【作者】 赵霞；

【导师】 管永清；

【作者基本信息】 河北医科大学 ， 眼科学， 2004， 硕士

【摘要】 目的：眼外伤除引起眼部结构的直接损伤外，尚引起屈光的改变，大部分表现为近视，称之为挫伤性近视。挫伤性近视是眼外伤后视力低下的主要原因之一，国内外许多学者为此进行了大量的研究，但其发病机制仍未完全明了。超声生物显微镜（Ultrasound Biomicroscope ，UBM）具有四大优点：1）无创。能对活体眼进行检查；2）能进行动态观察；3）能进行定量测量；4）能提供横断面、高分辨率的影像。因此本研究利用UBM并结合普通超声波，对钝挫伤眼在急性期和恢复期进行定量测量，并以正常眼为对照进行分析，从而对挫伤性近视的发病机制进行研究。方法: 对31例临床诊断为眼球钝挫伤的患者（除外角膜挫伤、晶体脱位、重度前房积血及玻璃体积血者）36只眼, 在急性期（患者受伤后3天内）和恢复期（受伤后1周）分别用自动验光仪测量屈光度；A超测量晶体厚度；UBM检测角膜厚度、前房轴深、小梁睫状突距离（TCPD）、A角、睫状突的高度（T值）。急性期和恢复期平均间隔12.47±3.65天。同时对36例正常对照组亦进行2次上述测量，间隔15天。每次测量30分钟前，均用复方托品酰胺眼药水散瞳，待瞳孔直径大于等于7.0mm时，进行测量。以上三部分由不同医生完成，每一种检查均由同一人完成。检查时不知另外两种检查结果，记录资料分开保存，最后汇总。所有资料均用SPSS软件包进行配对t检验，参数间的关系选用直线回<WP=4>归分析和相关分析。p<0.05为统计学上有显著差异，p<0.01为统计学上有非常显著差异。结果：1 自动验光仪测量屈光度的结果 眼球受钝挫伤后均表现为近视。眼钝挫伤患者在急性期屈光度平均为-2.34±2.63D，近视度随眼挫伤的好转而下降，至恢复期平均为-0.20±2.48D，差异具有显著性（t=8.184, p<0.05）。2 A超测量晶体厚度的结果 眼钝挫伤患者在急性期晶体厚度平均为4.02±0.41mm，恢复期平均为3.79±0.39mm，差异具有显著性（p<0.05）。3 UBM的测量结果3.1 角膜厚度的变化 眼钝挫伤患者角膜厚度在急性期变厚，平均为0.57±0.21mm，恢复期平均为0.56±0.25mm，无明显变化（p>0.05）。3.2前房轴深的改变 眼钝挫伤患者在急性期前房明显变浅，前房轴深平均为3.27±0.51mm，随着病情的好转，前房逐渐加深，至恢复期平均为3.40±0.39mm。差异具有显著性（p<0.05）。3.3小梁睫状突距离（TCPD）的改变 急性期TCPD缩短，平均为0.94±0.10mm , 恢复期平均为0.99±0.11mm，差异有显著性（p<0.05）。3.4 A角的改变 眼钝挫伤患者在急性期A角较小，平均为87.56±4.33度，随着病情的好转，A角逐渐变大，到恢复期平均为91.28±3.70度。急性期和恢复期A角的差值平均为3.73±2.91度，差异有显著性（p<0.05）。3.5睫状突的高度（T值）的改变 T值在急性期明显增大，平均为1.37±0.33mm，到恢复期平均为1.34±0.22mm。差异<WP=5>有显著性（t=7.73, p<0.05）。而对照组同样前后2次进行上述测量，各参数比较无明显差异（p>0.05）。4参数间的相关性对钝挫伤眼急性期和恢复期屈光度的差值与晶体厚度的差值作直线回归与相关分析，晶体厚度的差值为自变量，屈光度的差值为因变量，直线回归方程为：y=1.5413+2.4128x 相关系数为r=0.3473 (p<0.05)。对钝挫伤眼急性期和恢复期屈光度的差值与前房轴深的差值作直线回归与相关分析，前房轴深的差值为自变量，屈光度的差值为因变量，直线回归方程为：y=1.7727+2.7462x 相关系数为r=0.4375 (p<0.05)。对钝挫伤眼急性期和恢复期屈光度的差值与TCPD的差值作直线回归与相关分析，TCPD的差值为自变量，屈光度的差值为因变量，直线回归方程为：y=0.7209+29.6038x相关系数为r=0.6230 (p<0.05)。对钝挫伤眼急性期和恢复期屈光度的差值与A角的差值作直线回归与相关分析，A角的差值为自变量，屈光度的差值为因变量，直线回归方程为：y=0.7573+0.3520x 相关系数为r=0.6663 (p<0.05)。对钝挫伤眼急性期和恢复期屈光度的差值与T值的差值作直线回归与相关分析，T值的差值为自变量，屈光度的差值为因变量，直线回归方程为：y=0.8619+32.6847x 相关系数为r=0.6091 (p<0.05)。对钝挫伤眼急性期和恢复期前房轴深的差值与TCPD的差值作直线回归与相关分析，TCPD的差值为自变量，前房<WP=6>轴深的差值为因变量，直线回归方程为：y=-0.1298+5.2220x 相关系数为r=0.6899 (p<0.05)。对钝挫伤眼急性期和恢复期前房轴深的差值与A角的差值作直线回归与相关分析，A角的差值为自变量，前房轴深的差值为因变量，直线回归方程为：y=-0.1010+0.0531x 相关系数为r=0.6664 (p<0.05)。对钝挫伤眼急性期和恢复期前房轴深的差值与T值的差值作直线回归与相关分析，T值的差值为自变量，前房轴深的差值为因变量，直线回归方程为：y=-0.0964+5.5342x相关系数为r=0.6474 (p<0.05)。结论1睫状肌痉挛不是引起挫伤性近视的唯一机制。2挫伤性近视具有前房变浅、晶体变厚的形态特点。3挫伤性近视可能的发病机制 眼外伤致睫状血管的通透性增加，睫状体、脉络膜渗漏；睫状体水肿和脉络膜渗漏引起睫状体的增厚，睫状突的前移、前旋；导致虹膜，晶状体的前移。同时，睫状体?更多还原

【Abstract】 Objective: Hit by external force, eye ball would be injured not only structurally, but also functionally, most of which was refractive myopia. This kind of myopia was transient and the pathogenesis was unknown. Ultrasound Biomicroscope (UBM ) had advantages in high resolution and could measure the eye structure quantitatively, which performed in vivo without the limitation . In this study , we used UBM to measure the thickness of cornea, anterior chamber depth, trabecular ciliary process distance (TCPD), A-angle and the height of the ciliary process (T values), in order to investigate the pathogenesis of myopia after blunt eye trauma.Methods: A total of 31 patients, including 36 eyes, were diagnosed clinically as blunt eye trauma. The average interval was 12.47±3.65 days between the acute and convalescent stages. Refraction was measured with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The lens thickness were also measured by A-scan ultrasoundgraphy in the acute and convalescent stages. The cornea thickness、anterior chamber depth、TCPD、A-angle and the T values were examined by UBM in the acute and convalescent stages. At the same time, 36 normal eyes were measured twice as the control <WP=8>group. The average interval was 15 days. Topical mydrin P was applied to eyes 30 minutes before examination. All parameter were performed by paired T-test. We studied the correlationship among the difference of parameters. The significant lever was 0.05.Results1 Autorefractometer were used to measure refractive shift. All 36 eyes were diagnosed as traumatic myopia .The average myopia shift was –2.34±2.63D in the acute stage and –0.20 ±2.48D in the convalescent stage. The difference of the two group was significant (t=8.184, p<0.05). 2 The results were measured by A-scan ultrasonography.The average lens thickness was 4.02±0.41mm in the acute stage and 3.79±0.39mm in the convalescent stage. The difference of the two group was significant (p<0.05), which showed that the lens thickened in the acute stage. 3 The results were measured by UBM.3.1The average cornea thickness of traumatic eyes in the acute stages was 0.57±0.21 mm, while that was 0.56±025mm in the convalescent stages ,and the difference of the two groups was not significant (t=1.88, p>0.05) .3.2. The central anterior chamber depth was shallow after the injury in the acute stage. The average central anterior chamber depth was 3.27±0.51mm in the acute stage and 3.40± 0.39mm in the convalescent stage. The difference of the two group was significant (t=-2.468, p<0.05). <WP=9>3.3 The average TCPD was 0.94±0.10mm in the acute stage and 0.99±0.11mm in the convalescent stage. The difference of the two group was significant ( p<0.05). 3.4 A-angle in traumatic eyes were smaller in the acute stage than that in the convalescent stage. The average A-angle was 87.56±4.33D in the acute stage and 91.28±3.70D in the convalescent stage. The difference of the two group was significant (t=-7.680, p<0.05).3.5 T value in traumatic eyes was larger in the acute stages than that in the convalescent stages. The T value was 1.37± 0.33mm in the acute stage and 1.34±0.22mm ±in the convalescent stage. The difference of the two group was significant (p<0.05). The control group was measure twice in the same way. When parameters were compared, the difference was not significant (p>0.05).4 The correlations among the parameter The differences between lens thickness and refraction were positive correlation, the linear regression equation was y=1.5413+2.4128x and correlation coefficient was 0.3473 (p<0.05). The differences between anterior chamber depth and refraction were positive correlation, the linear regression equation was y=1.7727+2.7462x and correlation coefficient was 0.4375 (p<0.05). The differences between TCPD and refraction were positive <WP=10>correlation, the linear regression equation was y=0.7209+29.6038x and correlation coefficient was 0.6230 (p<0.05). The differences betwe更多还原