地区性圆锥角膜调查分析

Investigation and analysis of keratoconus in north China

目的分析地区性圆锥角膜的发病趋势及临床发病特点。方法对816例（1596只眼）圆锥角膜患者的病历资料进行回顾性分析。结果（1）就诊人数逐年增加；男女性别比例为4．7：1；以11～25岁年龄组居多，占总数的84．7％。（2）网锥角膜的发病基本上遵循近视-散光-戴镜无法矫正-圆锥角膜急性水肿期或瘢痕期；出现近视的年龄范围4～40岁，91．1％的患者发生在11～25岁。框架眼镜无法矫正时间范围1月～17年，96．8％的患者发生在4年内；其中111例患者发生了急性圆锥，有3例发生急性圆锥穿孔。（3）来院就诊圆锥角膜患眼完成期占60．7％，其中角膜变薄前突占91．1％，费氏环占73．3％，Vogt线占46．4％，Muson征占14．7％；在1596只患眼中，眼轴长度20．5～32．6ram，平均25．4mm。（4）15例患者被误诊；单眼发病率为0．6％，双患发病率为99．4％；仅有1例（0．1％）患者有家族遗传史；过敏性疾病8例（0．9％），先天智障5例（0．6％）；先天性脑瘫1例（0．1％）。结论圆锥角膜在我国北方地区患病率逐年增高，以男性为主，绝大部分为双眼发病，就诊时一般均有圆锥角膜的典型特征，并与轴性近视有一定关系，显性遗传的比例很小。

Objective To analyze clinical features and trend of keratoconus in north China.Metheds Medical records of eight hundred sixteen keratoconus patients（ 1,596 eyes ）were retrospectively reviewed.Resuits （ 1 ）Basic information ： Visiting patients increased yearly.Gender ratio ： 4.7 ： 1 ; 84.7% of patients were between 11 and 25 years. （ 2 ）Progression of disease and refractive status： The natural clinical history of these patients followed the model of： myopia--astigmatism--poor spectacle correction--acute corneal edema or stromal scarring.The presenting age Of myopia ranged from 4 to 40 years.91.1% were between 11 and 25 years.The interval time between emerging myopia and poor spectacle correction ranged from one month to 17 years,of which 96.8% were shorter than four years.One hundred eleven patients had acute corneal edema;three patients resulted in acute corneal perforation.3.Clinical stage and features：60.7% of keratoconus patients were in advanced stages, 91.1% of them with corneal thinning and protrusion, 73.3% with Fleischer ring,46.4% with Vogt＇s striae, 14.7% with Muson＇s sign;In the 1,596 eyes, the ocular axial length ranged from 20.5-32.6 mm, average 25.4 mm;4.Other related information：Fifteen keratoconus cases were misdiagnosed;Five patients （0.6%）had unilateral keratoconus and other patients（ 99.4% ）had bilateral keratoconus; One keratoconus patient had a positive family history;eight keratoconus patients had atopic diseases, five had intelligence defects, and one had congenital cerebral palsy.Conclusions The incidence of keratoconus in north China is increasing yearly.Keratoconus patients are predominately male.In the majority of patients, symptoms occurred bilaterally and had typical keratoconus clinical signs and symptoms.These eyes tend to have a higher incidence of longer ocular axial length and a lower incidence of dominant heredity.