目的 探讨儿童高度远视眼的屈光演变规律.方法 该研究为临床病例对照研究.收集1999—2008年在西安市碑林区中医医院眼科初诊为高度远视的3～7岁儿童50例(100眼),按首诊年龄分为5组(3岁组10只眼 、4岁组36只眼 、5岁组24只眼 、6岁组16只眼 、7岁组14只眼),按首诊不同眼位分为3组(正位组43只眼 、内斜组41只眼 、外斜组16只眼),按是否弱视分为2组(首诊弱视组59只眼 、首诊非弱视组41只眼),每年散瞳验光一次,连续5年,观察球镜和柱镜的演变规律.结果 球镜度数在3、4、5、6、7岁年龄组间(F=2.28,P>0.05),首诊不同眼位组间(F=0.38,P>0.05),以及弱视和非弱视组间(F=0.28,P>0.05)年均降幅无显著性差异;但在4、5、6、7岁年龄组(Wald值分别为15.30、10.10、4.05、13.40,均P<0.05)和首诊不同眼位组(Wald值分别为11.10、21.60、7.41,均P<0.05),以及弱视组和非弱视组组内(Wald值分别为28.40、19.30,均P<0.05)相邻年降低幅度有显著性差异.柱镜度数在3、4、5、6、7岁年龄组间年均降幅有显著性差异(F=2.74,P<0.05),组内相邻年降幅无显著性差异(Wald值分别为0.60、0.89、0.16、0.28、0.04,均P>0.05);首诊不同眼位组,组内相邻年(Wald值分别为0.15、0.19、1.20,均P>0.05)和组间年均降幅(F=1.05,P>0.05)变化不大,首诊弱视组和非弱视组,组内相邻年(Wald值分别为0.00、0.28,均P>0.05)和组间年均降幅(F=0.28,P>0.05)无差异.结论 儿童远视眼球镜度逐年降低,4～7岁年龄组相邻年降幅较大,年龄对年均降幅影响不大.柱镜度没有逐年下降趋势,首诊不同眼位对球镜度年均降幅影响不大,非弱视组的球镜度数年均降幅高于弱视组.%Objective To investigate the rules of refractive change in children with hyperpresbyopia .Methods Case-control study was used in investigation .Fifty children (100 eyes) at age of 3-7 newly diagnosed with hyperpresbyopia in department of ophthalmology in Beilin District Hospital of Traditional Chinese Medicine of Xi'an from 1999 to 2008 were selected .Grouping of patients was done according to various criteria .Patients were divided into 5 groups according to their age at first visit (10 eyes in 3-year old group ,36 eyes in 4-year old group ,24 eyes in 5-year old group ,16 eyes in 6-year old group ,14 eyes in 7-year old group) ,into 3 groups according to eye position of first visit (43 eyes in normal position group ,41 eyes in esotropia group ,16 eyes in exotropia group) and 2 groups based on whether patients were amblyopia (59 eyes in amblyopia group and 41 eyes in non amblyopia group) .All patients received retinoscope examination after cycloplegia once a year for 5 years .Change rules of sphere and cylinder were observed .Results There was no significant difference in average annual decline of sphere diopter among 3- ,4- ,5- ,6- and 7-year old groups (F = 2 .28 ,P > 0 .05) ,among different eye position groups (F = 0 .38 , P > 0 .05) ,and between amblyopia group and non amblyopia group (F = 0 .28 , P > 0 .05) ,but there was significant difference in average annual decline of sphere diopter among children of adjacent age within 4- ,5- ,6- and 7- year old groups (W ald value was 15 .30 ,10 .10 ,4 .05 and 13 .40 ,respectively ,allP < 0 .05) ,different eye position groups (W ald value was 11 .10 ,21 .60 and 7 .41 respectively ,all P < 0 .05) ,and within amblyopia and non amblyopia groups (W ald value was 28 .40 and 19 .30 respectively ,both P < 0 .05) .Difference in average annual decline of cylinder diopter was significant among 3- ,4- ,5- ,6- ,7-year old groups (F = 2 .74 , P < 0 .05) ,but no significant difference was found in children of adjacent age within each group (Wald value was 0 .60 ,0 .89 ,0 .16 ,0 .28 and 0 .04 ,respectively ,all P > 0 .05) . Difference in average annual decline of cylinder diopter was not significant among different eye position groups (F = 1 .05 , P >0 .05) and between children of adjacent age in each group (W ald value was 0 .15 ,0 .19 and 1 .20 ,respectively ,all P > 0 .05) .There was no significant difference in average annual decline of cylinder diopter between amblyopia and non amblyopia groups (F = 0 .28 ,P > 0 .05) and between children of adjacent age in each group (W ald value was 0 .00 and 0 .28 ,respectively ,both P > 0 .05) . Conclusion Sphere diopter of children with hyperpresbyopia decreases year by year and decrease is most obvious in children of adjacent age in 4-7 years old groups ,but age influence on annual decline is not remarkable .Cylinder diopter dose not have decline trend ,and influence of different eye position on annual decline is not obvious and annual decline in non amblyopia group is greater than that in amblyopia group .
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