近视性屈光参差主导眼的屈光状态及其调节功能

Refractive status and its accommodation of dominant eye in myopic anisometropia

目的研究近视性屈光参差主导眼与近视程度的关系以及主导眼与非主导眼调节功能分析,探讨屈光参差的成因及其发展原因。设计回顾性病例系列。研究对象8~35岁近视性屈光参差患者59例,根据屈光参差程度,将其分为低度屈光参差（1.00 D≤双眼等效球镜度差≤2.50 D）和高度屈光参差（双眼等效球镜度差〉2.50 D）两组。方法对各组别患者应用简化双手卡洞法测定双眼中的主导眼眼别。使用综合验光仪测定患者单、双眼正/负相对调节及其比值（PRA/NRA）。采用改良移近法及正负球镜翻转法分别测量单、双眼的调节幅度和调节灵活度。主要指标主导眼眼别与屈光度大的眼别的相关性。单、双眼正/负相对调节及其比值（PRA/NRA）,单、双眼的调节幅度和调节灵活度。结果低度屈光参差患者26例,主导眼为右眼者22例（84.5%）;主导眼平均屈光度为（-4.01±1.96）D,非主导眼为（-3.19±1.80）D,平均参差程度（1.76±0.21）D。主导眼屈光度高于非主导眼（z=-2.37,P=0.02）。高度屈光参差患者33例,主导眼为右眼者21例（63.6%）;主导眼平均屈光度为（-3.90±2.84）D,非主导眼平均屈光度为（-3.47±2.20）D,平均参差程度（3.40±0.81）D。主导眼与非主导眼屈光度比较无统计学差异（z=-0.57,P=0.57）。低度屈光参差组主导眼平均正相对调节为（-2.68±1.44）D,非主导眼为（-3.29±1.31）D,差异有统计学意义（z=-2.27,P=0.02）;高度屈光参差组主导眼平均正相对调节为（-3.14±1.84）D,非主导眼为（-4.10±1.59）D,差异有统计学意义（z=-3.54,P=0.00）。低度屈光参差组主导眼平均PRA/NRA绝对值为（1.15±0.58）,非主导眼为（1.36±0.52）,差异无统计学意义（z=-1.89,P=0.06）;高度屈光参差组主导眼平均PRA/NRA绝对值为（1.34±1.57）,非主导眼为（1.74±0.62）,差异有统计学意义（z=-3.03,P=0.00）。结论低度近视性屈光参差患者主导眼屈光度较非主导眼高;不同程度的屈光参差患者主导眼PRA及PRA/NRA低于非主导眼。

Objective To study the relationship between dominant eye, spherical equivalence（SE） of refractive error and accommodation in myopic anisometropia. Design Retrospective case series. Participants 59 myopic anisometropic patients were included in the study, with age varied from eight to thirty-five years. Patients were divided into two groups according to the anisometropic degree,group A（difference beween 1.00 D and 2.50 D in two eyes） and group B（difference more than 2.50 D）. Methods Monocular and binocular positive relative accommodation（PRA）, negative relative accommodation（NRA）, amplitude of accommodation, and accom-modative facility were all measured with phoropter. Dominant eye was identified by the means of hole shaped by two hands. Main Outcome Measures Dominant eye, SE, and monocular and binocular accommodation parameters（PRA, NRA, amplitude of accommo-dation, accommodative facility）. Results 26 patients were included in group A. Dominant eye was right in 22 patients（84.5%）. The mean SE was-4.01±1.96 D（mean ± standard deviation） and-3.19±1.80 D in dominant and non-dominant eye respectively. The mean anisometropia was 1.76±0.21 D. The refraction was significantly different in dominant and non-dominant eyes（z=-2.37, P=0.02）. 33 patients were included in group B. Dominant eye was right in 21 patients（63.6%）. The mean SE was-3.90 ±2.84 D and-3.47±2.20 D in dominant and non-dominant eye respectively. The mean anisometropia was 3.40 ±0.81 D. The refraction was no significantly different in dominant and non-dominant eyes（z=-0.57, P=0.57）. The mean PRA was-2.68±1.44 D and-3.29±1.31 D in dominant and non-dominant eyes in group A（z=-2.27, P=0.02）. The mean PRA was-3.14±1.84 D and-4.10±1.59 D in dominant and non-dominant eyes in group B（z=-3.54, P=0.00）. The mean absolute PRA/NRA value was 1.15±0.58 and 1.36±0.52 in dominant and non-dominant eyes in group A（z=-1.89, P=0.06）. The mean absolute PRA/NRA value was 1.34 ±1.57 and 1.74±0.62 in dominant and non-dominant eyes in group B（z=-3.03, P=0.00）. Conclusion SE in dominant eyes of patients with low myopic anisometropia was higher than non-dominant eyes. PRA and PRA/NRA in dominant eyes were lower than non-dominant eyes in different degree anisometropic patients.