间歇性外斜视合并近视患者调节功能的评价

doi:10.3760/cma.j.cn115909-20200527-00226

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摘要目的：分析间歇性外斜视（IXT）患者在近视及非近视状态下的调节功能相关指标的特点及参数差异。方法：回顾性系列病例研究。收集2019年12月至2020年1月在北京同仁医院就诊的6～15岁IXT患者40例，根据等效球镜度分为2组，其中IXT合并近视组20例，IXT非近视组20例。分析指标为屈光不正度数，主导眼别，斜视度数，调节性集合/调节（AC/A）比率，调节幅度，调节反应类型（调节超前、调节滞后、调节等同），正、负相对调节等。采用修正纽卡斯尔控制分数（RNCS）方法评估外斜视的控制能力并进行评分。组内两眼之间的比较采用配对t检验；2组间的比较采用独立样本t检验或秩和检验进行统计分析。定性资料用Fisher精确概率法或者χ2 检验进行比较。结果：IXT合并近视组的AC/A为2.78±1.09，明显低于非近视组的3.93±1.99（t=-2.263，P=0.029）。IXT合并近视组的主导眼（6.77±2.42）和非主导眼（6.52±2.16）调节幅度均分别明显低于IXT非近视组的主导眼（9.13±2.89）和非主导眼（8.07±2.60）（t=-2.80，P=0.008；t=-2.05，P=0.047），IXT非近视组的主导眼调节幅度高于非主导眼（t=2.572，P=0.019），IXT合并近视组的主导眼和非主导眼间调节幅度差异无统计学意义。IXT合并近视组正相对调节和负相对调节与IXT非近视组相比，差异均无统计学意义。 2组IXT患者的调节反应类型差异无统计学意义。IXT合并近视组Newcastle控制力评分（7.20±1.96）明显高于IXT非近视组（5.50±2.83），差异有统计学意义（t=2.203，P=0.034）。结论：IXT患者出现 AC/A下降、主导眼及非主导眼调节幅度下降且趋于平衡，是向近视转归的潜在重要体征，与近视的发展密切相关。

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Abstract： Objective: To compare the clinical characteristics relevant to the ability to accommodate in patients with intermittent exotropia (IXT) concomitant with myopia or non-myopia. Methods: This was a retrospective clinical study. Forty IXT patients between 6 and 15 years old were recruited from Beijing Tongren Hospital between December 2019 and January 2020. Of these, 20 patients were diagnosed with both IXT and myopia, while the other 20 patients were diagnosed with IXT and non-myopia. The evaluation parameters were refractive errors, dominant eyes, strabismus angle, AC/A, accommodative response (normal, accommodative lag, and accommodative lead), accommodative amplitude, and negative/positive relative accommodation. The revised Newcastle Control Score (RNCS) method was used to evaluate the ability to control exotropia. A paired t-test for dependent samples was used for comparison between the two eyes in each group and a two-sample t-test and nonparametric test were used to compare data between the two groups. Categorical data were compared using Fisher's exact test or a χ2 test. Results: The AC/A (2.78±1.09) of the myopia group was significantly lower than that of the non-myopia group (3.93±1.99) (t=-2.263, P=0.029). The accommodative amplitudes for the dominant eye (6.77±2.42) and non-dominant eye (6.52±2.16) in the myopia group were both lower than those for the dominant eye (9.14±2.89) and non-dominant eye (8.07±2.60) in the non-myopia group (t=-2.80, P=0.008; t=-2.05, P=0.047). The accommodative amplitude of the dominant eyes was significantly higher than the non-dominant eyes in the non-myopia group (t=2.572, P=0.019). The differences in accommodative amplitudes between the two eyes in the myopia group were not statistically significant. No significant differences were found in the positive relative accommodation, negative relative accommodation or accommodative response. The RNCS in the IXT combined with myopia group (7.20±1.96) was significantly higher than that in the non-myopia group (5.50±2.83)(t=2.203, P=0.034). Conclusions: Changes in accommodative characteristics are important indicators for the onset and progression of myopia, including a decline in AC/A and a decrease in accommodative amplitudes in the dominant and non-dominant eyes and a trend to balance between the two eyes.

Key words： intermittent exotropia accommodative ability myopia

收稿日期: 2020-05-27

PACS:

基金资助: 北京市卫生系统高层次卫生技术人才-学科骨干（2015-3-023）；北京市科学技术委员会首都临床特色应用研究专项课题（Z171100001017066）；北京市卫生和计划生育委员会首都卫生发展科研专项重点攻关（首发2018-1-2051）；北京市科学技术委员会首都临床诊疗技术研究及转化应用（Z201100005520044）

通讯作者: 付晶（ORCID：0000-0002-2939-9479），Email：fu_jing@126.com

引用本文:

戴薇付晶洪洁赵博文孟昭君. 间歇性外斜视合并近视患者调节功能的评价[J]. 中华眼视光学与视觉科学杂志, 2021, 23(1): 6-12. Wei Dai, Jing Fu, Jie Hong, Bowen Zhao, Zhaojun Meng. Evaluation of Accommodative Ability in Patients with Intermittent Exotropia Concomitant with Myopia. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(1): 6-12. DOI: 10.3760/cma.j.cn115909-20200527-00226

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200527-00226 或 https://www.cjoovs.com/CN/Y2021/V23/I1/6

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