【作者】 王一凡；

【导师】 任胜卫；

【作者基本信息】 郑州大学 ， 眼科学， 2025， 硕士

【摘要】 背景圆锥角膜是以角膜扩张、中央或旁中央角膜基质变薄、向前呈锥形突起及高度近视伴有不规则散光为特征的致盲性角膜病变。圆锥角膜常于青春期发病,疾病呈进行性发展,其病因目前尚不明确,既往研究发现揉眼与圆锥角膜的发生具有密切的相关性。多项病例报告报道了圆锥角膜患者在长期揉眼后发生了进展,而在停止揉眼后病情大多保持稳定。但关于儿童和青少年圆锥角膜患者随访期间干预揉眼成功与失败的疾病进展率的差异研究尚未见报道。目的探讨儿童和青少年圆锥角膜患者干预揉眼后圆锥角膜的进展情况。方法通过采用前瞻性队列研究,纳入中国圆锥角膜(Chinese keratoconus,CKC)专病队列中初诊有揉眼史的69例儿童和青少年圆锥角膜患者,告知初诊患者疾病的特征、揉眼的危害以及禁止揉眼,并针对揉眼原因给予对症处理。通过评估随访期间有无揉眼行为,将患者分为干预成功组及干预失败组。比较基线及末次随访的检查结果,评估随访期间圆锥角膜是否发生进展,通过卡方检验比较干预成功组和干预失败组的组间进展率有无差异。使用单因素及多因素logistic回归、Cox回归分析干预揉眼对圆锥角膜进展的影响,评估干预揉眼行为与进展的相关性。结果本研究纳入儿童和青少年圆锥角膜患者69例69眼。干预成功组53眼,年龄 18.00(15.00,18.00)岁,随访时间 16.00(12.00,28.00)月;干预失败组16 眼,年龄 15.00(13.04,18.00)岁,随访时间 10.50(6.00,52.25)月。两组性别、年龄、疾病严重程度等均无明显统计学差异(P>0.05)。采用1年内角膜前表面最大曲率值(Maximal keratometry,Kmax)增加≥1D评估进展情况,干预成功组的53眼中有10眼发生进展,进展率为18.87%;干预失败组的16眼中有11眼发生进展,进展率为68.75%,两组间进展率有统计学差异(P<0.001)。单因素及多因素logistic回归分析提示随访期间有效的干预揉眼与进展具有负相关性(P<0.05)。单因素及多因素Cox回归分析发现,成功干预揉眼行为能够延缓或控制疾病的进展(P<0.05)。结论本研究探讨了儿童和青少年干预揉眼行为与圆锥角膜进展的相关性。结果提示儿童和青少年圆锥角膜患者可以通过干预揉眼行为延缓或控制疾病进展,避免病情的发展、视力的进一步损害,为圆锥角膜的个性化防治提供参考。更多还原

【Abstract】 BackgroundKeratoconus is a blinding potential corneal disease characterized by corneal ectasia,central or paracentral corneal stromal thinning,conical protrusion,and high myopia with irregular astigmatism.Keratoconus often occurs in adolescence,and the disease is progressive.The etiology of keratoconus is still unclear,previous studies have found that eye-rubbing is closely related to the occurrence of keratoconus.Several case reports have reported progression of keratoconus after prolonged eyerubbing,while patients mostly remained stable after stopping eye-rubbing.However,there is no report on the difference in disease progression rate between intervention eye-rubbing success and failure in children and adolescent keratoconus during followup.ObjectiveTo investigate the progression of keratoconus after intervention eye-rubbing in children and adolescents with keratoconus.MethodA total of 69 children and adolescent keratoconus who had a history of eyerubbing from the Chinese keratoconus(CKC)cohort study was included in this prospective cohort study.The patients were informed of the characteristics of the disease and the harm of eye-rubbing,informed to stop eye-rubbing,and given symptomatic treatment for the causes of eye-rubbing.Patients were divided into intervention success group and intervention failure group by assessing the presence of eye-rubbing behavior during the follow-up.The examine results at baseline and the last follow-up were compared to evaluate the progression of keratoconus during the follow-up period.The chi-square test was used to compare the progression rate between the intervention success group and intervention failure group.Univariate and multivariate logistic regression analysis and Cox regression analysis were used to analyze the factors affecting the disease progression,and to evaluation the correlation between intervention eye-rubbing behavior and the disease progression.ResultsThis study included 69 eyes of children and adolescents with keratoconus.53 eyes were included in the intervention success group,with a mean age of 18.00(15.00,18.00)years and a mean follow-up time of 16.00(12.00,28.00)months;16 eyes were included in the intervention failure group,with a mean age of 15.00(13.04,18.00)years and a mean follow-up time of 10.50(6.00,52.25)months.There were no significant differences in gender,age and disease severity between the two groups(P>0.05).The progression was considered as maximal keratometry(Kmax)change value greater than or equal to 1D within 1 year,10 of 53 eyes have progressed in the intervention success group,the progression rate was 18.87%;11 of 16 eyes have progressed in the intervention failure group,the progression rate was 68.75%,the difference in progression rate was statistically significant(P<0.001).Univariate and multivariate logistic regression analysis showed that the effective intervention of eyerubbing during the follow-up period was negatively correlated with the progression of the disease(P<0.05).In the univariate and multivariate Cox regression analysis,the successful intervention could delay or control the progression(P<0.05).ConclusionThis study investigated the correlation between intervention eye-rubbing behavior and progression in children and adolescent keratoconus.Results suggest that the progression in children and adolescent keratoconus can be delayed or ceased by intervening eye-rubbing,in order to avoid the development of the disease and further damaged vision,providing a reference for the personalized prevention and treatment for keratoconus.更多还原