【摘要】：目的分析先天性白內(nèi)障形覺剝奪患者臨床資料探討其眼球發(fā)育特點(diǎn)。方法回顧性系列病例研究。收集2009年03月-2015年7月在山東省眼科研究所暨青島眼科醫(yī)院診斷為先天性白內(nèi)障并入院接受治療的264例(432眼)患者的臨床資料,年齡2個(gè)月-28歲(平均4.21±4.36歲)。其中:男124人,女140人;單眼患者96人,雙眼患者168人。根據(jù)眼球發(fā)育規(guī)律將以6個(gè)月、1歲、3歲、5歲、14歲為界劃分為6個(gè)年齡段。(一)分析單眼先天性白內(nèi)障形覺剝奪患者眼球發(fā)育情況:對(duì)符合條件的90例單眼患者分析,不同年齡段人數(shù)分布為:(6個(gè)月以下)組11例,(6個(gè)月及以上~1歲)組6例,(1歲及以上~3歲)組20例,(3歲及以上~5歲)組20例,(5歲以上~14歲)組33例。注:14歲以上的樣本數(shù)較少這里不做分析。(1)采用配對(duì)t檢驗(yàn)分別比較5個(gè)年齡段患者的患眼與健眼眼軸長(zhǎng)度的差異。(2)根據(jù)患眼和健眼眼軸相對(duì)長(zhǎng)度,將患者分為短眼軸患者(40例)和長(zhǎng)眼軸患者(50例),分析隨剝奪時(shí)間的延長(zhǎng),長(zhǎng)眼軸組、短眼軸組在相應(yīng)年齡段中所占比例的變化情況情況,并用相關(guān)性檢驗(yàn)分析患健眼眼軸長(zhǎng)度差值與形覺剝奪時(shí)間的關(guān)系。(3)根據(jù)形覺剝奪程度將患者分為全混型(完全形覺剝奪)(24例)及非全混型(非完全形覺剝奪)(66例)兩組,以多元回歸分析性別、眼球震顫、斜視、形覺剝奪時(shí)間、形覺剝奪程度對(duì)患健眼眼軸長(zhǎng)度差值的影響。(4)采用配對(duì)t檢驗(yàn)分別比較5個(gè)年齡段患者的患眼與健眼角膜曲率的差異。(二)統(tǒng)計(jì)雙眼先天性白內(nèi)障形覺剝奪患者的眼軸和角膜曲率發(fā)育情況。(三)統(tǒng)計(jì)先天性白內(nèi)障患者晶狀體混濁類型、眼球震顫、斜視、角膜直徑等情況臨床資料。結(jié)果(一)對(duì)單眼先天性白內(nèi)障形覺剝奪患者的眼軸發(fā)育分析(1)(6個(gè)月以下)組中患眼眼軸比對(duì)側(cè)健眼眼軸短(t=-4.80,P0.01);(5歲以上~14歲)患眼眼軸比對(duì)側(cè)健眼眼軸長(zhǎng)(t=2.54,P0.05);(6個(gè)月及以上~5歲)3組患者患健眼眼軸長(zhǎng)度差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.36、0.30、1.43,P0.05)。(2)形覺剝奪時(shí)間與患健眼眼軸長(zhǎng)度差值呈正相關(guān)(r=0.294,P0.01)。(3)隨年齡增長(zhǎng),長(zhǎng)眼軸患者在相應(yīng)年齡段中所占比例逐漸增加,短眼軸患者在相應(yīng)年齡段中所占比例逐漸減少。多元回歸分析顯示患健眼眼軸長(zhǎng)度差值隨著形覺剝奪時(shí)間的延長(zhǎng)而增大(r=0.142,P0.05),完全形覺剝奪對(duì)患健眼眼軸差值影響顯著高于非完全形覺剝奪(r=0.819,P0.01),而性別、眼球震顫、斜視對(duì)患健眼眼軸差值無(wú)影響(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個(gè)年齡段中患健眼角膜曲率差異均沒有統(tǒng)計(jì)學(xué)意義(t=1.39、1.31、1.76、0.90、0.80,p0.05)。(二)雙眼先天性白內(nèi)障形覺剝奪患者的眼軸及角膜曲率發(fā)育情況。(6個(gè)月以下)、(6個(gè)月及以上~1歲)、(1歲及以上~3歲)、(3歲及以上~5歲)、(5歲以上~14歲)5個(gè)年齡段眼軸長(zhǎng)度平均值分別為17.97±1.42mm、20.10±1.48mm、21.93±1.47mm、22.12±2.35mm、23.66±1.72mm。(三)先天性白內(nèi)障患者晶狀體混濁類型、眼球震顫、斜視等情況。(1)晶狀體混濁類型:432眼中,囊膜性白內(nèi)障26眼(6.02%);極性白內(nèi)障17眼(3.94%);縫合性白內(nèi)障30眼(6.94%);胚胎核性白內(nèi)障8眼(1.85%);核性白內(nèi)障30眼(6.95%);繞核性白內(nèi)障70眼(16.20%);全白內(nèi)障125眼(28.94%);發(fā)育性白內(nèi)障30眼(6.95%);合并兩種以上混濁96眼(22.22%)。(2)眼球震顫:264例患者中震顫患者53例(20.08%),其中雙眼患者41人(在雙眼患者中占24.05%);單眼患者12人(在雙眼患者中占12.50%)(3)斜視:264例患者中斜視患者占49例(18.56%),其中雙眼患者23人(在雙眼患者中占13.69%);單眼患者26人(在單眼患者中占27.08%)結(jié)論(1)先天性白內(nèi)障形覺剝奪早期患眼軸比健眼眼軸短;后期形覺剝奪造成患眼眼軸比健眼眼軸長(zhǎng);(2)形覺剝奪程度、形覺剝奪時(shí)間對(duì)眼軸發(fā)育影響明顯;(3)先天性白內(nèi)障育形覺剝奪對(duì)患者角膜發(fā)育無(wú)明顯影響。
[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.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R776.1

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