4~12岁儿童周边视网膜离焦状态分析

Analysis of Peripheral Retinal Defocus in ChildrenAged 4-12 Years

目的:运用多光谱视网膜屈光地形图(MRT)测量4~12岁儿童不同区域周边视网膜的离焦量(RPRE),探讨RPRE与近视发展之间的关系。方法:病例对照研究。连续性纳入2021年9月至2022年3月在长沙湘江爱尔眼科医院门诊就诊的4~12岁儿童170例,根据屈光状态分为轻度近视组78例,轻度远视组49例,正视组43例。所有儿童在充分散瞳后,运用带状检影镜检测屈光度数,并以等效球镜度(SE)记录;运用Lenstar LS900光学生物测量仪检测生物学参数,包括眼轴长度(AL)、中央角膜厚度(CCT)、前房深度(AD)、晶状体厚度(LT)、角膜曲率度数(K1、K2)和散光(AST=K2-K1);采用MRT测量儿童不同区域的RPRE并汇总得出其平均值,记录如下:周边视网膜总RPRE的平均值(TRVD)、0°~15°周边视网膜的离焦量平均值(RDV-15°)、周边视网膜15°~30°方向的RPRE平均值(RDV-30°)、周边视网膜30°~45°方向的RPRE平均值(RDV-45°),所有检测结果均取右眼。通过非参数检验分析不同偏心度RPRE的差异;Spearman相关性分析不同屈光度与RPRE的关系、多元线性回归检验不同偏心度RPRE与眼球生物参数之间的相关性。结果:在偏心度15°~45°范围,低度近视儿童RPRE为远视性离焦,且RPRE随着偏心度增大而增加;相反,低度远视儿童RPRE为近视性离焦,且RPRE随着偏心度增大而减少;正视儿童偏心度30°以内的屈光状态与黄斑中心凹处的屈光状态基本相同,而偏心度30°~45°时,RPRE随着离黄斑中心凹距离增大而增加,且为远视性离焦;偏心度0°~15°时,RPRE与AL均无相关性(P>0.05)。偏心度15°~30°和30°~45°时,RPRE与AL呈正相关(r=0.33、0.40,均P<0.001)。偏心度0°~15°时,RPRE与眼生物学参数无相关性(P>0.05);偏心度15°~30°和30°~45°时,AL是RPRE的独立危险因素(均P<0.001)。结论:4~12岁低度近视和正视儿童RPRE为远视性离焦,低度远视儿童RPRE为近视性离焦,且在偏心度15°~45°范围内RPRE可能与儿童轴性近视发生发展密切相关。

Objective:The relative peripheral refractive errors(RPRE)of retina in different regions of children aged 4-12 years were measured by using multispectral retinal refractive topography(MRT),and the relationship between RPRE and the development of myopia was discussed.Methods:In this cases control study,170 children(170 eyes)aged 4 to 12 years were recruited in Changsha Xiangjiang Aier Eye Hospital from September 2021 to March 2022.According to the refractive status,the patients were divided into low myopia group(n=78),low hyperopia group(n=49)and emmetropia group(n=43).Eye biometrics were measured before pupil dilation using the LS900.Axial length(AL),central corneal thickness(CCT),anterior chamber depth(AD),lens thickness(LT),keratometry(K1,K2)and astigmatism(AST=K2-K1)were recorded.MRT was used to measure the RPRE in different areas of children after pupil dilation,and the average values were summarized as follows:TRVD(Peripheral refractive error from center to peripheral 53°of retina),RDV-15(The difference of central refractive error and paracentral refractive error from center to 15°of retina),RDV-30(The difference of central refractive error and paracentral refractive error from 15°to 30°of retina),TRV-45(The difference of central refractive error and paracentral refractive error from 30°to 45°of retina).All test results were taken from the right eye.The differences of RPRE with different eccentricities were analyzed by nonparametric test.Spearman correlation analysis was used to analyze the relationship between different diopters and RPRE.Multiple linear regression was used to test the correlation between different eccentricity degrees of RPRE and eyeball biological parameters.Results:In the eccentricity range of 15°to 45°,the RPRE of low myopia children was hyperopic defocus,and the RPRE increased with the increase of eccentricity.On the contrary,the RPRE of children with low hyperopia was myopic defocus,and RPRE decreases with the increase of eccentricity.In emmetropic children,the refractive state within 30°of eccentricity was basically the same as that at the fovea.However,when eccentricity is between 30°and 45°,RPRE increases with the increase of distance from the fovea,and it is a hyperopic defocus.There was no correlation between RPRE and AL when eccentricity was 0°-15°(P>0.05).When eccentricity was 15°-30°and 30°-45°,RPRE was positively correlated withAL(r=0.33,0.40,both P<0.001).When eccentricity was 0°-15°,there was no signifcant correlation between RPRE and ocular biological parameters(P>0.05).When eccentricity was 15°-30°and 30°-45°,AL was an independent risk factor for RPRE(both P<0.001).Conclusions:RPRE in children aged 4-12 years with low myopia and emmetropia is hyperopic defocus,RPRE in children with low hyperopia is myopic defocus,and RPRE in the eccentricity range of 15°to 45°may be closely related to the development of axial myopia in children.