【摘要】 目的：探讨儿童远视眼与发生近视的相关性。方法：经常规扩瞳验光后诊断+0.75～+4.00D的远视眼儿童122例244眼，分戴镜治疗组和非戴镜对照组;每3mo复查常瞳的裸眼、戴镜视力和显性屈光状态1次，每年常规扩瞳验光1次;应用复方托吡咔胺滴眼液作睫状肌麻痹剂，滴眼共6次，滴最后1次40min后检影验光;连续3a观察屈光状态的演变。结果：戴镜组7,8,9岁的平均远视度分别是+1.66D,+1.71D和+1.65D,非戴镜组7,8,9岁的平均远视度分别是+1.28D,+1.08D和+1.10D;观察满3a时，戴镜组年均下降远视度分别是+0.26D,+0.26D和+0.31D，发生近视分别有2眼(4.8%),1眼(2.5%)和4眼(10.0%);非戴镜组年均下降远视度分别是+0.58D,+0.59D和+0.66D，发生近视分别有18眼(42.9%),24眼(60.0%)和33眼(82.5%)。两组相比，有非常显著性的差异(P<0.01)。结论：戴镜矫治远视眼儿童的远视屈光度比不戴镜矫治的下降慢，近视的发生率比不戴镜矫治的明显低。
【关键词】 远视眼;学龄儿童;近视;因果关系
Effect of cum correction for hypermetropia on myopia development in school children
XiuZhang Yang, JunHong Fang, GuangMian Tan, QiLing Peng, Li Ji, ChunXian Lin, FengMei Tan
Foundation item:Science Research Foundation Project of Health Office of Guangdong Province,Guangdong Province,China(No.A2005607)
Department of Ophthalmology, the Peoples Hospital of Baiyun District, Guangzhou 510500, Guangdong Province, China
AbstractAIM: To investigate effect of cum correction for hypermetropia on myopia development in school children.METHODS: One hundred and twentytwo school children (244 eyes) aged 79 years old were diagnozed as +0.75+4.00D hyperopia by mydriatics refraction and randomly divided into two groups: the treatment group wearing glasses and the control group of no glasses. They were checked the naked visual acuity, correted visual acuity and dominant refractive status one time per 3 months, and mydriatics refraction one time per year. Compound tropicamide eye drops was taken as cycloplegics to drop the eyes 6 times, and 40 minutes after the last time retinoscopy optometry was made. The changes of refractive status of them were observed three years continuously.RESULTS: The average diopters of hyperopia in the group wearing glasses were +1.66D,+1.71D,+1.65D in various ages at the first time. The average diopters of hyperopia in the group not wearing glasses were +1.28D,+1.08D,+1.10D in various ages at the first time, the annual average decreased diopters of hyperopia in group wearing glasses were +0.26D,+0.26D,+0.31D at the end of the third year, and myopia happened in 2 eyes (4.8%), 1 eye (2.5%), 4 eyes(10.0%); and the annual average decreased diopters of hyperopia in group not wearing glasses were +0.58D,+0.59D,+0.66D at the end of the third year. Myopia happened in 18 eyes (42.9%), 24 eyes(60.0%), 33 eyes(82.5%). The annual average decreased diopters of hyperopia and the rate of myopia were significantly different in the two groups at various ages (P<0.01) .CONCLUSION: Diopter of hyperopia in the group wearing glasses decreased slower than that in the group of no glasses, and the incidence rate of myopia was significantly lower than that in the group not wearing glasses.
KEYWORDS: hyperopia;school chlidren;myopia;causation
0引言
现阶段以主诉频眨眼或双眼痒等类似慢性结膜炎症状而就诊的学龄儿童较多，而且对此类儿童行扩瞳验光都显远视状态，经戴镜矫治可减轻或消除有关症状。为探讨儿童远视状态眼是否是造成视疲劳及早发生近视的隐因，寻求相应的防治措施，我们自200510以来开展相关的研究如下。
1对象和方法
1.1对象 广州市龙岗路小学1～3年级(7～9岁)学生，经常规扩瞳验光诊断+0.75～+4.00D远视眼122例244眼，其中7岁42例，8岁40例，9岁40例(表1)。
1.2方法 先行常规扩瞳验光试镜，同时查眼前段和眼底，排除其他眼病，诊断远视度是+0.75～+4.00D的儿童，分戴镜组(A组)和非戴镜对照组(B组);每3mo复查常瞳的裸眼、戴镜视力和屈光状态1次，每年行常规扩瞳验光试镜1次，戴镜组儿童根据其远视度改变的情况，调整戴镜度数;选用复方托吡卡胺滴眼液作睫状肌麻痹剂，表1儿童远视屈光状态(按等效球镜计)眼每5min滴眼1次，共6次，滴最后1次40min后检影验光试镜。把经连续3a观察视力、屈光状态演变情况资料完整的研究对象列入本文总结分析。年均下降屈光度=(初诊屈光度末次屈光度)/观察年数3。
2结果
戴镜组和非戴镜观察组儿童的远视屈光度均呈逐年下降趋势，每组各年龄阶的下降速度稍有差异，而各年龄阶两组分别下降的远视度数有显著性的差异(P<0.01，表2)。戴镜组中，有频眨眼或眼痒等视疲劳症状者，经戴镜矫治后，相关症状消失或仅偶有。观察3a时，非戴镜组各年龄阶近视已占一定比例，而戴镜治疗组各年龄阶段近视的发生率甚低;两组相比，有非常显著性的差异意义(5.7%vs 61.5%，P<0.01)。
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