不同散光类型对儿童子午线性弱视诊断影响的研究

Effects of different type of astigmatism on diagnosis of meridional amblyopia in children

目的明确不同类型散光引起儿童子午线性弱视的临界值。方法收集2008年至2011年间在我院眼科门诊就诊,以散光为主要屈光异常的4～8岁儿童共1005例(1910眼)为研究对象。纳入标准:球镜≤±3.00D,散光度绝对值(以下简称散光度)≥1.00D,双眼球镜差值≤1.50D,双眼柱镜差值≤1.00D。分析散光类型和年龄对诊断子午线性弱视的影响。结果远视散光包括复性远视散光和单纯远视散光共1229眼,占总眼数的64.3%,91.5%为弱视眼,引起轻度弱视的散光度数为(1.50±0.59)D,95%可信区间为(1.46D,1.54D)。混合性散光共561眼,占总眼数的29.4%,94.8%为弱视眼,引起轻度弱视的散光度数为(2.58±0.96)D,95%可信区间为(2.48D,2.67D)。近视散光包括复性近视散光和单纯近视散光共120眼,占总眼数的6.3%,94.2%为弱视眼,引起轻度弱视的散光度数为(1.75±0.65)D,95%可信区间为(1.61D,1.90D)。远视性散光组≥7岁组引起子午线性弱视的散光度临界值(1.75D)较4～6岁组(1.50D)高;混合性散光引起子午线性弱视的散光度临界值≥6岁组(2.75D)较<6岁组(2.50D)高;近视性散光引起的子午线性弱视的散光度临界值≥6岁组(1.75D)亦较<6岁组(1.50D)高。结论不同散光类型引起子午线弱视的散光度临界值不同。远视性散光值超过1.50D可引起子午线性弱视,混合性散光的散光值超过2.50D可引起弱视,近视性散光值超过1.61D可引起弱视。年龄越小,较小的散光度就可以引起子午线性弱视。

Objective To investigate the critical values of meridional amblyopia on children induced by different type of astigmatism. Methods A total of 1005 chil- dren with ametria （aged 4 -8 years, 1910 eyes） were selected. Astigmatism was equal to or more than 1.00 D and sphere equal to or less than 3.00 D. The difference of sphere in both eyes was less than 1.50 D. The difference of astigmatism in both eyes was less than 1.00 D. All astigmatism was calculated by the absolute value. Results Com- pound and simple hyperopic astigmatism appeared in 1229 eyes （ 54. 3% ）, of which 91.5% had amblyopia. The mean astigmatism of mild amblyopia was （ 1.50 ± 0.59 ） D, 95% confidence interval was （ 1.46 D, 1.54 D）. Mixed astigmatism appeared in 561 eyes （29. 4% ）, of which 94. 8% had amblyopia. The mean astigmatism of mild amblyopia was （2.58±0.96） D,95% confidence interval was （2.48 D,2.57 D）. Compound and simple myopic astigmatism appeared in 120 eyes （5.3%） ,of which 94.1% had amblyo- pia. The mean astigmatism of mild amblyopia was （ 1.75±0.55 ） D, 95% confidence in- terval was （ 1.61 D, 1.90 D）. The critical value of meridional amblyopia on children aged more than 7 years （ 1.75 D） induced by different astigmatism types was lower than children aged from 4 years to 6 years （ 1.50 D） in hyperopic astigmatism group. As forthe mixed and myopic astigmatism, children aged equal to or more than 5 years old （2.75 D） was lower than children aged 5 years （2. 50 D）. Conclusion The critical values of astigmatism are different in meridional amblyopia induced by differ- ent type of astigmatism. Astigmatism more than 1.50D can cause mild meridional amblyopia in compound and simple hyper- opic astigmatism,the referral cirteria of mixed astigmtism is 2.50 D, and myopic astigmatism is 1.51 D. Younger children with lower astigmatism can cause amblyopia.