国人61岁以上高度近视眼眼底改变及相关生物参数演变趋势

The evolution trends of ocular biological parameters related with high myopic fundus in Chinese people over 61 years old

目的对国人61岁以上高度近视眼形成的眼底退行性病变自然病程进行观察,即该年龄组屈光度、眼轴、眼压、眼球形态下的[底改变]化趋势。方法入选包括：61岁以上、屈光度≥-6 D、眼轴≥25 mm。并按年龄分为3组：~65岁组,~70岁组,71岁以上组。对门诊查体和就诊人群89例（89只眼）进行眼底照相、A/B超、验光、眼压等相关眼科检查,记录并归纳整理。SPSS10.0统计。根据检眼镜、KOWA眼底照相、Heidelberg HRA2激光扫描眼底荧光造影系统进行荧光/吲哚青绿血管造影检查,将眼底形态分为4组：无变化、黄斑局限病灶、豹纹状眼底、后极广泛病灶或混合（即病理性近视）。BVI A/B超仪测量眼轴,并将眼球形态分为无变化、均匀扩张、后巩膜葡萄肿3组。复方托比卡胺滴眼液散瞳,主观检影验光测定眼屈光度。使用Topcon CT60自动眼压计测量眼压。结果 （1）89例（89只眼）中,非病理性改变主要表现为豹纹状改变,占34.8%,无眼底变化仅占1.1%,与~20岁以下组的36.8%、~40岁以下组的25%、~60岁以下组的11.7%相比,呈现阶段性减少趋势;病理性改变明显升高达64%,70岁以上组达81%,与~20岁以下组的15.8%、~40岁以下组的28.5%、~60岁以下组的46.8%相比,呈现阶段性增加趋势。（2）平均近视度数-10 D,平均眼轴27.65 mm;-6.9 D、眼轴26.54 mm时眼底呈现豹纹状改变,-12.6 D、眼轴28.5 mm时呈病理性改变。结论 61岁以上的老年高度近视眼底形态变化与年龄、度数有着内在的规律,病理性眼底呈持续进展趋势,呈现出与机体衰老过程叠加加剧。眼底病理性改变的屈光度与眼轴的偏差加大、分布离散,病变程度继续加重。

Objective To observe the fundus appearances and their evolution trends with their biological parameters in the high myopia eyes in Chinese people over 60 years old.Methods The enrolled included people ages over 61 years old,their refraction error were over-6D,and the eyeball axis were over 25 mm.They were divided 4 subgroups： ～65 year-old,～70 year-old,,and over 71～ year-old.The fundus appearances were divided into 4 groups among 89 patients by clinical sequence,negative,focal lesions,tessellation,and pathologic changes,according to the KOWA fundus camera and Heidelberg HRA2 fluorecein /indocraine angiophotography.At the meantime,myopic severity was checked with cycloplegic objective refraction by NIKON SPEEDY-K automatic optometry and retinoscopy.Ocular axis and shape of eyeball were measured and recorded by BVI A/B-scan.The intraocular pressures were measured by auto-applanation tonometry of Topcon CT60.The collected data were analyzed statistically by SPSS10.0.Results（1）There were 35.9% cases with the non-pathologic appearances in 89 cases of high myopia,including 34.8% with tessellation changes and 1.1% with normal appearance（which was lower than 36.8% of～20 year group,25% of～40 year group,and 11.7% of ～60 year group as our previous reports）.The diffused pathologic myopias were in 64%,even 81% of over70 years old group,higher than the teenagers＇ 15.8% the ～40 year group＇ 28.5%.and ～60 year group＇ 46.8%.（2）The average refraction error was-10.0 D,the axis 27.65 mm.There may appear tessellation change with-6.9 D/26.54 mm.The pathologic change appeared mainly in the eyes with-12.6 D/28.5 mm.Conclusion There existed relationships among the fundus appearances of the high myopia with the ages,eyeball axis,and refraction errors in young people over 61 years old： There may keep worsen in high myopic fundus even after 61 years old,coincided with aging and myopic choroidoretinal degeneration;so we should take the aging into consideration,besides the myopic degeneration.