本文關(guān)鍵詞： 法醫(yī)臨床學(xué) 高度近視 視力 屈光度 眼軸 眼底　出處：《蘇州大學(xué)》2009年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:研究中青年近視者的眼球結(jié)構(gòu)變化與近視程度改變的規(guī)律,探討高度近視者眼球結(jié)構(gòu)和視力的關(guān)系,篩選出與視力變化關(guān)系密切的眼球結(jié)構(gòu)相關(guān)檢查指標(biāo),據(jù)此建立根據(jù)高度近視眼球結(jié)構(gòu)變化的相關(guān)參數(shù)推斷受試者行為視力的方法,確保眼損傷法醫(yī)學(xué)鑒定的科學(xué)性和準(zhǔn)確性。 方法:檢查受試者(152人,283眼)的矯正視力、角膜曲率半徑、前房深度、眼軸長度、眼底、黃斑6mm直徑范圍視網(wǎng)膜厚度,根據(jù)眼底圖像測量近視弧與視盤的面積并計(jì)算得出弧盤比值;根據(jù)受試者屈光度、眼軸及眼底參數(shù)的不同進(jìn)行分組或分級(jí);采用SAS8.1及SPSS15.0統(tǒng)計(jì)軟件包對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,分別進(jìn)行年齡、屈光度、眼軸長度、角膜曲率半徑、前房深度、弧盤比值、眼底分級(jí)、黃斑厚度、黃斑容積與視力之間的相關(guān)性分析、多元回歸分析,探討屈光度、眼軸長度及眼底近視改變與視力的關(guān)系,最后擬出根據(jù)受試者眼球結(jié)構(gòu)指標(biāo)推導(dǎo)受試者視力的數(shù)學(xué)模型。 結(jié)果:①年齡、眼底分級(jí)、近視弧大小、眼軸長度、屈光度與視力呈中度相關(guān)(｜r｜0.4,p0.0001),黃斑容積、黃斑厚度與視力呈低度相關(guān)(｜r｜接近于0.4,p0.0001),角膜曲率及前房深度與視力無顯著相關(guān)性。②在一定范圍內(nèi),近視眼球結(jié)構(gòu)改變對(duì)視力沒有顯著影響,但當(dāng)屈光度增加到一定程度時(shí),視力會(huì)隨著眼球結(jié)構(gòu)改變加重而下降:如眼軸長度小于28.5mm、屈光度低于-10.00D、眼底分級(jí)在2級(jí)以下者,其視力多在正常范圍內(nèi)(1.0左右);當(dāng)眼軸長度大于30.00mm、屈光度大于-20.00D、眼底分級(jí)為4級(jí)者,其視力多低于0.5。③建立了根據(jù)高度近視眼患者眼球結(jié)構(gòu)參數(shù)推斷視力的數(shù)學(xué)模型,將樣本進(jìn)行自身回代,誤差在±0.1時(shí),準(zhǔn)確率達(dá)到75%以上,誤差在±0.15時(shí),準(zhǔn)確率高達(dá)90%。 結(jié)論:①高度近視眼患者視力隨年齡增長、眼軸延長、屈光度加深、眼底病變程度加重而降低,眼球后極部尤其是黃斑區(qū)病變的類型與程度為影響視力的主要因素。②通過對(duì)高度近視者眼球形態(tài)結(jié)構(gòu)的檢查,根據(jù)高度近視者眼球形態(tài)結(jié)構(gòu)變化的相關(guān)參數(shù)以及依此建立的數(shù)學(xué)模型可以較準(zhǔn)確地評(píng)估受試者的行為視力。
[Abstract]:Objective: to study the regularity of the changes of eyeball structure and degree of myopia in young and middle-aged myopia, to explore the relationship between eyeball structure and visual acuity in high myopia, and to screen out the relative examination indexes of eyeball structure which are closely related to the change of eyesight. Based on this, a method to infer the behavioral visual acuity of the subjects according to the parameters of ocular structure changes in high myopia was established to ensure the scientific and accurate forensic identification of ocular injuries. Methods: the corrected visual acuity, radius of curvature of cornea, depth of anterior chamber, axial length, fundus, macular diameter and retinal thickness were examined in 152 patients (283 eyes). The area of myopic arc and optic disc was measured according to the fundus image and the ratio of arc to disc was calculated. According to the diopter, the axial and fundus parameters of the subjects were grouped or graded. The data were analyzed by SAS8.1 and SPSS15.0 statistical software package. Age, diopter, length of eye axis, radius of curvature of cornea, depth of anterior chamber, arc disc ratio, fundus grade, macular thickness, macular volume and visual acuity were analyzed. The relationship between the length of eye axis and the change of myopia and visual acuity was discussed. Finally, the mathematical model of visual acuity was deduced according to the index of eyeball structure. Results the age, fundus grade, myopic arc size, axial length and diopter were moderately correlated with visual acuity (r 0.4 p 0.0001, macular volume). There was a low correlation between macular thickness and visual acuity (r = 0.4 p 0.0001g). There was no significant correlation between corneal curvature and anterior chamber depth and visual acuity in a certain range. The change of myopic eye structure had no significant effect on visual acuity, but when the diopter increased to a certain extent, there was no significant correlation between macular thickness and visual acuity. Visual acuity decreases as the structure of the eyeball worsens: if the axial length is less than 28.5 mm, the diopter is less than -10.00D, and the fundus grade is below grade 2, The visual acuity was about 1.0 in the normal range, and when the axial length was more than 30.00mm, the diopter was greater than -20.00D, and the fundus grade was grade 4, the visual acuity of the patients with high myopia was more than 0.5.3. A mathematical model was established to infer the visual acuity based on the eyeball structure parameters of the patients with high myopia. The error is 鹵0.1, and the accuracy is more than 75%. When the error is 鹵0. 15, the accuracy is as high as 90. Conclusion the visual acuity of the patients with high myopia increases with age, the axis of the eye lengthens, the diopter deepens, and the degree of fundus lesion becomes worse. The type and extent of the lesions in the posterior pole of the eyeball, especially in the macular area, were the main factors affecting the visual acuity by examining the morphology and structure of the eyeball in the patients with high myopia. According to the parameters of the morphological changes of the eyeball and the mathematical model, the behavioral visual acuity of the subjects can be evaluated more accurately.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：D919

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