角膜屈光手术近视患者调节和集合功能异常的检出率

The prevalence of accommodation and convergence dysfunction in myopic patients undergoing corneal refractive surgery

目的分析行角膜屈光手术的近视患者中调节和集合功能异常的检出率,强调术前视功能检查的重要性。方法对2020年1月到2020年7月期间在我院角膜屈光手术中心进行术前检查的患者的临床资料进行回顾性研究。选取年龄在18~35周岁、视功能检查均由同一技师完成的765例患者作为研究对象,检查包括矫正视力、屈光度、近远距水平隐斜量、调节性聚散/调节比值(AC/A)、正负相对调节、调节反应、调节幅度、调节灵敏度、集合近点、Worth四点和立体视。结果调节和集合功能异常的发生率为67.2%;调节功能异常的患者占49.7%,集合功能异常的患者占17.5%;各屈光不正组中调节不足的发生比例的差异有统计学意义(χ^(2)=14.370,P=0.001),高度近视组的发生比例低于低、中度近视组;集合不足在各屈光不正组中差异有统计学意义(χ^(2)=7.862,P=0.020),高度近视组的发生比例要高于低、中度近视组;男性发生比例71.1%,女性发生比例57.0%,差异有统计学意义(χ^(2)=13.968,P<0.001)。结论在行角膜屈光手术的近视人群中,调节和集合功能异常的发生率很高,且男性发生比例高于女性,需要引起重视。

Objective To analyze the prevalence of non-strabismic binocular vision anomalies in myopia populationundergoing corneal refractive surgeryand to emphasize the importance of preoperative examination.Methods A retrospective case series study.765 myopic patients who underwent preoperative examination in the Corneal Refractive Surgery Center of Jinan Mingshui Eye Hospital between January 2020 and July 2020 were included.The patients aged 18~35 years who completed the visual function test by the same technician were selected as the study subjects.Corrected visual acuity,refraction,near and distancehorizontal faint,accommodative convergence/accommodation(AC/A),positive and negative relative accommodation,accommodative response,accommodative amplitude,accommodative facility,convergence near point,and worth four points and stereopsis.Results The prevalence of accommodation and vergence dysfunction was 67.2%(95%confidence interval(CI):61.7%~68.0%;99%CI:60.7%~69.0%).49.7%patients had accommodation dysfunction and 17.5%had convergence dysfunction.The difference in the prevalence of accommodation deficiency in different diopters was statistically significant(χ^(2)=14.370,P=0.001),and the prevalence in the high group was lower than that in the low-moderate group.The difference in the prevalence of convergence deficiency in each refractive error was statistically significant(χ^(2)=7.862,P=0.020),and the prevalence in the high group was higher than that in the low-moderate group.The prevalence was 71.1%in men and 57.0%in women,and the difference was statistically significant(χ^(2)=13.968,P<0.001).conclusions In myopia population undergoing corneal refractive surgery,the prevalence of accommodation and convergence dysfunction is high,and the prevalence is higher in men than in women,the problem needs attention.