【摘要】：目的:Welchallyn Suresight視力篩查儀等手持式的驗光設(shè)備因其方便攜帶,不需要兒童的主觀合作等特點,目前越來越多的應(yīng)用于兒童視力篩查中。本研究對一組屈光不正患者分別用Welchallyn Suresight一代(SS1)和二代(SS2)以及Topcon電腦驗光儀和視網(wǎng)膜檢影法測量其屈光不正度數(shù),并對數(shù)據(jù)進行了分析比較,探討SS1和SS2所測量數(shù)據(jù)的可重復(fù)性與一致性,評價SS1和SS2的臨床應(yīng)用價值。方法:研究所選51例102只眼,均為在廣州市婦女兒童醫(yī)療中心眼科經(jīng)檢查確診的屈光不正患者�；颊吣挲g2~16歲(平均年齡10.26歲),排除有其他眼部疾病,眼部手術(shù)史以及全身系統(tǒng)性疾病的患者。受檢患者先在自然瞳孔狀態(tài)下分別用SS1和SS2視力篩查儀,Topcon電腦驗光儀進行檢查,記錄屈光結(jié)果。之后用0.5%托吡卡胺滴眼液散瞳30-45分鐘,再進行視網(wǎng)膜檢影驗光,記錄屈光結(jié)果。屈光數(shù)據(jù)的可重復(fù)性研究采用個體分別測量,三次結(jié)果的組內(nèi)相關(guān)系數(shù)(intraclass correlation coefficient,ICC)以及重復(fù)系數(shù)作為重復(fù)測量精確性的分析指標(biāo)。SS1,SS2和Topcon電腦驗光儀三組數(shù)據(jù),和視網(wǎng)膜檢影比較的95%一致性界限,作為一致性的分析指標(biāo)。結(jié)果:1.在柱鏡度數(shù)測量方面,SS1,SS2和Topcon電腦驗光儀三組與散瞳后檢影結(jié)果的差值比較無顯著性差異(P0.05),在球鏡(-5D至+5D),球鏡(-10D至+5D)度數(shù)和柱鏡軸向測量方面,SS1,SS2和Topcon電腦驗光儀三組與散瞳后檢影結(jié)果的差值有統(tǒng)計學(xué)意義(P0.05)。2.可重復(fù)性:SS1,SS2及Topcon電腦驗光儀三者在球鏡度數(shù)測量方面ICC均大于0.75,有很好的可重復(fù)性;柱鏡度數(shù)測量方面SS1 ICC為0.66,SS2和Topcon電腦驗光儀ICC分別為0.88和0.99,SS2可重復(fù)性較SS1好;柱鏡軸向方面SS1和SS2 ICC分別為0.71和0.72,在除去柱鏡度數(shù)小于0.5D的數(shù)據(jù)后SS1和SS2的測量可重復(fù)性有提高,分別為0.83和0.73。3.95%一致性界限:SS1與視網(wǎng)膜檢影法比較的95%一致性界限在球鏡(-5D至+5D)度數(shù)測量方面為(-3.09,1.94)D,柱鏡度數(shù)測量方面為(-1.76,1.75)D,柱鏡軸向(本組全部數(shù)據(jù))測量方面為(-41.66,53.02)°,柱鏡軸向(柱鏡度數(shù)≥0.5D)測量方面為(-33.55,32.31)°;SS2與視網(wǎng)膜檢影法比較的95%一致性界限在球鏡(-5D至+5D)度數(shù)測量方面為(-3.15,1.83)D,球鏡(-10D至+5D)度數(shù)測量方面為(-2.96,2.23)D,柱鏡度數(shù)測量方面為(-1.26,1.27)D,柱鏡軸向(本組全部數(shù)據(jù))測量方面為(-44.69,68.35)°,柱鏡軸向(柱鏡度數(shù)≥0.5D)測量方面為(-38.86,45.50)°;Topcon電腦驗光儀與視網(wǎng)膜檢影法比較的95%一致性界限在球鏡(-5D至+5D)度數(shù)測量方面為(-2.57,0.94)D,球鏡(-10D至+5D)度數(shù)測量方面為(-3.10,1.25)D,柱鏡度數(shù)測量方面為(-0.61,0.54)D,柱鏡軸向(本組全部數(shù)據(jù))測量方面為(-31.92,36.35)°,柱鏡軸向(柱鏡度數(shù)≥0.5D)測量方面為(-22.97,19.75)°。SS1和SS2的95%一致性界限均較Topcon電腦驗光儀寬。結(jié)論:1.SS1,SS2在自然瞳孔狀態(tài)下球鏡度數(shù)測量方面,與Topcon電腦驗光儀比較,一致性與可重復(fù)性均較好。2.相對于SS1,SS2所拓寬的負性屈光度數(shù)測量范圍,測量結(jié)果與Topcon電腦驗光儀比較,一致性與可重復(fù)性均較好。在遠視測量方面,SS2跟SS1比較無明顯差異;3.在柱鏡測量方面,SS1和SS2也有較好的一致性與可重復(fù)性。雖然其對柱鏡軸向測量的表現(xiàn)略差于Topcon電腦驗光儀,但這不影響它在群體性篩查中的應(yīng)用。4.本研究表明在自然瞳孔狀態(tài)下,Welch Allyn Suresight視力篩查儀的屈光檢查結(jié)果對于初步了解兒童屈光狀態(tài),發(fā)現(xiàn)可能導(dǎo)致弱視的嚴(yán)重屈光不正并指導(dǎo)下一步的臨床處理有很大的意義。目的:本研究對一組經(jīng)視網(wǎng)膜激光光凝術(shù)治療后的ROP患者和一組無ROP的早產(chǎn)兒以及一組足月兒應(yīng)用光學(xué)相干斷層掃描儀(OCT)測量了黃斑區(qū)視網(wǎng)膜厚度和容積,并對數(shù)據(jù)進行了分析比較,探討ROP以及低出生胎齡對兒童視網(wǎng)膜發(fā)育的影響。方法:研究所選39例72只眼,均為在廣州市婦女兒童醫(yī)療中心就診的兒童,分為三組(第一組為有激光光凝手術(shù)史的ROP患者,第二組為無ROP的正常早產(chǎn)兒,第三組為其年齡相匹配的足月兒)。其中,激光光凝術(shù)后的ROP患者16例26只眼(激光光凝組)。所有納入研究的均為高危閾值前期1型和閾值期ROP,經(jīng)激光光凝術(shù)治療后視網(wǎng)膜血管的發(fā)育趨于正常,臨床癥狀消失的患者。無高度屈光不正及其他眼底病變的正常早產(chǎn)兒7例14只眼(正常早產(chǎn)兒組)。與患者年齡性別匹配的足月兒16例32只眼(足月兒組)。應(yīng)用Topcon 3D OCT-1000對受檢者黃斑區(qū)及周圍6.0×6.0mm區(qū)域行放射狀掃描,測量黃斑區(qū)視網(wǎng)膜厚度與容積,記錄結(jié)果。結(jié)果:1.黃斑區(qū)視網(wǎng)膜厚度的比較:激光光凝組與正常早產(chǎn)兒組比較,在所分成的九區(qū)中,激光光凝組視網(wǎng)膜厚度均較正常早產(chǎn)兒組增厚,差異均有統(tǒng)計學(xué)意義(P0.05)。激光光凝組與足月兒組比較,在黃斑中心凹區(qū)(Fovea)和黃斑中心凹內(nèi)環(huán)下方區(qū)(I?),激光光凝組視網(wǎng)膜厚度較足月兒組增厚(P0.05),差異有統(tǒng)計學(xué)意義。在其余各區(qū),激光光凝組與足月兒組視網(wǎng)膜厚度無顯著性差異(P0.05)。正常早產(chǎn)兒組與足月兒組比較,在黃斑中心凹區(qū)(Fovea),兩組視網(wǎng)膜厚度無顯著性差異(P0.05)。在其余各區(qū),正常早產(chǎn)兒組視網(wǎng)膜厚度較足月兒組薄(P0.05),差異均有統(tǒng)計學(xué)意義。2.黃斑區(qū)視網(wǎng)膜容積的比較:激光光凝組與正常早產(chǎn)兒組比較,激光光凝組黃斑區(qū)視網(wǎng)膜總?cè)莘e較正常早產(chǎn)兒組大,差異有統(tǒng)計學(xué)意義(P0.05)。在所分成的九區(qū)中,激光光凝組視網(wǎng)膜容積均較正常早產(chǎn)兒組大(P0.05),差異均有統(tǒng)計學(xué)意義。激光光凝組與足月兒組比較,黃斑區(qū)視網(wǎng)膜總?cè)莘e無明顯差異(P0.05)。在黃斑中心凹區(qū)(Fovea)和黃斑中心凹內(nèi)環(huán)下方區(qū)(I?),激光光凝組視網(wǎng)膜容積較足月兒組大(P0.05),差異有統(tǒng)計學(xué)意義。在其余各區(qū),激光光凝組與足月兒組視網(wǎng)膜容積無顯著性差異(P0.05)。正常早產(chǎn)兒組與足月兒組比較,正常早產(chǎn)兒組黃斑區(qū)視網(wǎng)膜總?cè)莘e較足月兒組小,差異有統(tǒng)計學(xué)意義(P0.05)。在黃斑中心凹區(qū)(Fovea),正常早產(chǎn)兒組視網(wǎng)膜容積與足月兒組比較差異無統(tǒng)計學(xué)意義(P0.05)。在其余各區(qū),正常早產(chǎn)兒視網(wǎng)膜容積均較足月兒組小(P0.05),差異均有統(tǒng)計學(xué)意義。結(jié)論:1.正常早產(chǎn)兒組和足月兒組比較,正常早產(chǎn)兒組的黃斑中心凹區(qū)視網(wǎng)膜厚度較足月兒組厚,中心凹周邊部視網(wǎng)膜厚度較足月兒組薄;正常早產(chǎn)兒組的黃斑區(qū)視網(wǎng)膜總?cè)莘e較足月兒組小,黃斑中心凹區(qū)視網(wǎng)膜容積較足月兒組大,中心凹周邊部視網(wǎng)膜容積較足月兒組小。2.激光光凝組和正常早產(chǎn)兒組比較,激光光凝組的黃斑中心凹區(qū)以及中心凹周邊部視網(wǎng)膜厚度均較正常早產(chǎn)兒組厚;激光光凝組的黃斑區(qū)視網(wǎng)膜總?cè)莘e,黃斑中心凹區(qū)視網(wǎng)膜容積以及中心凹周邊部視網(wǎng)膜容積均較正常早產(chǎn)兒組大。
[Abstract]:Objective: Welchallyn Suresight eyesight screening instrument, such as hand-held optometry, is used in children's vision screening because of its convenience and no need for children's subjective cooperation. In this study, a group of patients with ametropia use Welchallyn Suresight (SS1) and two generation (SS2) and Topcon optometry, respectively. The refractive error of the retina was measured and the data were analyzed and compared. The repeatability and consistency of the data measured by SS1 and SS2 and the clinical application value of SS1 and SS2 were evaluated. Methods: 51 cases of 102 eyes selected from the research institute were diagnosed as ametropia in the ophthalmology of Guangzhou women and children's medical treatment center. Patients aged 2~16 (10.26 years of age) were excluded from other ocular diseases, eye surgery, and systemic systemic diseases. The patients were examined first in the natural pupil, with the SS1 and SS2 eyesight screening apparatus, the Topcon optometry, and the refraction results. Then the 0.5% Tropicamide Eye Drops pupil was used for 30-45 minutes. Retinometry and refraction were performed. The reproducibility of the refractive data was measured by individual measurements, the intra group correlation coefficient (intraclass correlation coefficient, ICC) and the repetition coefficient were used as an indicator of the accuracy of repeated measurements,.SS1, SS2 and the Topcon computer optometry data, and the retina, and the retina, and the retina. The 95% consistency limit of the contrast, as an indicator of consistency. Results: 1. there was no significant difference in the difference between the three groups of SS1, SS2 and Topcon optometry and the results of pupil examination (P0.05), in the sphere (-5D to +5D), the degree of -10D to +5D, and the axial measurement of the cylindrical mirror, SS1, SS2, and Topcon computers. The difference between the three groups of the optometre and the results of the pupil after the pupil was statistically significant (P0.05).2. repeatability: SS1, SS2 and Topcon computer optometry were more than 0.75 in the sphere mirror degree measurement, with a good repeatability; the SS1 ICC of the column mirror degree measurement was 0.66, and the SS2 and Topcon optometry was 0.88 and 0.99 respectively. SS2 could be repeated, respectively. The sex is better than SS1; the axial aspect of the column mirror SS1 and SS2 ICC are 0.71 and 0.72, respectively, and the repeatability of SS1 and SS2 is improved after removing the column mirror degree less than 0.5D, and the 0.83 and 0.73.3.95% conformance boundaries are respectively: the 95% conformance boundary of the SS1 and retinoscopy is in the sphere (-5D to +5D) degree measurement. Mirror degree measurement is (-1.76,1.75) D, the axial (all data of this group) is measured (-41.66,53.02), and the axial (columnar degree or 0.5D) measurement is (-33.55,32.31) degrees; the 95% consistency limit of SS2 and retinoscopy is (-3.15,1.83) D, and the degree of spherical mirror (-10D to +5D) degrees in the sphere (-5D to +5D) degree measurement. The measurement is (-2.96,2.23) D, the degree measurement of columnar mirror degree is (-1.26,1.27) D, the axial (all data of this group) is measured (-44.69,68.35), the axis of the columnoscope (the degree of columnar degree > 0.5D) is (-38.86,45.50); the 95% consistency limit of the Topcon computer optometry is compared with the retina detection method in the sphere (-5D to +5D) degree measurement In terms of (-2.57,0.94) D, the degree measurement of the sphere mirror (-10D to +5D) is (-3.10,1.25) D, the degree measurement of the columnoscope is (-0.61,0.54) D, the axial (all data) of the columnoscope (-31.92,36.35) degree is (-31.92,36.35), and the axis of the columnoscope (columnoscope degree > 0.5D) is the (-22.97,19.75) degree of the 95% conformance between the.SS1 and the gland. Conclusion: 1.SS1, SS2 in the sphere mirror degree measurement of natural pupil, compared with Topcon computer optometry, the consistency and repeatability are better than that of SS1 and SS2, the measurement result is better than that of the Topcon computer optometry. The consistency and repeatability are better. In the hyperopia measurement side, the measurement result is better. There is no obvious difference between SS2 and SS1; 3. in cylindrical mirror measurement, SS1 and SS2 also have better consistency and repeatability. Although the axial measurement of the column mirror is slightly worse than the Topcon computer optometry, it does not affect the application of the.4. in the group screening. The Welch Allyn Suresight visual sieves are shown in the natural pupil state. The results of the refraction of the instrument are of great significance for a preliminary understanding of the diopter of children, the detection of severe ametropia that may lead to amblyopia and the guidance of the next step of clinical treatment. Objective: This study used a group of ROP patients after the optic retinal laser photocoagulation treatment and a group of preterm infants without ROP and a group of foot months. A dry fault scanner (OCT) was used to measure the retinal thickness and volume of the macular region. The effects of ROP and low birth gestational age on the development of retina in children were analyzed and compared. Methods: 39 cases of 72 eyes selected in the study were divided into three groups (the first group was treated with laser photocoagulation. " The second group of ROP patients with a history of operation were normal preterm infants without ROP, and the third group was the matched foot of the age. Among them, 16 cases of 26 eyes (laser photocoagulation group) after laser photocoagulation (laser photocoagulation group). All the subjects included in the study were the prethreshold 1 type and the threshold period ROP, and the retinal vascular development tended to be normal after the photocoagulation therapy. Patients with disappearance of clinical symptoms. 7 normal preterm infants without high diopter and other fundus lesions (normal preterm infants). 16 cases of 32 eyes (foot Moon Group) matched with age and sex of the patient, 32 eyes (foot month group). Topcon 3D OCT-1000 was used to scan the macular area and the surrounding 6 x 6.0mm region, and the macular area was measured. The thickness and volume of the membrane were recorded. Results: 1. comparison of retinal thickness in the macula area: the laser photocoagulation group was compared with the normal preterm infant group. In the nine areas, the retinal thickness of the laser photocoagulation group was thicker than the normal preterm group (P0.05). The laser photocoagulation group was compared with the foot Moon Group, in the macular fovea region (F The retinal thickness of the laser photocoagulation group was more thicker than that of the foot Moon Group (P0.05). There was no significant difference in retinal thickness between the laser photocoagulation group and the foot Moon Group (P0.05) in the rest of the areas (P0.05). The two groups of retina were in the two groups of retina in the normal preterm group and the foot Moon Group (Fovea). There was no significant difference in thickness (P0.05). In the rest of the areas, the retinal thickness of the normal preterm infants was thinner than that of the full moon group (P0.05). The difference was statistically significant in the retinal volume of.2. macula region: compared with the normal prematurity group, the total volume of the retina in the laser photocoagulation group was larger than that in the normal preterm group, and the difference was statistically significant. Significance (P0.05). In the divided nine regions, the retinal volume of the laser photocoagulation group was larger than that of the normal preterm group (P0.05). There was no significant difference between the laser photocoagulation group and the foot moon group. There was no significant difference in the total volume of retina in the macular region (P0.05). In the macular fovea (Fovea) and the underneath of the macular fovea (I?), laser photocoagulation The retinal volume of the group was larger than that of the full moon group (P0.05). There was no significant difference in the retinal volume between the laser photocoagulation group and the foot Moon Group (P0.05). In the normal preterm infants, the total retinal volume of the macular area in normal preterm infants was smaller than that in the full moon group (P0.05). The difference was statistically significant. There was no significant difference in retinal volume of normal preterm infants (Fovea) in the normal preterm infants (P0.05). In the other areas, the retinal volume of normal preterm infants was smaller than that of the full moon group (P0.05). The difference was statistically significant. Conclusion: 1. normal preterm infants were compared with the foot Moon Group, and the macular fovea in the normal preterm infants group. The thickness of the retina was thicker than that of the full moon group, and the retinal thickness around the central fovea was thinner than that of the foot moon group; the total retinal volume of the macular area in the normal preterm group was smaller than that in the foot Moon Group, and the retinal volume in the macular fovea was larger than that in the full moon group. The volume of the retina in the periphery of the central fovea was more than that of the small.2. laser photocoagulation group and the normal preterm group. In the laser photocoagulation group, the retinal thickness of the macular center and the periphery of the central fovea were all thicker than that of the normal preterm infants. The total volume of the retina in the macular region, the volume of the retina in the macular fovea and the volume of the peripheral retina around the central fovea were greater in the laser photocoagulation group than in the normal prematurity group.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R774.1

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