不同年龄、不同程度先天性上睑下垂患儿角膜形态与散光的差异

Difference of Corneal Morphology and Astigmatism in Children with Congenital Ptosis of Different Ages and Different Degrees

【目的】了解中、重度先天性上睑下垂患儿不同年龄组角膜形态及散光情况，并分析其与上睑下垂程度及年龄的关系。【方法】对湖南省儿童医院眼科确诊为中、重度先天性上睑下垂的患儿83例（114眼）进行详尽的病史收集及眼科检查，根据患儿年龄分为A组（3≤年龄〈5）；B组（5≤年龄〈12），分析患者的角膜形态及散光情况，并比较不同程度、不同年龄上睑下垂患者之间的角膜形态和散光差异。【结果】n4眼中，同一年龄段不同程度上睑下垂患者，角膜地形图所测角膜散光[CyI（D）]、表面规则指数（SRI）、表面不对称指数（SAI）与视网膜检影总散光值EC（D）]差异无统计学意义（P〉0．05）；术前角膜地形图结果显示随着年龄增长，患儿逆规和斜向散光比例增大，差异有统计学意义（P〈0．05）；中度上睑下垂组中顺规散光患儿37．0％，逆规散光25．9％，斜向散光37．0％；重度上险下垂组中顺规散光患儿65．0％，逆规散光11．7％，斜向散光22．3％，两组比较，差异有统计学意义（P〈0．05）。【结论】上睑下垂患儿随年龄增长其斜向及逆规散光比例增大，但与上睑下垂程度无明显相关。建议眼睑手术在3～5岁进行，并在术后进行屈光矫正。

[Objective]To investigate the corneal morphology and astigmatism in different age groups of moderate and severe congenital ptosis and analyze the relationship between ptosis and age.[Methods]Eighty-three cases （114 eyes） of moderate and severe congenital blepharoptosis diagnosed by ophthalmology in Hunan Children＇s Hospital were collected in detail and examined by ophthalmology. According to the age of the children, they were divided into two groups; group A （ 3 ≤ age 〈 5） and group B （ 5 ≤age 〈 12）. The corneal morphology and astigmatism of patients with blepharop- tosis at different ages were analyzed, and the differences of corneal morphology and astigmatism among patients with blepharoptosis at different ages were compared.[Results]In 114 eyes , there was no significant difference in corneal astig- matism [CyI（D）], surface rule index （SRI）, surface asymmetry index （SAD and total astigmatism of retina [C（D）]in patients with different degrees of ptosis in the same age group （ P 〉0.05）. The results of preoperative corneal topography showed that the ratio of inverse rule and oblique astigmatism increased with age, and the difference was statistically signif icant （ P 〈0.05）. In the moderate blepharoptosis group, there were 37.0% children with conformable astigmatism, 25.9 % with reverse astigmatism, 37.0 % with oblique astigmatism. In the severe blepharoptosis group, 65.0 % of children with conformable astigmatism, 11.7% of converse astigmatism and 22.3% of oblique astigmatism, there was significant difference between the two groups （ P 〈0.05）/[Conclusion]Children with ptosis increase with age.The proportion of ob- lique and inverse astigmatism increased with age, but there was no significant correlation with the degree of blepharopto- sis. It is suggested that eyelid surgery should be performed at the age of 3 and 5 years, and refractive correction should be performed after operation.