儿童和青少年远视性屈光参差调节功能的研究

Accommodative function in adolescent hyperopic anisometropes

目的研究远视性屈光参差患儿的调节幅度和调节滞后量,并比较其主导眼和非主导眼的差别。方法18例远视性屈光参差患儿,年龄6.5～15(10.5±2.6)岁,屈光参差度+1.75～5.0(+3.5±0.9)D,7例伴有单眼轻中度弱视,11例不伴弱视。采用动态检影法检查患者40cm处的调节滞后情况,移近法测量调节幅度,区分主导眼和非主导眼,并与同期就诊的25例远视屈光不正患儿[年龄7～14(9.8±2.4)岁,屈光度(+4.5±2.3)D]和20例正视儿童[年龄7～12(9.5±2.6)岁]进行对照比较。采用t检验对所得数据进行统计学分析。结果远视性屈光参差患儿主导眼的调节幅度和调节滞后量分别为(13.3±3.2)D和(0.79±0.39)D,与正视儿童及远视屈光不正患儿无明显差别;非主导眼的调节幅度为(11.3±3.3)D,与正视儿童及远视屈光不正患儿无明显差别;调节滞后量为(1.10±0.12)D,与正视儿童及远视屈光不正患儿差异均有统计学意义(t=2.79,P=0.03;t=2.95,P=0.02)。远视性屈光参差患儿主导眼和非主导眼的调节幅度和调节滞后量不同,差异均有显著的统计学意义(t=3.12,P=0.006;t=4.10,P=0.001)。伴弱视者主导眼调节滞后量比无弱视者主导眼调节滞后量大,差异有统计学意义(t=2.43,P=0.027),而两组非主导眼的调节滞后量的差异无统计学意义(t=0.78,P=0.45)。结论儿童和青少年远视性屈光参差的主导眼和非主导眼的调节幅度和调节滞后不同;其主导眼的调节功能与同龄儿童无明显差别,非主导眼的调节功能存在缺陷。伴弱视者,其主导眼的调节功能也存在缺陷。

Objective To investigate the accommodative lag and accommodative amplitude in the adolescent hyperopic anisometrope and to compare the differences of them between the dominant and non-dominant eyes. Methods The accommodative lag and amplitude of dominant and non-dominant eyes were assessed in 63 cases of school-age subjects [18 hyperopic anisometropes with a refractive error of （3.5±0.9）D and an age range of 6.5-15（10.5±2.6）years; 25 hyperopes with a refractive error of （4.5±2.3）D and an age range of 7-14（9.8±2.4）years and 20 emmetropes with an age range of 7-12（9.5±2.6）years. Accommodative lag was assessed using MEM dynamic retinoscopy and accommodative amplitude was assessed with a push-up test. The binocular vision function was studied at the same time. Results The accommodative amplitude and lag of the dominant eyes were （13.3±3.2）D and （0.79±0.39）D in the 18 hyperopie anisometropic patients, There was no significant difference in the accommodative lag and amplitude of the dominant eyes between the anisometropes and the hyperopic and emmetropic groups. The accommodative amplitude and lag of the non-dominant eyes were （11.3±3.3）D and （1.10±0.12）D in the anisometropic group. The accommodative lag of the non-dominant eyes in the anisometropie group was greater than that of the hyperopie and emmetropie groups （t=2.79, P=0.03; t=2.95, P=0.02）. Both the accommodative lag and amplitude between the dominant and non-dominant eyes were sig- nificantly different in the anisometropic group （t=3.12, P=0.006; t= 4.10, P=0.001）. The accommodative lag of the dominant eyes in patients with ambiyopia was greater than that of patients without amblyopia （t=2.43, P=0.027）, while the accommodative lag of the non-dominant eyes was not significantly different （t=0.78, P=0.45）. Conclusion The accommodative function （accommodative lag and amplitude） of the dominant and non-dominant eye has significant differences in the adolescent hyperopic anisometrope. There is an accommodative dysfunction in the non-dominant eye.