CAJ | 학술논문

目的探讨集合与调节比率(AC/A)与合并屈光不正的间歇性外斜视发生的关系.方法临床回顾性研究.观察和分析135例2008至2010年在天津市眼科医院就诊的间歇性外斜视患者,根据检影屈光性质将患者分为3组,单纯间歇性外斜视组(屈光度数为-0.50～ +3.00 D的3～6岁患者及屈光度数为-0.50～ +2.00的7～ 40岁患者)、间歇性外斜视合并近视组(-0.50 ～7.75 D)及间歇性外斜视合并远视组(≥+3.00D的3～6岁患者及≥+2.00 D的7～40岁患者).同视机法测定AC/A,三棱镜中和法测定视远(5 m)和视近(33 cm)斜视度数,比较各组AC/A、视近斜视度及视远斜视度,分析AC/A与屈光度及年龄的相关性.组间数据比较采用方差分析,近视与远视斜视度数的比较采用配对t检验,相关性分析采用线性回归法.结果单纯间歇性外斜视、间歇性外斜视合并近视及间歇性外斜视合并远视三组患者AC/A比较,差异有统计学意义(2.686±1.372、1.773±1.110、4.581±1.552;F=36.323,P＜0.01);视远斜视度数比较,差异无统计学意义(40.333Δ±19.474Δ、44.052Δ±23.722Δ、35.590Δ±11.143Δ;F=1.444,P=0.24);视近斜视度数比较,差异有统计学意义(44.473Δ±19.008Δ、53.621Δ±20.749Δ、34.455Δ±13.292Δ;F=8.762,P＜0.01).合并近视和合并远视的两组间歇性外斜视患者,AC/A与屈光度数呈负相关(分别为r=0.320,P=-0.469;r=-0.046,P=0.036).无屈光不正的间歇性外斜视患者,AC/A随年龄的增加而下降(r=-0.320,P=0.019);在合并近视组及合并近视组,未发现AC/A与年龄存在相关性(r=-0.023,P=0.865;r =0.246,P=0.296).结论远视性和近视性屈光不正合并异常高或低的AC/A可能破坏了眼外肌的平衡,易导致外斜视的发生.
목적 탐토집합여조절비솔(AC/A)여합병굴광불정적간헐성외사시발생적관계.방법 림상회고성연구.관찰화분석135례2008지2010년재천진시안과의원취진적간헐성외사시환자,근거검영굴광성질장환자분위3조,단순간헐성외사시조(굴광도수위-0.50～ +3.00 D적3～6세환자급굴광도수위-0.50～ +2.00적7～ 40세환자)、간헐성외사시합병근시조(-0.50 ～7.75 D)급간헐성외사시합병원시조(≥+3.00D적3～6세환자급≥+2.00 D적7～40세환자).동시궤법측정AC/A,삼릉경중화법측정시원(5 m)화시근(33 cm)사시도수,비교각조AC/A、시근사시도급시원사시도,분석AC/A여굴광도급년령적상관성.조간수거비교채용방차분석,근시여원시사시도수적비교채용배대t검험,상관성분석채용선성회귀법.결과 단순간헐성외사시、간헐성외사시합병근시급간헐성외사시합병원시삼조환자AC/A비교,차이유통계학의의(2.686±1.372、1.773±1.110、4.581±1.552;F=36.323,P＜0.01);시원사시도수비교,차이무통계학의의(40.333Δ±19.474Δ、44.052Δ±23.722Δ、35.590Δ±11.143Δ;F=1.444,P=0.24);시근사시도수비교,차이유통계학의의(44.473Δ±19.008Δ、53.621Δ±20.749Δ、34.455Δ±13.292Δ;F=8.762,P＜0.01).합병근시화합병원시적량조간헐성외사시환자,AC/A여굴광도수정부상관(분별위r=0.320,P=-0.469;r=-0.046,P=0.036).무굴광불정적간헐성외사시환자,AC/A수년령적증가이하강(r=-0.320,P=0.019);재합병근시조급합병근시조,미발현AC/A여년령존재상관성(r=-0.023,P=0.865;r =0.246,P=0.296).결론 원시성화근시성굴광불정합병이상고혹저적AC/A가능파배료안외기적평형,역도치외사시적발생.
Objective To investigate AC/A ratio and coexisting ametropia in intermittent exotropia.To discuss the relation between AC/A ratio and the development of intermittent exotropia.Methods The medical records of 135 patients who had an exotropia were retrospectively reviewed.Patients were divided into 3 groups based on the type of ametropia:exotropia without ametropia(-0.50-+ 3.00 D between the age of 3-6 years old,-0.50-+ 2.00 D between the age of 7-40 years old),exotropia coexisting with myopia (-0.50-7.75 D)and exotropia coexisting with hypermetropia(≥ + 3.00 D of 3-6 years old,≥ + 2.00 D of 7 ～40 years old).AC/A ratios of all patients were assessed using synoptophore method.Distance and near deviations were assessed using prism cover test.AC/A ratios and deviation angles of 3 groups were compared.The relationship between AC/A ratios and ametropia/age were investigated.Results There were obvious differences in AC/A ratios (2.686 ± 1.372,1.773 ± 1.110,4.581 ± 1.552,F =36.323,P ＜ 0.001) and in near deviation angles (44.473Δ ± 19.008Δ,53.621Δ ± 20.749Δ,34.455Δ ± 13.292Δ,F =8.762,P =＜0.001) between 3 groups of patients,no obvious differences were seen in distance deviation angles(40.333Δ ± 19.474Δ,44.052Δ ± 23.722Δ,35.590Δ ± 11.143Δ,F =1.444,P =0.24).AC/A ratios were negative linear correlated with refractive powers for patients of intermittent extropia coexisting with myopia or with hypermetropia(r =0.320,P =-0.469 and r =-0.046,P =0.036,respectively).A trend of decline with age was found for AC/A ratios only in patients of intermittent extropia without ametropia(r =-0.320,P =0.019 ; r =-0.023,P =0.865 ; r =0.246,P =0.296 for the other 2 groups,respectively).Conclusions Myopia and hypermetropia,when coexisting with abnormally low or high AC/A ratio,can destroy the balance between extraocular muscles and induce exophoria to be manifest.