调节性内斜视儿童远视矫正后的散光变化

Astigmatism changes following hyperopia correction in accommodative esotropia children

目的观察调节性内斜视儿童远视矫正后的散光改变。方法收集看远和看近内斜视10PD以上、远视1．0D以上、配戴足矫远视眼镜看远斜视度在10PD以内的初诊病人；按初诊年龄分为≥2岁〈4岁组和≥4岁〈8岁组；根据睫状肌麻痹检影验光结果予以配戴足矫眼镜。每年再次验光，应用向量分解法，用90°1-80°轴向的散光J180，及45°～135°轴向的散光J45作为散光统计指标。连续观察3年以上。结果符合条件的调节性内斜视儿童共44名，平均初诊年龄（4．7±1．7）岁，观察（4．3±1．4）年。≥2岁〈4岁组儿童右眼的散光J180平均为（0．35±0．34）D，在配戴眼镜的第2年和第3年出现了分别为0．28D、0．20D的散光增加（P〈0．05），≥4岁〈8岁组右眼的散光180，平均为（0．34±0．44）D，在戴镜后的第1年和第2年也分别增加了0．22D和0．18D（P〈0．05），两组儿童在随后的2-3年下降到初诊水平并保持稳定；两组儿童的散光J45平均为（0．14±0．16）D、（-0．002±0．16）D，数值小且无明显变化。结论调节性内斜视配戴远视足矫眼镜以后散光会出现少量的增加，之后有所降低，该变化与最初配戴眼镜的年龄无关。戴镜在一定时期内能影响儿童屈光的发育趋势。

Objective To assess the longitudinal changes in the astigmatism of children with ac- commodative esotropia. Methods Refractive errors were followed longitudinally for accommodative esotropia children complying with inclusion criteria. Cycloplegic refractions were performed using reti- noscopy and full corrections were prescribed. The refractive data were analyzed for two groups of children based on their age at the time spectacles were first prescribed and then followed every year for at least 3 years. Astigmatism was analyzed using 90-180 degree astigmatism J180 and 45-135 de- gree astigmatism J45. Results Forty-four children were recruited aged 4.7±1.7 years with follow up of 4.3±1.4 years. In age group ≥2yrs 〈4yrs, the mean J180 was initially 0.35±0.34D and had a 0.28D and 0.20D increased at 2nd and 3rd year after glasses wearing, respectively. In ≥4yrs 〈8yrs age group, the mean J180 was initially 0.34±0.44D and had a 0.22D and 0.18D increased at 1st and 2nd year （P 〈0.05）, respectively. J180 decreased to the initial level in later years for both groups. Over time, the mean J45 remained low level with little variation. Conclusions Astigmatism increas- es following prescribing and decreases to initial degree of astigmatism for children with accommoda- tive esotropia and this change has no relation with their age when spectacle wear is initiated. Glass- es wearing might influence the refractive development in certain time.