瞳孔直径不同对青少年近视发展的影响

Effects of different pupil diameter on the development of adolescent myopia

目的研究不同瞳孔直径大小所致的视网膜周边离焦区别对青少年近视发展的影响。方法选取秦皇岛市第一医院2016年7月至2017年7月期间门诊收治的8~12岁青少年低中度近视病人200例200眼,均进行屈光度、瞳孔直径、眼轴长度、角膜曲率等检测后,佩戴夜戴型角膜塑形镜,并进行为期2年的随访,每3个月随访1次,详细记录屈光度、瞳孔直径、眼轴长度、角膜曲率等数据;根据不同光线下瞳孔直径大小分组,比较戴镜前后各组病人瞳孔直径大小变化量、屈光度增长量、眼轴增长量、角膜曲率改变量,并分析初始瞳孔直径与屈光度增长量、眼轴增长量、角膜曲率改变量之间的相关性。结果在不同光线条件下,瞳孔直径大于平均值病人的屈光度增长量为(-0.48±0.12)D、眼轴增长量为(0.79±0.14)mm,均要显著低于瞳孔直径小于平均值病人(P<0.05),角膜曲率改变量与瞳孔直径小于平均值病人相比差异无统计学意义(P>0.05);暗室条件下初始瞳孔直径与佩戴角膜塑形镜2年后的屈光度增长量和眼轴增长量均呈负相关(r=-0.4164、-0.5123,P<0.001),与角膜曲率改变量无显著相关性(r=0.1322,P>0.05);自然光条件下初始瞳孔直径与佩戴角膜塑形镜2年后的屈光度增长量和眼轴增长量均呈负相关(r=-0.4170、-0.5292,P<0.001),与角膜曲率改变量无显著相关性(r=-0.1630,P>0.05)。结论瞳孔直径较大有利于角膜塑形镜对视网膜周边近视性离焦的干预,进而更好地控制近视发展进程。

Objective To study the effects of differences in retinal periphery defocus caused by different pupil diameter on the development of adolescent myopia.Methods A total of 200 adolescent patients(200 eyes)with low to moderate myopia aged 8 to12 years old who were admitted to outpatient of Qinhuangdao First Hospital from July 2016 to July 2017 were enrolled.All of them were examined for diopter,pupil diameter,axial length and corneal curvature.Night-wearing orthokeratology was given to them.They were followed up for 2 years,once every 3 months.The diopter,pupil diameter,axial length,and corneal curvature were recorded in detail.According to different pupil diameter under different light,grouping was conducted.The changes in pupil diameter,diopter increment,axial increment,changes in corneal curvature before and after wearing glasses were compared among all groups.The correlation between initial pupil diameter and diopter increment,axial increment,changes in corneal curvature was analyzed.Results Under different light conditions,diopter increment and axial increment in patients with pupil diameter greater than mean value were-0.48±0.12 D and 0.79±0.14 mm,significantly lower than those with pupil diameter less than mean value(P<0.05).There was no significant difference in corneal curvature changes between the two kinds of patients(P>0.05).Under darkroom condition,initial pupil diameter was negatively correlated with diopter increment at 2 years after wearing orthokeratology and axial increment(r=-0.4164,-0.5123,P<0.001),while not significantly correlated with corneal curvature changes(r=0.1322,P>0.05).Under natural light condition,initial pupil diameter was negatively correlated with diopter increment at 2 years after wearing orthokeratology and axial increment(r=-0.4170,-0.5292,P<0.001),while not significantly correlated with corneal curvature changes(r=-0.1630,P>0.05).Conclusion The larger pupil diameter is beneficial to intervention of orthokeratology on retinal periphery myopic defocus,so as to better control the development of myopia.