不同类型高度病理性屈光参差屈光要素分析

Refractive element of different types of high pathological anisometropia

目的分析不同类型高度病理性屈光参差同例双眼的屈光要素构成差异,探索影响屈光状态的主要因素、相互关系。方法收集136例等效球镜>3.00D的单纯近视性、远视性屈光参差,复性近视性、远视性屈光参差患者的临床资料,按屈光度数不同分为高屈光眼组和低屈光眼组;按屈光状态不同分为近视性屈光参差组(104例)和远视性屈光参差组(32例)。对所有患者双眼进行角膜地形图检查角膜屈光力,眼部A超检查前房深度、晶状体厚度及眼轴长度,对相关数据进行配对t检验,对各屈光要素与眼球屈光度进行多元线性回归分析。结果角膜屈光力近视性屈光参差组双眼相似率为79.81%,高于远视性屈光参差组的68.75%(P<0.05);前房深度近视性屈光参差组双眼相似率为68.27%,远视性屈光参差组为59.38%,二者差异无统计学意义(P>0.05);晶状体厚度近性视屈光参差组双眼相似率为79.81%,远视性屈光参差组为90.63%,二者差异无统计学意义(P>0.05);眼轴长度近视性屈光参差组双眼相似率为12.50%,远视性屈光参差组为18.75%,相似率均较低(P>0.05)。多元线性回归分析示:近视性屈光参差屈光度数与角膜屈光力、晶状体厚度及眼轴长度呈正相关关系(b=0.836、1.406、2.279,均为P<0.05),与前房深度呈负相关关系(b=-2.051,P<0.05);远视性屈光参差屈光度数与角膜屈光力、晶状体厚度及眼轴长度成负相关关系(b=-0.912、-1.389、-2.318,均为P<0.05),与前房深度无显著相关关系(P>0.05)。结论角膜屈光力及眼轴长度是影响眼球屈光状态的主要因素。前房深度及晶状体厚度在眼纵轴线上的位置对眼球屈光状态的影响不容忽视。

Objective To analyze the ocular refractive elements differences between two eyes in one person with different types of high pathological anisometropia,and explore the main factors on ocular refraction and the relationship of them.Methods There were 136 cases of simple myopia,hyperopic anisometropia and compound myopic anisometropia,compound hyperopic anisometropia.The corneal curvature was checked by corneal topography,anterior chamber depth,lens thickness and axial length were detected by A ultrasound.The relevant data were dealt with the paired t test,the refractive elements and ocular refraction with multivariate linear regression analysis.Results The similar rate of binocular corneal refractive power was 79.80% in myopic group,68.75% in hyperopic group（P0.05）.The similar rate of binocular anterior chamber depth was 68.27% in myopic group,59.38% in hyperopic group（P0.05）.The similar rate of binocular lens thickness was 79.81% in myopic group,90.63% in hyperopic group）（P0.05）.The similar rate of binocular axial length was 12.50% in myopic group,18.75% in hyperopic group（P0.05）.Among myopic group,the diopter was positive related with corneal refractive power,lens thickness and axial length（b=0.836,1.406,2.279,all P0.05）,and negative related with anterior chamber depth（b=-2.051,P0.05）.Among hyperopic group,the diopter was negative related with corneal refractive power,lens thickness and axial length（b=-0.912,-1.389,-2.318,all P0.05）,but had no significant relation with anterior chamber depth（P0.05）.Conclusion Corneal curvature and axial length are the main factors to refraction.The effect of anterior chamber depth and the position of lens on the longitudinal ocular axis on refraction and refractive power should not be ignored.