近视屈光度较高眼调节数值-近视屈光度较低眼调节数值）之间的差异。对3组间调节参数比较采用单因素方差分析；对屈光参差程度与双眼调节参数值及双眼间调节参数差值间的关系分析选择Spearman相关分析。结果：3组间双眼NRA、PRA、AR、AF值及单眼间NRA、AF差值比较差异均无统计学意义。3组AR差值分别为-0.03±0.25、0.20±0.30、0.26±0.36，差异有统计学意义（F=7.36，P<0.001）；3组PRA差值分别为0.04±0.27、0.34±0.72、0.66±0.63，差异有统计学意义（W=7.47，P<0.001）；3组AMP差值分别为0.41±0.86、-1.07±1.53、-1.02±2.18，差异有统计学意义（W=9.25，P<0.001）。事后多重比较显示，屈光不正组与低度屈光参差组和高度屈光参差的AR差值、PRA差值、AMP差值比较差异均有统计学意义（均P<0.05）。相关性分析显示，SE差值与AR差值、AMP差值存在低强度的正相关性（r=0.22，P=0.014；r=0.36，P<0.001）。结论：不同程度近视性屈光参差患者双眼间调节参数差值不同，且双眼间AR差值、AMP差值与双眼间屈光度差异程度存在一定相关性。

Analysis on the Difference of Binocular Adjustment Parameters in Patients with Different Degrees of Myopic Anisometropia

Objective: To explore the relationship between the difference of accommodation between two eyes and the degree of anisometropia in patients with myopic anisometropia. Methods: In this cross-sectional study, a total of 123 myopic patients (246 eyes) who were admitted to the Qingdao Eye Hospital of Shandong First Medical University aged from 8 to 21 years old were collected from November 2019 to June 2021. According to the difference of equivalent spherical refraction (SE) between two eyes, there were 29 cases in ametropia group (SE difference ≤ 0.25 D), 62 cases in low anisometropia group (1.00 D ≤ SE<2.50 D) and 32 cases in high anisometropia group (SE difference ≥ 2.50 D). All patients meet the binocular best corrected visual acuity (BCVA) ≥ 0.8 and the original data were perfect. The monocular and binocular negative relative accommodation (NRA), accommodative reaction (AR), positive relative accommodation (PRA), accommodative facility (AF) and monocular accommodative amplitude (AMP) were measured by comprehensive optometry. The refraction between the two eyes was determined after optometry under cycloplegic. The differences of interocular accommodation related parameters and the difference of binocular accommodation parameters among the three groups (binocular accommodation parameter difference=myopia diopter higher eye accommodation value-myopia diopter lower eye accommodation value) were analyzed. One-way ANOVA was used to compare the accommodation parameters among the three groups, and Spearman correlation analysis was used to analyze the relationship between the degree of anisometropia and interocular accommodation parameters and the difference between binocular accommodation parameters. Results: There was no statistically significant difference between the three groups in the difference between the NRA, PRA, AR, AF values and the difference between the interocular NRA and AF values (all P>0.05). AR values were -0.03±0.25 in the ametropia group, 0.20±0.30 in the low anisometropia, and 0.26±0.36 in the high anisometropia groups respectively, with statistically significant differences (F=7.36, P<0.001). The PRA difference between the three groups was 0.04±0.27, 0.34±0.72, 0.66±0.63, with statistically significant differences (F=7.47, P<0.001). The difference in AMP was statistically significant (F=9.25, P<0.001) among the three groups (0.41±0.86, -1.07±1.53, and -1.02±2.18, respectively). Multiple comparison showed that there were significant differences in AR difference, PRA difference and AMP difference between anisometropia group and low anisometropia group and high anisometropia group (all P<0.05). In addition, SE differences were associated with lower intensity of AR and AMP differences (r=0.22, P=0.014; r=0.36, P<0.001). Conclusion: The value of accommodation parameters between the eyes of patients with different degrees of myopia refractive variance is different, and there is a correlation of the difference between the difference of AR and AMP with the degree of myopia refractive variance between the eyes.