CAJ | 학술논문

目的探讨近视眼在不同状态下,调节刺激与调节滞后的变化关系.方法临床病例对照研究.对2011年4～7月在天津眼科医院就诊病人,选取25只正视眼,72只近视眼,并按屈光度数分成低中高三组.注视调节E视标,同时使用开视野红外验光仪,测量不同距离以及不同近用附加状态下双眼的实际调节反应；应用综合验光仪测量近用隐斜度,比较近用隐斜与调节滞后的关系.结果双眼视状态下,高度近视组和正视组在4 D (P =0.049)、5 D(P=0.018)的调节刺激下,调节滞后量差异有统计学意义(P＜0.05),而正视组、低度近视组、中度近视组间的调节滞后量无统计学意义；受试者40 cm处右眼的调节滞后量与40cm处的隐斜量呈线性相关(y=O.0606x+0.9655,r=0.483 P=0.001,P＜0.05)；比较正视眼组和近视眼组在40cm处无附加,+1 D以及-1 D附加的三种情况下的平均调节反应,在-1 D附加时,正视组(-1.74±0.47)与近视组(-2.02±0.35)的调节反应差异有统计学意义(P =0.000).结论在相同调节刺激下,近视眼的调节滞后量大于正视眼,其中高度近视眼表现尤为明显；近用隐斜度数影响近用调节滞后的幅度,外隐斜使调节滞后量相对减少,内隐斜使调节滞后量相对增多；正性近用附加使调节滞后量减小,负性附加使调节滞后量增大,且近视组的滞后量明显大于正视组.
목적 탐토근시안재불동상태하,조절자격여조절체후적변화관계.방법 림상병례대조연구.대2011년4～7월재천진안과의원취진병인,선취25지정시안,72지근시안,병안굴광도수분성저중고삼조.주시조절E시표,동시사용개시야홍외험광의,측량불동거리이급불동근용부가상태하쌍안적실제조절반응；응용종합험광의측량근용은사도,비교근용은사여조절체후적관계.결과 쌍안시상태하,고도근시조화정시조재4 D (P =0.049)、5 D(P=0.018)적조절자격하,조절체후량차이유통계학의의(P＜0.05),이정시조、저도근시조、중도근시조간적조절체후량무통계학의의；수시자40 cm처우안적조절체후량여40cm처적은사량정선성상관(y=O.0606x+0.9655,r=0.483 P=0.001,P＜0.05)； 비교정시안조화근시안조재40cm처무부가,+1 D이급-1 D부가적삼충정황하적평균조절반응,재-1 D부가시,정시조(-1.74±0.47)여근시조(-2.02±0.35)적조절반응차이유통계학의의(P =0.000).결론 재상동조절자격하,근시안적조절체후량대우정시안,기중고도근시안표현우위명현；근용은사도수영향근용조절체후적폭도,외은사사조절체후량상대감소,내은사사조절체후량상대증다；정성근용부가사조절체후량감소,부성부가사조절체후량증대,차근시조적체후량명현대우정시조.
Objective To discuss the relation between accommodation and lag in different condition and in different refractive group. Methods Twenty-five emmetropia and 72 myopia were recruited.The myopic group was divided into three groups according to the different refractive number.Using open field infrared refractometer,accommodative response was objectively measured while they were binocularly viewing accommodation E target at different measuring distance and different near adds through fully correcting glasses; meanwhile,using the integrated refractometer measure near phoria so that we can compare the relation between near phoria and accommodation lag. Results High myopia showed higher lag through their spectacle corrections compared to emmetropes,but the lag had no difference in other groups; the number of phoria in 40cm had a linear related with accommodation lag,y=0.0606x+0.9655,r =0.483 (P =0.001),which had a statistically significant differences;With -1D near adds,the lag of accommodation in emmetropia (-1.74±0.47) had a statistically significant differences with it in myopia (-2.02±0.35) (P =0.000). Conclusions In the same accommodation stimulation,accommodation lag of stability myopia is greater than emmetropia,especially in high myopia group; myopic subjects with near-point exophoria tend to show smaller lags of accommodation,exophoria can reduce the lag relatively,esophoria can increase the relative amount; +1D near adds make the amount of accommodation lag decrease and -1D near adds make it increase,most importantly the lag of myopia is significantly greater than emmetropia.