6～15岁屈光不正者散瞳前后屈光度变化与眼动参数的相关性

A comparative study of the changes in refractive error before and after cycloplegia and oculomotor functions in schoolchildren 6-15 years of age

目的分析6～15岁青少年屈光不正患者散瞳前后屈光度变化与视功能中相应眼动参数的相关性。方法横断面研究。屈光不正患者75例（150眼），年龄6—15岁。首先在自然光线小瞳孔状态下，应用综合验光仪进行单眼屈光、双眼平衡检查，在最正球镜之最佳视力（MPMVA）度数基础上进行调节功能及双眼视功能检查，包括负相对性调节（NRA）／t相对性调节（PRA）、调节滞后／调节超前（BCC）、调节性集合／调节（AC／A）。而后应用复方托吡卡胺滴眼液散瞳，散瞳后进行二次屈光检查。按照散瞳前后屈光度变化值分组，有变化组是指球镜或散光差异≥0．50D．共29例：无变化组是指球镜或散光差异≤0．25D，共46例。应用Mann—WhitneyU检验、x2检验、Spearman相关分析和独立样本t检验对所测结果进行分析。结果散瞳前后有变化组球镜度的中位数为-1．75D，小于无变化组（-2．50D），差异有统计学意义（Z=-3．328，P〈0．01）；NRA在有变化组为（1．72±0．48）D，小于无变化组的（2．27±0．33）D，差异有统计学意义（t=5．409，P〈0．01）；BCC在有变化组为（-0．09±0．60）D．小于无变化组的（0．31±0．46）D，差异有统计学意义（t=-3．295，P〈0．01）；PRA在有变化组平均为（-2．14±1．35）D，大于无变化组（-1．63±0．76）D，两组差异无统计学意义。两组之间年龄，性别及AC／A和散光度差异无统计学意义。NRA与散瞳前后屈光度变化的等效球镜度呈负相关（r=-0．393，P〈0．01）。结论6—15岁青少年屈光不正患者中，散瞳前后的屈光度变化与年龄、性别、散光度数及AC／A大小无明显相关性，与视功能参数中的NRA呈负相关。

Objective To analyze the relationship between the changes in refractive error with and without cyeloplegia and oculomotor functions in schoolchildren 6-15 years of age. Methods One hundred fifty eyes of 75 young patients were included in this cross-sectional study. Refractive error was measured with a phoropter before and after cycloplegia induced with the compound tropicamide. Negative relative accommodation （NRA）, positive relative accommodation （PRA）, BCC and AC/A were measured with a phoropter before cycloplegia. Children were grouped according to changes in their refractive error with and without cycloplegia： a change in sphere or cylinder not less than 0.5 D was the changed group, 28 children （56 eyes）; a change in sphere or cylinder not more than 0.25 D was the no change group, 46 children （92 eyes）. A Mann-Whitney U test, X2 test, Spearman correlation analysis and independent t test were used to analyze the data. Results Noncycloplegic measurements of spheres were consistently more negative in the no change group with a median of -2.50 D than in the changed group, -1.75 D （Z=-3.328, P〈0.01）. The mean NRAs were 2.27±0.33 D and 1.72±0.48 D in the no change group and changed group,respectively. There was a statistically significant difference between the two groups （t=-5.409, P〈0.01）. The mean BCCs were 0.31±0.46 D and -0.09±0.60 D in the no change group and changed group, respectively （t=-3.295, P〈0.01）. The mean PRAs were -1.63±0.76 D and -2.14±1.35 D in the no change group and changed group, respectively. Although there was no statistically significant difference between the two groups, PRA was larger in the changed group than in the no change group. There were no statistically significant differences for age, sex, cylinders or AC/A between the two groups. The changes in equivalent spheres before and after cycloplegia were smaller with an increase in NRA （r=-0.393, P〈0.01）. Conclusion The changes in refractive error with and without cycloplegia were not correlated with age, sex, cylinders or AC/A in sehoolchildren 6-15 years of age. However, it is negatively correlated with NRA.