2～15周岁儿童青少年睫状肌麻痹前后屈光度变化研究

Changes in refraction before and after cycloplegia among children and adolescents aged from 2 to 15 years

目的通过对2~15周岁儿童、青少年进行睫状肌麻痹前后的屈光检查,探讨在不同年龄组以及在不同屈光状态下屈光度的变化规律。方法研究入选本科屈光门诊就诊儿童、青少年894例[平均年龄为(7.3±2.9)岁;男性462例、女性432例]。睫状肌麻痹前采用自动电脑验光仪测量双眼屈光度[包括球镜(DS)、柱镜(DC)和等效球镜(SE)],睫状肌麻痹后采用电脑验光联合检影验光再次测量双眼屈光度。所有病例右眼纳入统计分析,睫状肌麻痹前后屈光度变化采用Wilcoxon分析,年龄和屈光状态对睫状肌麻痹前后屈光度变化量的影响采用混合线性模型Bonferroni两两比较,P<0.05为差异有统计学意义。结果睫状肌麻痹后DS(Z=-24.082,P<0.001)、DC(Z=-10.795,P<0.001)和SE(Z=-24.850,P<0.001)均较睫状肌麻痹前发生显著的远视漂移。DS和SE变化量均受患者年龄(F=10.967,P<0.001;F=9.786,P<0.001)、屈光状态(F=56.864,P<0.001;F=56.292,P<0.001)及年龄×屈光状态的交互影响(F=2.121,P=0.014;F=2.009,P=0.021)。进一步分析发现,2~4周岁儿童睫状肌麻痹后DS和SE远视漂移量显著高于其他各年龄组(post hoc P值均<0.05)。远视患儿睫状肌麻痹后DS和SE远视漂移量显著高于正视和近视患儿(post hoc P值均<0.01)。年龄(F=2.048,P=0.106)、屈光状态(F=1.341,P=0.253)及年龄×屈光状态的交互效应(F=0.479,P=0.927)对睫状肌麻痹前后柱镜屈光度变化量影响差异无统计学意义。结论 2~15周岁儿童、青少年睫状肌麻痹前后DS、DC和SE变化差异显著。DS和SE变化受年龄和屈光状态影响,且年龄越小和远视SE越高的患儿,睫状肌麻痹后远视漂移越明显。年龄和屈光状态对睫状肌麻痹前后柱镜屈光度变化影响不明显。

Object ive To investigate the changes in refract ion before and af ter cycloplegia in different agegroups and refractive conditions among children and adolescents aged from 2 to 15 years. Methods ninety-four children and adolescents （the average age was 7.3 ±2.9 years,462 boys and 432 girls） were recruited.Diopters of sphere （DS）,cylinder （DC） and spherical equivalent （SE） were evaluated before cycloplegefractometry and ater cycloplegia using retinoscopy with auto-refractometry data results,respectively. The differences n the values of DS,DC,SE of right eyes before and a f te r cycloplegia were as se ssed using Wilcoxon analysis. Mixedinear model with Bonferroni-adjusted post hoc comparisons were performed to assess the main effects of age and efraction as well as the interaction effect of age x refraction on the changes in the values of DS,DC and SE. Cut-off P value was 0.05. Results Significant hyperopic shifts were detected in the values of DS（Z= - 2 4 0 8 2,P〈0. 001）,DC（Z = - 10.795 ,P 〈0.001 ） and SE（Z=-24.850,P〈0.001） after cycloplegia. The changes in the values of DS and SE were both afected by age （ F= 10.967,P〈0.001; F = 9.786 ,P〈0.001）,refractive status （F=56.864,P〈0.001;F=56.292,P〈0.001） and the interaction effect of age x refractive status （ F = 2.121, P =0.014; F=2.009,P =0.021）. Further analysis detected that the chi ldren aged less than 5 years （2 years 矣age 〈5 years） had the maximal hyperopic shift in DS and SEafter cycloplegia,meanwhile the hyperopic shift of thosehyperopic eyes （ 〉＋ 0. 50D） was also significantly greater than that of those emmetropic（≥-0.50 D and ≤＋0.50 D） and myopic （〈-0.50 D） eyes（ post hoc P values 〈0.01）. The DC variation was independent on age（F=2.048,P=0.106）,refractive status （F=1.341,P=0.253）as well as the interaction of age×refractive status The DS and SE values bedore and after cycloplegia were affected by age and refractive status. Younger children with higher hyperopia tend to have greater hyperopic shift after cycloplegia.The DC variation was independent on age and refractive status.