Objective To observe the fundus appearances and their evolution trends with their biological parameters in the high myopia eye in Chinese of 41 to 60 years old. Methods People aged among 41 to 60 years old with refrac-tion error over -6 D and the eyeball axis measured over 25 mm were included. They were divided into 4 subgroups: ～ 45year-old, ～50 year-old, ～55 year-old, and ～ 60 year-old. Based on the fundus appearances taken by the KOWA fundus camera and Heidelherg HRA2 fluorecein /indocraine angiophotography, 154 patients were divided into 4 groups : the negative group, the groups with focal lesions, tessellation, and pathologic myopia. At the meantime, myopia was examed with cycloplegic objective refraction by NIKON SPEEDY-K automatic optometry. Retinoscopy, ocular axis and shape of eye ball were measured and recorded hy BVI A/B-scan, and intraocular pressures were measured by auto-applanation tonometry of Topcon CT60. The data were analyzed statistically by SPSS10. 0. Results ( 1 )There were 45. 5％ cases with the non-path-ologic appearances in 154 cases with high myopia, including 33. 8％ with tessellation changes and 11. 7％ with normal appearance ( which was lower than 36. 8％ of ～ 20 years group, and 25％ of ～ 40 years group as in our previous reports ). The diffused pathologic myopias were in 46. 8％ , which were higher than the teenagers, 15. 8％ and the ～ 40 year group' 28. 5％ . The focal lesions were 7. 8％ .( 2 )The average refraction error was - 10. 0 D and the axis was 27 mm in group under 45 -year-old, while in the other 3 older subgroups, The average refraction error was -11. 5 D and the axis was 28 mm ,respectively. 3、1 )Among 4 subgroups, the eyes may appear no change with -7 D and 27 mm axis as the same as the in ～20 year group and ～40 year group in previous reports. 2 )Changes of fundus appearance were various. The eyes with ～14. 0 D/28 mm may show tessellation change only but may appear pathologic changes when ocular axis over 28 mm, as the same as in the ～40 year group. 3 ) The pathologic change appeared mainly in the eyes with - 11. 0 D and 28 ～ 29 mm. 4、 The mean intraocular pressure was 17 mm Hg, which was higher than the younger ones considering the ocular axis and eyeball expansion. Conclusions There were relationships between the fundus appearances of the high myopia and the ages,eyeball axis, and refraction errors in young people aged 41 ～ 60 years: ( 1 )The fundus may keep worsen in high myopic eyes after 40 years old, coinciding with aging and myopic choroidoretinal degeneration; we should consider the myopic degeneration , besides the aging. ( 2 )The eyes may tolerate the longer axis and higher refraction error with tessellation change,which means the tessellation change may be considered as pre-pathologic changes. The control of tessellation change may influence the progression of disease.( 3 )The control of intraocular pressure below the average 16 mm Hg with 1 to 2 stand ard error according to the real thickness of eyeball wall with its expansion may be a target aim.%目的 观察国人进入中年的高度近视眼的自然演变病程,即41～60岁年龄组屈光度、眼轴、眼压、眼球形态下的眼底改变演化趋势.方法 入选包括:41～60岁、屈光度≥-6 D、眼轴≥25 mm.并将年龄分为4组:～45岁组,～50岁组,～55岁组,～60岁组.对门诊查体和就诊人群154例(154只眼)进行眼底照相、A/B超、验光、眼压等相关眼科检查,记录并归纳整理.SPSS10.0统计.根据检眼镜、KOWA眼底照相、Heidelberg HRA2激光扫描眼底荧光造影系统进行荧光/吲哚青绿眼底血管造影检查,将眼底形态分为4组:无变化、黄斑局限病灶、豹纹状眼底、后极广泛病灶或混合(即病理性近视).BVI A/B超仪测量眼轴,并将眼球形态分为无变化、均匀扩张、后巩膜葡萄肿3组.复方托比卡胺散瞳,主观检影验光测定眼屈光度.使用Topcon CT60自动眼压计测量眼压.结果 (1)154例(154只眼)中,非病理性改变占45.5%,其中豹纹状改变者33.8%,无眼底变化者11.7%(前期报告中,～20岁以下组的占36.8%,～40岁以下组占25%);病理性改变明显升高达46.8%(前期研究中,～20岁以下组15.8%,～40岁以下组28.5%).黄斑局限病灶占7.8%.(2)～45岁组平均近视度--10D,平均眼轴27 mm.～50岁组、～55岁组、～60岁组平均近视度-11.5 D,平均眼轴28 mm.(3)1)与前期～20岁组、～40岁组相同,41～60年龄段稳定在-7 D、眼轴27 mm以内眼底可以无改变;2)眼底变化呈多样性,即-14 D、28 mm的眼底仅呈现豹纹状改变,但眼轴28 mm可呈病理性改变,这与前期的～40岁组的变化相同;3)病理性眼底改变基本分布在11 D左右,但眼轴多在27~29 mm.(4)平均眼压17 mm Hg,与前期～20岁组、～40岁组阶段相比,并综合考虑眼轴和球壁变化,呈相对的较高状态.结论 41～60年龄段的高度近视眼形态变化与年龄、度数有着内在的规律.(1)是发生病理性近视改变的关键年龄段;(2)41～60岁的中年人高度近视眼眼底形态变化呈持续进展趋势,可能与机体衰老过程叠加,或受其他参数或中老年高发病的影响,提示临床对此组人群将高度近视眼的自然衰老与机体的自然衰老综合认识的必要性.(3)非病理性眼底改变(豹纹状眼底)可以耐受较高的近视屈光度数和较长的眼轴变化,故豹纹状改变应作为重要的病理前改变标志,控制豹纹状改变的不同阶段,可能阻止进入中老年龄段后病理性改变的演变和发生.(4)应采用校正眼压以排除球壁的影响,各个阶段控制眼压在正常平均值以下1至2个标准差可能是安全控制眼底豹纹状改变向病理性改变转移的指标.
展开▼
