| 背景• 病程冗长long long history
• 繁杂的病变complicated fundus changes
– 相互交叉、重叠、不断演变 mixed-up, developmental,keep-changing
• 青少年没有典型病理性改变 atypical appearance in children
• 高度近视-6D作为基础 based on -6D diopter
– 在-6～-10D之间仍有10%左右不表现出病理性
There would show no pathologic changes in fundus with -6D to -10D of 10%
目的Purpose
• 探讨高度近视眼中单纯性向病理性近视演变过程的早期特征以及规律性
• To explore the early characteristics and evolution from physiologic to pathologic myopia in high myopia
方法1 Method1
• 观察城区中小学生308人615眼的眼屈光状态中的高度近视构成的演变趋势
• To observe the evolution tendency of high myopia in Xi’an city schoolchildren
方法2 Method2
• 观察354例（眼）的眼底形态：无变化,局灶性 改变,豹纹状改变,病理性改变
• Fundus appearances normal, focal, tessellation, pathologic changes
• 年龄 ～20岁,～40岁,～60岁,＞60岁
• Ages ～20yrs,～40 yrs,～60 yrs, ＞60 yrs
• 近视程度 -6.0D～高度近视,-10.0D～重度近视,-15.0D～超高度近视
• Severity -6.0D～high, -10.0D～severe, -15.0D～ severe high
• 验光,眼底照相,A超眼轴测量,B超
• cycloplegic retinoscopy, fundus photography,A/B ultrasonography
方法3
• 观察76例（眼）20岁及以下高度近视，每5岁分为1个年龄段组(～10岁组，～15岁组，～20岁组) ，以Curtin的病理性近视眼底改变分期分类
• To observe the fundus with 5-year interval according to Curtin’ classification of pathologic myopia
• 验光,眼底照相,A超眼轴测量,B超
• cycloplegic retinoscopy, fundus photography,A/B ultrasonography
• Curtin’的眼底改变描述
• Curtin’ description of fundus
– 按眼底发生的部位、病程的演变顺序，划分和认识与过量膨胀相关
• 1）后极部posterior pole: 豹纹状改变tesellation,后葡萄肿staphyloma,视网膜脉络膜病变choroidoretinopathy
• 2）视盘区optic disc: 鼻侧过度牵引supertraction,弧形斑crescent,视盘倾斜tilting
• 3）黄斑区macular
结果 1 Result1
• 整个中小学12年间
– 高度近视构成呈持续上升的发展趋势
– 并在高小～初中阶段、初中～高中阶段呈现跳跃式上升
• There was continuous increasing trend in high myopia’ constitute during 12-year schoolchildren
– a leap increase
– between senior primary and junior middle school stage
– between junior and senior middle school stage
• 小学阶段
– 初小阶段高度近视的分布在低端的-6D
• 中学阶段
– 初中阶段高度近视的分布进入偏高端的-8.0D
– 初二～高中阶段进入具有病理性意义的-10.0D的重度高度近视范围
• The distribution of high myopia was
– at lower level of -6D in senior primary school
– at a higher level of -8D in junior middle school
– up to -10D in senior middle school that means high risk of pathologic myopia development during their late lifespan
图 中小学不同年级和阶段的高度近视构成（%）
the detective rate of high myopia
图 中小学各年级高度近视分布（眼）
Distribution of high myopia in schoolchildren
结果2 Results2
• 眼底无改变的高度近视集中于20岁以下、-6～D、眼轴＜25mm组、B超无改变；
• there were relatively no fundus (44.8%) changes at the 20-year-old period with 25mm eyeball axis(40.5%) and -6D refraction error
• 20-40岁组、-10D组、25-27mm时豹纹状眼底形成高峰，B超呈均匀扩张状；
• between 20-40-year-old period, tessellation change formed(46.1%) with the axis elongated to 27mm(51.9%), eyeball expanded (58.90%)and the refraction error increased to -10D rapidly
• -15D以上组、40岁以上组混合改变占主要构成，B超葡萄肿改变与A超眼轴＞27mm组与之对应。
• over 40-year-old period, the pathologic change was the mainly portion (70.8% )with over -15D, eyeball enlarged to over 27mm (73.9%)and staphyloma formed(70.20%)
结果3Result3
• 1)10岁以内屈光度-6D，平均眼轴26mm时多预示病理性过程的发生，眼球对眼轴等变化的耐受程度差(1mm )；仅呈豹纹状改变（35.7%）
• 1)They may have developed pathologic fundus change , only showed tesellation &palor, in the kids younger than 10-year-old with 26mm eyeball axis and -6D refraction errorwhich means the younger kids’ eye may not tolerate the axis changes(1mm)
结论1 Conclusion1
• 青春发育期的14～18岁阶段是形成病理性近视的关键
• The key stage was in their adolescent development state between 14 to 18 years old with a pathological significance
结论2 Conclusion2
• 1）高度近视演变早期的观察指标:
– 20 岁青春期、眼球扩张初期的豹纹状眼底改变
– -6 ～-10D, 眼轴25 -27mm,B 超呈均匀扩张状
• The early tessellation change , a sign of eyeball expansion, at the age of 20-year-old of adolescence period , may be a criterion to observe early pathologic myopia evolution
• 2)10～15岁之间眼球快速发育（眼轴27mm ，近视度-7.89D ）, 呈豹纹状改变（33.3%）,与青春身体发育吻合
• 2)Between 10 to 15-year-old, paralleled with their adolescence stage, their axis were elongated to 27mm and the refraction error to -7.89D ，with 50% of tessellation
• 3)～20岁组
• -10D、28mm眼底仅呈现豹纹状改变(50%)
• 3) In～20-year-old group, the average was -9.68D and 27.5mm, the tessellation may be showed with -10D, 28mm
结论3 Conclution3
• 在～20岁以下、眼轴25～28mm，屈光度-9～-10D的豹纹状改变可作为重要的病理前改变标志
• During the age younger than 20-year-old, the early tessellation change may be considered as a sign of the pre-pathologic myopia development with the change of ocular axis 25 to 28mm, refraction error -9 to -10D |
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