远视足矫对屈光性调节性内斜视患者正视化的影响

The effects of full correction of hypermetropia on emmetropization in children with refractive accommodative esotropia

目的探讨屈光性调节性内斜视患者配戴完全远视矫正眼镜对正视化的影响。方法临床病例对照研究。收集1990～1997年期间在中山大学眼科中心66例屈光性调节性内斜视和95例远视不伴有内斜的患儿进行回顾性调查研究。共计161例，322只眼，全部患者用1％Atropine睫状肌麻痹剂散瞳验光，将远视性屈光不正完全矫正的屈光性调节性内斜患者66例（132只眼）归为足矫组，远视性屈光不正部分矫正的普通远视患者95例（190只眼）归为欠矫组，采用重复测量资料分析方法比较两组患者3、5、7、9岁时远视性屈光不正的变化趋势。结果足矫组患者，3岁屈光度（＋5．45±2．22）D，5岁屈光度（＋5．64±1．99）D，7岁屈光度（＋5．48±2．05）D，9岁屈光度（＋5．30±1．93）D。欠矫组患者，3岁屈光度（＋3．98±2．14）D，5岁（＋4．26±2．48）D，7岁（＋3．97±2．43）D，9岁（＋3．44±2．48）D。3±5岁，足矫组的远视屈光度增加＋0．19D，欠矫组增加＋0．28D（P〈0．05）；5-7岁，足矫组的远视屈光度下降＋0．16D，而欠矫组下降＋0．29D（P〈0．05）；7-9岁，足矫组的远视屈光度下降＋0．18D，欠矫组下降＋0．53D（P〈0．05）。将两组患儿的研究始末的屈光度改变作比较，足矫组从3～9岁远视屈光度平均减少了＋0．15D，欠矫组则平均减小了＋0．54D。结论配戴足度远视镜的3-9岁屈光性调节性内斜视儿童的正视化过程比远视欠矫的远视性屈光不正儿童慢。

Objective To evaluate the influence of full correction of hypermetropia on emmetropization in refractive accommodative esotropic children. Methods A retrospective study in 161 patients （322 eyes） was performed from the year of 1990 to 1997 in Zhongshan Ophthalmic Center, Sun Yat-sen University, China. The 66 patients （132 eyes） with refractive accommodative esotropia were prescribed full optical correction of hyperopia, while the 95 hypermetropic patients （190 eyes） without strabismus were prescribed undercorrection of hyperopia. Repeated measurement date analysis was applied to make a comparison of the longitudinal refractive changes between the two groups in the 3rd year, the 5th year, the 7th year and the 9th year. Results The mean refractive errors of the full correction group were （＋5.45±2.22）D in the 3rd year, （＋5.64±1.99）D in the 5th year, （＋5.48± 2.05）D in the 7th year and （＋5.30±1.93）D in the 9th year respectively. The mean refractive errors of the under correction group were （＋3.98±2.14）D in the 3rd year, （＋4.26±2.48）D in the 5th year, （＋ 3.97±2.43）D in the 7th year and （＋3.44±2.48）D in the 9th year. From the 3rd year to the 5th year, the hyperopic refractive errors was increased by ＋0.19D in the full correction group, and the hyperopic refractive errors was increased by ＋0.28D in the under correction group （P 〈0.05）; from the 5th year to the 7th year, the hyperopic refractive errors was decreased by ＋0.16D in the full correction group, and the hyperopic refractive errors was decreased by ＋0.29D in the under correctiongroup （P 〈0.05）; from the 7th year to the 9th year, the hyperopic refractive errors was decreased by ＋0.18D in the full correction group, and the hyperopic refractive errors was decreased by ＋0.53D in the under correction group （P 〈0.05）. In comparison, there were a reduction of ＋0.15D in the full correction group from the 3rd year to the 9th year, and a reduction of ＋0.54D in the under correction group from the 3rd year to the 9th year. Conclusions The full correction of hypermetropia in accommodative esotropic children impedes their emmetropization from the age of 3 years to 9 years.