先天性小眼球患儿眼睑和眼眶发育的形态测量学研究

The morphometric study of eyelid and orbital development in congenital microphthalmia

目的探讨先天性小眼球患儿的眼睑、眼眶发育情况。设计前瞻性病例系列。研究对象6～78个月的先天性小眼球患儿23例(23眼)。方法测量患儿的睑裂横径、垂直径,采用CT影像和计算机软件辅助技术相结合的方法测量眼球前后径和眼眶容积,分析眼球前后径、年龄分别与睑裂横径、垂直径及眼眶容积的关系,评价眼睑和眼眶发育的影响因素。主要指标睑裂横径、垂直径、眼球前后径和眼眶容积。结果睑裂横径、垂直径、眼球前后径和眼眶容积分别为(16.44±3.24)mm、(2.47±1.48)mm、(11.99±3.33)mm、(14.19±2.37)ml,均明显小于健侧(P均=0.000)。眼眶容积分别与眼球前后径、年龄呈正相关(r=0.62,0.63;P=0.037.0.035)。睑裂横径、垂直径与眼球前后径呈正相关(r=0.54,0.53;P=0.030,0.034),而均与年龄无关。眼球前后径≤12 mm组(10例)和>12 mm组(13例)的睑裂横径、垂直径和眼眶容积分别为(13.50±1.97)mm、(1.08±0.66)mm;(12.73±0.95)ml、(18.20±2.49) mm;(3.30±1.16)mm、(15.05±2.57)ml(P=0.001,0.003,0.024)。结论先天性小眼球患儿的眼睑和眼眶发育明显迟滞。眼球越小,对眼睑和眼眶发育的影响越大。尽可能早期干预治疗是促进眼睑和眼眶发育,预防和减轻眶发育畸形的根本方法。

Objective To investigate the eyelid and orbital development of congenital microphthalmia. Design Prospective case series. Participants 23 eyes of 23 patients with congenital microphthalmia aged from 6 months to 78 months. Methods The parameters of palpebral fissure length （PFL）, palpebral fissure height（PFH） were measured in all patients. Also, combining the computer tomography （CT） imaging with the computer-aided design system, the anteroposterior axis of eyeball and orbital volumn were calculated automatically. To evaluate the influence factor of eyelid and orbital growth, correlations between age, anteroposterior axis of eyeball and PFL, PFH, orbital volumn were analyzed. Main Outcome Measures PFL, PFH, anteroposterior axis of eyeball and orbital volumn. Results The PFL, PFH, anteroposterior axis of eyeball and orbital volumn in micro-side were （16.44±3.24） mm, （2.47±1.48） mm, （11.99±3.33） mm, （14.19±2.37） ml respectively. These parameters above were all significantly smaller than the unaffected side （all P=0.000）. Moreover, orbital volume showed a strong linear correlation with the anteroposterior axis of eyeball and age （r=0.62, 0.63; P=-0.037, 0.035）. Both PFL and PFH were corelated with the anteroposterior axis of eyeball （r=0.54, 0.53; P=0.030,0.034）, while showing no significant difference with age. According to the anteroposterior axis of eyeball, two groups, including group less than or equal to 12 mm （10 cases） and group more than 12 mm （13cases）, whose PFL, PFH and orbital volumn were （13.50±1.97） mm, （1.08±0.66） mm; （12.73±0.95） ml, （18.20±2.49） mm; （3.30±1.16） mm, （15.05± 2.57） ml, respectively. They had statistically significant difference in PFL PFH and orbital volumn （P=0.001, 0.003,0.024）. Conclusion The development of eyelid and orbit with congenital mierophthalmia is obviously retarded. The smaller the eyeball is, the much worse influence in eyelid and orbital growth is. The intervention therapy in early stage as far as possible is fundamental approach in simulating the eyelid and orbital development, or preventing and reducing the incidence of orbital deformity.