进展性近视与正视儿童眼调节功能特征比较

摘要

Objective: To investigate differences in accommodative parameters between progressive myopic and emmetropic children, and to determine the potential role of accommodation in myopia. Methods: Thirty-four children with progressive myopia (SE of -0.75 D or more) and 34 children with emmetropia (SE between -0.50 D and 0.50 D) from December 2015 to May 2016 in Eye Hospital, Wenzhou MedicalUniversity participated in this case control study. Subjective accommodative amplitude (SAA), monocular distance accommodative facility (DAF) and accommodative stimulus-response curves (ASRCs) were measured. An independent samples t test was used to compare differences in accommodation between those two groups. Results: Mean SE was 0.18±0.28 D and -2.88±1.03 D for emmetropes and progressive myopes, respectively (t=-16.72, P<0.001). The SAA of progressive myopes was significantly lower than that for emmetropes (t=-2.22, P=0.03). No differences were found in the DAF, OAA, and ASRC slopes between the two groups (all P>0.05). Progressive myopic children had a larger accommodative lag area and higher accommodative lag at 1 D, 2 D, 3 D, 4 D, 5 D than emmetropes (t=2.40, 2.78, 2.79, 2.49, 2.12, all P<0.05). Accommodative lag at 6 D was slightly higher in progressive myopes, but no significant difference was found (t=1.83, P=0.07). Conclusions: The features of accommodative function in progressive myopic children are not exactly the same as emmetropes. Progressive myopic children have a higher accommodative lag than emmetropes, suggesting that accommodative lag may play a role in myopia.%目的:比较儿童进展性近视眼与正视眼的调节功能特征,探讨调节对近视的潜在影响.方法:病例对照研究.选择2015年12月至2016年5月于温州医科大学附属眼视光医院就诊的68例儿童,进展性近视组[(等效球镜度(SE)≤-0.75 D)]与正视组(+0.50 D≥SE≥-0.50 D)各34例,测量内容包括主观调节幅度、远距调节灵活度及调节刺激-反应曲线(ASRC).采用独立样本t检验比较2组间调节功能的差异.结果:正视组、进展性近视组SE分别为(0.18±0.28)D、(-2.88±1.03)D,差异有统计学意义(t=-16.72,P<0.001).进展性近视组的主观调节幅度低于正视组(t=-2.22,P=0.03).2组间的远距调节灵活度与ASRC斜率差异均无统计学意义(t=-0.82,P=0.41;t=1.58,P=0.12).进展性近视组和正视组在0～6 D调节刺激范围的调节滞后面积分别为(7.35±1.54)D2、(6.48±1.05)D2(t=2.74,P=0.01);且在不同调节刺激水平下(1、2、3、4、5 D),进展性近视比正视眼的调节滞后量大(t=2.40、2.78、2.79、2.49、2.12,P<0.05).而进展性近视组在6 D刺激水平的调节滞后量比正视组稍高,但差异无统计意义(t=1.83,P=0.07).结论:儿童进展性近视眼的调节反应特征与正视眼不完全一致,其中进展性近视眼的调节滞后量高于正视眼,提示调节滞后可能在近视发生中具有一定的作用.