摘要背景 近视的进展与眼轴扩张引起的生物力学改变有关,近视患者眼底和巩膜的伸长性改变使眼球壁的厚度和弹性模量减小,从而更易受到眼压的影响. 目的 对不同程度近视儿童屈光度、眼轴长度(AL)和眼压(IOP)进行分析,探讨IOP在儿童屈光状态和AL变化中的作用.方法 采用前瞻性病例对照研究设计,纳入2014年2-12月于郑州大学第二附属医院眼科就诊的不同屈光状态儿童428例428眼,年龄4 ～14岁,根据扩瞳验光后测得屈光状态分为4个组,远视及正视组患者93例93眼,等效球镜度(SE)为(1.81±2.32)D;低度近视组192例192眼,屈光度为(-1.43±0.74)D;中度近视组83例83眼,屈光度为(-4.09±0.89)D;高度近视组60例60眼,屈光度为(-8.02±2.61)D.每个受检眼采用IOL Master测量AL;采用iCare回弹式眼压计测量受检验IOP,并采用OCT测量中央角膜厚度(CCT),根据IOP校正=IOPCAT+(544-CCT)/37.03的公式获得IOP校正.将测量结果进行组间比较,并分析IOP校正与不同程度屈光度和AL的关系.结果 远视及正视组、低度近视组、中度近视组和高度近视组患者AL分别为(22.44±1.32)、(23.89±1.09)、(25.05±0.89)和(26.47±1.20)mm,组间总体比较差异有统计学意义(F=177.336,P=0.000).远视及正视组、低度近视组、中度近视组和高度近视组患者IOP校正分别为(15.24±2.73)、(17.51±2.98)、(17.94±2.34)和(18.49±2.90)mmHg(1 mmHg =0.133 kPa),总体比较差异有统计学意义(F=22.104,P=0.000),其中低度、中度、高度近视组IOP校正均明显高于远视及正视组,差异均有统计学意义(均P＜0.05),高度近视组IOP校正明显高于低度近视组,差异有统计学意义(P=0.018).受检眼IOP校正与屈光度呈负相关(r=-0.384,P＜0.01),而与AL呈正相关(r=0.377,P＜0.01).结论 儿童屈光不正患者IOP校正值随着近视程度的增加和AL的增长而增加,发育期儿童眼压偏高可能促进近视进展和眼轴增长.

abstractsBackground The development and progression of myopic eyes is biomechanical and dominated by axial elongation.The biomechanics change of stretching of the fundus and sclera appears to reduce its thickness and elastic modulus,which make eyeballs more susceptible to the distending forces of intraocular pressure (IOP).Objective This study was to analyz the axial length (AL) and IOP changes in different degree of myopia and investigate the roles of IOP in myopia development and AL elongation.Methods A prospective cases-controlled study was performed under the informed consent of patients and custodian.Four hundred and twenty-eight eyes of 428 children aged 4-14 years were enrolled in Affilicated Second Hospital of Zhengzhou University from February to December 2014.The patients were divided into 4 groups based on the refractive status.Ninety-three eyes of 93 patients were in the hyperopic-emmetropia group with the spherical equivalent (SE) of (1.81±2.32) D,192 eyes of 192 patients were in mild myopia group with the SE of (-1.43±0.74)D,83 eyes of 83 patients were in the moderate myopia group with the SE of (-4.09±0.89) D and 60 eyes of 60 patients were in the high myopia group with the SE of (-8.02±2.61) D.AL was measured by IOL Master system,IOP was measured by iCare tomnometer,and the central corneal thickness (CCT) was measured by OCT.The corrected IOP was calculated based on IOPcorrection =IOPGAT+(544-CCT)/37.03.The correlations between IOP ion and AL or diopter were analyzed.Results The AL values were (22.44±1.32) mm,(23.89±1.09) mm,(25.05±0.89) mm and (26.47±1.20) mm in the hyperopic-emmetropia group,mild myopia group,moderate myopia group and the high myopia group,showing a significant difference among the four groups (F =177.336,P =0.000).The IOP ion values were (15.24 ±2.73) mmHg,(17.51 ±2.98) mmHg,(17.94 ±2.34) mmHg and (18.49 ± 2.90) mmHg in the hyperopic-emmetropia group,mild myopia group,moderate myopia group and the high myopia group,with a significant difference among the four groups (F =22.104,P =0.000).The IOP tion values were significantly lower in the hyperopic-emmetropia group than that in the mild myopia group,moderate myopia group and high myopia group (all at P＜0.05),and the mean IOP tion value in the high myopia group was significantly higher than that in the mild myopia group (P =0.018).The IOP tion was negatively correlated with diopter (r =-0.384,P＜0.01) and positively correlated with AL (r =0.377,P＜0.01).Conclusions As the increase of myopic diopter and elongation of AL,IOPcorrection is considerably elevated in childhood.IOP tion rising in childhood probably promotes the progression of myopia and elongation of AL.