青少年近视患者黄斑区脉络膜厚度的研究

发布时间：2018-07-09 13:46

本文选题：光学相干断层扫描 + 脉络膜厚度　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景随着科技的进步,人们的生活方式有了较大改变,电子产品已走进千家万户,丰富了人们的生活,但问题随之而来,目前我国成为了近视人数最多的国家,近视患者占总人口的三分之一左右。近年来由于不良的用眼习惯,“低头族”已不仅仅是成年人的专属,青少年近视的发病率在逐年增加,近视的发生、发展,尤其是高度近视,导致眼部组织发生一系列变化,如眼轴的拉长、玻璃体的混浊、后巩膜葡萄肿的发生、视网膜色素上皮层和脉络膜的萎缩等。而脉络膜厚度的变化与多种眼底疾病的发生息息相关,视网膜脱离、脉络膜新生血管等等,这些疾病都会导致视力不可逆性下降甚至失明。一直以来,受医疗技术和设备限制,人们对于近视的发生、发展仍处于不断探索阶段,随着先进设备的临床应用,人们可以清晰的观测到近视患者眼后节的变化,量化脉络膜的厚度,为近视的形成与发展提供更深层次的理论依据。目的应用光学相干断层扫描技术(Optical Coherence Tomography,OCT)测量青少年近视患者黄斑区域脉络膜的厚度,观察青少年近视患者与正常青少年脉络膜厚度的差异,探讨低度、中度、高度近视患者不同方位脉络膜厚度的变化特点,进一步分析青少年近视患者黄斑区域脉络膜厚度的变化与屈光度、眼轴长度、眼压之间的相关性。方法采用临床对照研究。选取2015年9月至2016年9月在我院眼视光中心门诊就诊和体检的青少年60例120眼,年龄12~17岁,平均年龄(14.57±1.63)岁,按等效球镜和裸眼视力及最佳矫正视力把研究对象分为4组,其中正常组15例30眼(裸眼视力≥1.0),低度近视组15例30眼(-0.50D≤等效球镜-3.00D,最佳矫正视力≥1.0),中度近视组15例30眼(-3.00D≤等效球镜-6.00D,最佳矫正视力≥1.0),高度近视组15例30眼(-6.00D≤等效球镜-10.00D,最佳矫正视力≥0.8)。运用蔡司频域光学相干断层扫描仪Cirrus HD OCT(Carl Zeiss Meditrc Inc,4000),采用高清五线光栅,对黄斑中心凹分别行0°和90°方位加强深度扫描(enhanced depth imaging,EDI),获取经黄斑中心凹下水平和垂直横断面图像,手动测量黄斑中心凹下和距黄斑中心凹1000μm、3000μm的鼻侧、颞侧、上方、下方9个位点脉络膜厚度值。所有测量均由两名经验丰富医师独立完成,分别测量3次,共6次取其平均值为最终参考数据。结果本次研究共选取60例120眼,各组间年龄、性别差异不显著,无统计学意义(P0.05);正常组、低度近视组、中度近视组、高度近视组黄斑中心凹脉络膜厚度分别为(347.62±6.00)μm、(300.14±13.85)μm、(234.49±18.71)μm、(183.39±25.12)μm;各组内不同位点脉络膜厚度差异有统计学意义(P0.05);不同组间,低度近视组颞侧1000μm脉络膜平均厚度大于正常组颞侧1000μm,正常组颞侧3000μm和低度近视组颞侧3000μm、正常组上方3000μm和低度近视组上方3000μm、正常组下方3000μm和低度近视组下方3000μm、正常组鼻侧3000μm和低度近视组鼻侧3000μm差异无统计学意义(P0.05),其余各组间相同位点脉络膜厚度差异均有统计学意义(P0.05),随着屈光度越偏向负值,脉络膜厚度越薄;黄斑中心凹脉络膜厚度与等效球镜呈显著正相关、与眼轴长度呈显著负相关、与眼压呈负相关。结论青少年近视患者黄斑区脉络膜厚度随着屈光度越偏向负值,脉络膜厚度越薄,黄斑中心凹较周边部变化明显。青少年近视患者黄斑中心凹脉络膜厚度与屈光度呈显著正相关、与眼轴长度呈显著负相关、与眼压呈负相关。
[Abstract]:Background with the progress of science and technology, people's way of life has changed greatly, electronic products have entered thousands of households and enrich people's lives, but the problems come with them. At present, our country has become the country with the largest number of myopia, and the myopia patients account for about 1/3 of the total population. In recent years, due to bad eye use habits, "low head family" has already been used. The incidence of myopia is increasing year by year, the incidence of myopia is increasing year by year, the occurrence of myopia, development, especially high myopia, causing a series of changes in ocular tissue, such as the lengthening of the eye axis, the opacity of the vitreous, the occurrence of the staphyloma in the posterior sclera, the atrophy of the retina and the choroid, and the change of the choroid thickness. It is closely related to the occurrence of a variety of fundus diseases, retinal detachment, choroidal neovascularization, and so on. These diseases will cause the decrease of vision irreversibility or even blindness. Since the limitation of medical technology and equipment, the development of myopia is still in the stage of exploration, with the clinical application of advanced equipment, people The changes in the posterior segment of the eye can be clearly observed and the thickness of the choroid can be quantified to provide a deeper theoretical basis for the formation and development of myopia. Objective to use Optical Coherence Tomography (OCT) to measure the choroidal thickness of the macular region of adolescent myopia and to observe the juvenile myopia. The difference of choroidal thickness between the normal and normal adolescents and the characteristics of the different azimuth choroidal thickness of the low, moderate and high myopia patients were discussed. The correlation between the changes of the choroidal thickness in the macular region and the refractive index, the axial length and the intraocular pressure were further analyzed. The clinical control study was conducted in September 2015. In September 2016, 60 teenagers, aged 12~17, aged (14.57 + 1.63) years old, were divided into 4 groups, including 15 cases in normal group 30 eyes (naked eye > 1), 15 in low myopia group and 30 eyes (-0.50D < -3 equivalent sphere -3). .00D, the best corrected visual acuity was more than 1), 15 cases in the moderate myopia group, 30 eyes (-3.00D < -6.00D, the best corrected visual acuity > 1), 15 cases in the high myopia group 30 eyes (-6.00D < -10.00D, the best corrected visual acuity > 0.8). Using Zeiss frequency domain optical coherence tomography Cirrus HD OCT (Carl Zeiss Meditrc Inc, 4000), using high definition five line The enhanced depth imaging (EDI) was performed on the macular central fovea (enhanced depth imaging, EDI) to obtain the horizontal and vertical cross-sectional images of the macular fovea, and to manually measure the choroidal thickness of the nasal, temporal, upper and lower 9 loci of the macular fovea and 1000 mu m to the macular fovea, 3000 mu m. All the measurements were made. Two experienced doctors were completed independently and measured 3 times respectively. The average value of 6 times was taken as the final reference data. Results this study selected 60 cases and 120 eyes. The age of each group was not significant, no significant difference (P0.05); normal group, low myopia group, moderate myopia group, and high myopia group with macular choroid thickness were 3 47.62 + 6) mu m, (300.14 + 13.85) mu m, (234.49 + 18.71) mu m, (183.39 + 25.12) mu m, and the difference of choroidal thickness between the different points in each group was statistically significant (P0.05). The average thickness of the temporal 1000 mu choroidal membrane in the low myopia group was greater than that of the normal temporal side 1000 mu m, and the normal group was on the temporal lateral temporal 3000 mu m in the temporal lateral 3000 and myopia group, and in the normal group, the normal group was on the normal group. 3000 u m and low myopia group were 3000 m above, below the normal group of 3000 mu m and low myopia group 3000 m. There was no statistical difference between the normal group and the nasal side 3000 mu m and the low myopia group (P0.05). The difference of choroidal thickness between the other groups was statistically significant (P0.05), with the diopter negative, choroid membrane The thickness of the macular fovea choroidal thickness was significantly positively correlated with the equivalent lens, and the length of the ocular axis was negatively correlated with the ocular pressure. Conclusion the choroidal thickness of the macular area in adolescent myopia was negative with the diopter, the thinner the choroidal thickness was, the change of the macular fovea was more obvious than that of the surrounding area. Foveal choroidal thickness was positively correlated with diopter, negatively correlated with axial length, and negatively correlated with IOP.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R778.11

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