先天性白内障形觉剥夺患者眼球发育特点的临床观察

发布时间：2018-08-12 15:12

【摘要】：目的分析先天性白内障形觉剥夺患者临床资料探讨其眼球发育特点。方法回顾性系列病例研究。收集2009年03月-2015年7月在山东省眼科研究所暨青岛眼科医院诊断为先天性白内障并入院接受治疗的264例(432眼)患者的临床资料,年龄2个月-28岁(平均4.21±4.36岁)。其中:男124人,女140人;单眼患者96人,双眼患者168人。根据眼球发育规律将以6个月、1岁、3岁、5岁、14岁为界划分为6个年龄段。(一)分析单眼先天性白内障形觉剥夺患者眼球发育情况:对符合条件的90例单眼患者分析,不同年龄段人数分布为:(6个月以下)组11例,(6个月及以上~1岁)组6例,(1岁及以上~3岁)组20例,(3岁及以上~5岁)组20例,(5岁以上~14岁)组33例。注:14岁以上的样本数较少这里不做分析。(1)采用配对t检验分别比较5个年龄段患者的患眼与健眼眼轴长度的差异。(2)根据患眼和健眼眼轴相对长度,将患者分为短眼轴患者(40例)和长眼轴患者(50例),分析随剥夺时间的延长,长眼轴组、短眼轴组在相应年龄段中所占比例的变化情况情况,并用相关性检验分析患健眼眼轴长度差值与形觉剥夺时间的关系。(3)根据形觉剥夺程度将患者分为全混型(完全形觉剥夺)(24例)及非全混型(非完全形觉剥夺)(66例)两组,以多元回归分析性别、眼球震颤、斜视、形觉剥夺时间、形觉剥夺程度对患健眼眼轴长度差值的影响。(4)采用配对t检验分别比较5个年龄段患者的患眼与健眼角膜曲率的差异。(二)统计双眼先天性白内障形觉剥夺患者的眼轴和角膜曲率发育情况。(三)统计先天性白内障患者晶状体混浊类型、眼球震颤、斜视、角膜直径等情况临床资料。结果(一)对单眼先天性白内障形觉剥夺患者的眼轴发育分析(1)(6个月以下)组中患眼眼轴比对侧健眼眼轴短(t=-4.80,P0.01);(5岁以上~14岁)患眼眼轴比对侧健眼眼轴长(t=2.54,P0.05);(6个月及以上~5岁)3组患者患健眼眼轴长度差异无统计学意义(t=-0.36、0.30、1.43,P0.05)。(2)形觉剥夺时间与患健眼眼轴长度差值呈正相关(r=0.294,P0.01)。(3)随年龄增长,长眼轴患者在相应年龄段中所占比例逐渐增加,短眼轴患者在相应年龄段中所占比例逐渐减少。多元回归分析显示患健眼眼轴长度差值随着形觉剥夺时间的延长而增大(r=0.142,P0.05),完全形觉剥夺对患健眼眼轴差值影响显著高于非完全形觉剥夺(r=0.819,P0.01),而性别、眼球震颤、斜视对患健眼眼轴差值无影响(r=0.017,P0.05)。(4)患眼曲率平均43.73±2.01D,健眼曲率平均43.31±1.65D,5个年龄段中患健眼角膜曲率差异均没有统计学意义(t=1.39、1.31、1.76、0.90、0.80,p0.05)。(二)双眼先天性白内障形觉剥夺患者的眼轴及角膜曲率发育情况。(6个月以下)、(6个月及以上~1岁)、(1岁及以上~3岁)、(3岁及以上~5岁)、(5岁以上~14岁)5个年龄段眼轴长度平均值分别为17.97±1.42mm、20.10±1.48mm、21.93±1.47mm、22.12±2.35mm、23.66±1.72mm。(三)先天性白内障患者晶状体混浊类型、眼球震颤、斜视等情况。(1)晶状体混浊类型:432眼中,囊膜性白内障26眼(6.02%);极性白内障17眼(3.94%);缝合性白内障30眼(6.94%);胚胎核性白内障8眼(1.85%);核性白内障30眼(6.95%);绕核性白内障70眼(16.20%);全白内障125眼(28.94%);发育性白内障30眼(6.95%);合并两种以上混浊96眼(22.22%)。(2)眼球震颤:264例患者中震颤患者53例(20.08%),其中双眼患者41人(在双眼患者中占24.05%);单眼患者12人(在双眼患者中占12.50%)(3)斜视:264例患者中斜视患者占49例(18.56%),其中双眼患者23人(在双眼患者中占13.69%);单眼患者26人(在单眼患者中占27.08%)结论(1)先天性白内障形觉剥夺早期患眼轴比健眼眼轴短;后期形觉剥夺造成患眼眼轴比健眼眼轴长;(2)形觉剥夺程度、形觉剥夺时间对眼轴发育影响明显;(3)先天性白内障育形觉剥夺对患者角膜发育无明显影响。
[Abstract]:Objective To analyze the clinical data of congenital cataract patients with form deprivation and to explore the characteristics of their eyeball development.Methods A retrospective series of case studies were conducted.264 patients (432 eyes) with congenital cataract diagnosed and treated in Shandong Institute of Ophthalmology and Qingdao Ophthalmological Hospital from March 2009 to July 2015 were collected. Month-28 years old (average 4.21 (+ 4.36 years). Among them, 124 were male and 140 were female, 96 were monocular and 168 were binocular. According to the development of eyeball, the patients were divided into six age groups: 6 months, 1 year, 3 years, 5 years and 14 years old. The distribution of the same age group was as follows: (below 6 months) 11 cases (6 months and above to 1 year) 6 cases (1 year and above to 3 years) 20 cases (3 years and above to 5 years) 20 cases (5 years old to 14 years old) 33 cases (above 5 years old) group. Note: The sample number of patients aged 14 years and above is less than the analysis here. (1) The paired t test was used to compare the axis of the affected eye with the healthy eye in 5 age groups. (2) According to the relative length of the axis of the affected eye and the healthy eye, the patients were divided into short axis group (40 cases) and long axis group (50 cases). The changes of the proportion of the long axis group and short axis group in the corresponding age group were analyzed with the prolongation of deprivation time, and the correlation test was used to analyze the difference of the axial length of the affected eye and the shape abruption. (3) According to the degree of form deprivation, the patients were divided into two groups: total mixed type (complete form deprivation) (24 cases) and incomplete form deprivation (incomplete form deprivation) (66 cases). The effects of sex, nystagmus, strabismus, form deprivation time and form deprivation degree on the axial length difference of healthy eyes were analyzed by multiple regression analysis. (4) Paired t test scores were used. The differences of corneal curvature between normal eyes and affected eyes in 5 age groups were compared. (2) The development of axial and corneal curvature in binocular congenital cataract with form deprivation was analyzed. (3) The clinical data of lens opacity, nystagmus, strabismus and corneal diameter in patients with congenital cataract were analyzed. Analysis of axial development in patients with cataract form deprivation (1) (less than 6 months) The axial length of the affected eye was shorter than that of the contralateral eye (t = - 4.80, P 0.01); the axial length of the affected eye was longer than that of the contralateral eye (t = 2.54, P 0.05); and the axial length of the affected eye was not significantly different among the three groups (t = - 0.36, 0.30, 1.43, P 0.05). (3) With age increasing, the proportion of long axis patients in the corresponding age group gradually increased, while the proportion of short axis patients in the corresponding age group gradually decreased. Multivariate regression analysis showed that the difference of axial length between healthy eyes with age increasing. Long and enlarged (r = 0.142, P 0.05), the effect of complete form deprivation on axial deviation of healthy eyes was significantly higher than that of incomplete form deprivation (r = 0.819, P 0.01), while sex, nystagmus and strabismus had no effect on axial deviation of healthy eyes (r = 0.017, P 0.05). (4) The average curvature of healthy eyes was 43.73 (+ 2.01D), and the average curvature of healthy eyes was 43.31 (+ 1.65D). There was no significant difference in curvature (t = 1.39, 1.31, 1.76, 0.90, 0.80, p0.05). (2) Axis and corneal curvature development in patients with bilateral congenital cataract form deprivation. (6 months or less), (6 months or more to 1 year old), (1 year or more to 3 years old, (3 years or more to 5 years old), (5 years or more to 14 years old) Axis length averaged 1. (3) The types of lens opacity, nystagmus and strabismus in patients with congenital cataract: 432 eyes, 26 eyes (6.02%) of capsular cataract, 17 eyes (3.94%) of polar cataract, 30 eyes (6.94%) of suture cataract, 8 eyes of embryonic nuclear cataract, and so on. (1.85%); nuclear cataract 30 eyes (6.95%); circumnuclear cataract 70 eyes (16.20%); total cataract 125 eyes (28.94%); developmental cataract 30 eyes (6.95%); more than two kinds of opacity 96 eyes (22.22%). (2) nystagmus: 264 patients with tremor in 53 cases (20.08%), including 41 patients in both eyes (24.05%); monocular patients 12 patients (in both eyes); 12.50% (3) Strabismus: 49 (18.56%) of 264 patients were strabismus, 23 (13.69%) were binocular, 26 (27.08%) were monocular. Conclusion (1) The axial length of congenital cataract with form deprivation was shorter in early stage than that of healthy eye, and it was shorter in late stage than that of normal eye. Long; (2) Degree of form deprivation and time of form deprivation have obvious effect on the development of ocular axis; (3) Congenital cataract has no obvious effect on corneal development.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R776.1

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