Clinical Studies on the Changes of Intraocular Pressure and Keratometry before and after Pupil Dilation in Children and Teenagers
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摘要:
目的 探讨儿童青少年散瞳前后眼压及角膜曲率的变化情况。 方法 前瞻性研究。选取2015年12月至2019年1月至就诊于昆明市儿童医院眼科的儿童青少年487 例（974眼），女性248例，男性239例，年龄4～17岁（9.92±2.47岁）、屈光度为 （+3.50～-10.00）D 。在散瞳前后分别用非接触式眼压仪测量眼压、用电脑验光仪（TOPCON KR-8900）及角膜地形图测量角膜曲率，t 检验分析散瞳前后眼压及角膜曲率变化情况、眼压差变化在不同眼别和性别间的差异，采用 Pearson 相关分析眼压差与等效球镜度（spherical equivalent，SE）、年龄的相关性。 结果 （1）右眼散瞳前后眼压分别为（17.02±2.27）mmHg、（16.86±2.86）mmHg，左眼散瞳前后眼压分别为（17.19±2.30）mmHg、（16.90±2.81）mmHg，双眼散瞳前后眼压差异无统计学意义（P > 0.05）；（2）散瞳前后眼压差（ΔIOP）在性别、眼别差异无统计学意（ P > 0.05）；（3）ΔIOP与等效球镜SE（ r = 0.001，P = 0.981）、年龄（r = 0.037，P = 0.561）无明显相关性（P > 0.05）；（4）同一种仪器所测量的角膜曲率在散瞳前后K f及KS差异均无统计学意义（P > 0.05）。（5）不同仪器所测量的角膜曲率在散瞳前右眼K f电脑验光仪与角膜地形图差异无统计学意义（P > 0.05）；K s角膜地形图高于电脑验光，差异有统计学意义（P < 0.05）。左眼K f角膜地形图略高于电脑验光，差异有统计学意义；Ks角膜地形图与电脑验光差异无统计学意义（P > 0.05）；（6）散瞳后角膜地形图所测角膜曲率双眼K f及Ks均高于电脑验光仪所测角膜曲率，差异有统计学意义（P < 0.05）。 结论 （1）双眼眼压在散瞳前后无明显差异，散瞳前后的眼压差无性别、眼别差异，与年龄及SE无明显相关性；（2）散瞳前后同一种仪器所测角膜曲率无明显差异。散瞳后双眼角膜地形图所测角膜曲率高于电脑验光。 Abstract:Objective To investigate the changes of intraocular pressure and keratometry before and after pupil dilation in children and teenagers. Methods This prospective clinical study included 487 （974 normal eyes） children and teenagers, mean age of （9.92±2.47） years range 4-17 years and refractive diopter range +3.50 - -10D） from the Department of Ophthalmology, Kunming Children’s Hospital from December 2015 to January 2019. The intraocular pressure （IOP） was measured by non-contact tonometer and keratometry was measured by computer optometry instrument and corneal topography. Data were analyzed using pearson correlation analysis and t test. Results （1） The IOP before and after the pupil dilation were 17.02±2.27 mmHg、16.86±2.86 mmHg in the right eye, and 17.19±2.30 mmHg and 16.90±2.81 mmHg in the left eye. There was no significant difference in IOP before and after the pupil dilation in both eyes （P > 0.05）; （2） There was no statistically significant difference between either right and left eyes or males and females （ P > 0.05） in ΔIOP. （3） There was no significant correlation between ΔIOP and SE and age. （4） There was no significant difference in K f and KS of keratometry measured by the same instrument before and after the dilation （P > 0.05） . （5） There was no significant difference in keratometry measured by different instruments between computer optometer and corneal topography before the dilation of the right eyes in K f （P > 0.05） ; corneal topography was higher than computer optometry, the difference was statistically significant （ P < 0.05） in K S. The Kf corneal topography of the left eye was slightly higher than that of computer optometry, and the difference was statistically significant （P < 0.05）; there was no significant difference between Ks corneal topography and computer optometry （ P > 0.05） . （6） There was statistically significant difference （ P < 0.05） in keratometry after the pupil dilation between corneal topographic map computer optometer. Conclusion There is no significant change in IOP and keratometry after the pupil dilation in children and teenagers. -
Key words:
- Children and teenagers /
- Pupil dilation /
- Intraocular pressure /
- Keratometry
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表 1 散瞳前后眼压（IOP）变化比较（mmHg）
Table 1. Comparison of intraocular pressure （IOP） before and after pupil dilation （mmHg）
眼别 散瞳前 散瞳后 t P 右眼 17.02 ± 2.27 16.86 ± 2.86 0.954 0.340 左眼 17.19 ± 2.30 16.90 ± 2.81 1.797 0.073 
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表 2 散瞳前后眼压差ΔIOP（mmHg）
Table 2. Comparison of ΔIOP before and after pupil dilation （mmHg）
眼别 女性（n = 248） 男性（n = 239） t P 右眼ΔIOP 0.27 ± 2.06 0.29 ± 2.42 1.185 0.237 左眼ΔIOP 0.38 ± 2.06 0.21 ± 2.54 0.850 0.396
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表 3 眼压差ΔIOP与SE、年龄相关性分析
Table 3. Correlation analysis of ΔIOP with SE and age
眼别 r P 右眼 ΔIOP &年龄 0.037 0.561 右眼ΔIOP & SE 0.001 0.981 左眼ΔIOP & 年龄 −0.003 0.957 左眼ΔIOP & SE −0.012 0.799
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表 4 散瞳前后角膜曲率（K）的变化（D）
Table 4. Comparison of keratometry before and after pupil dilation （Diopters）
眼别 散瞳前 散瞳后 t P OD CO Kf 42.61 ± 1.41 42.61 ± 1.39 0.037 0.971 OD CO Ks 43.78 ± 1.58 43.85 ± 1.57 −0.625 0.515 OD CT Kf 42.78 ± 1.40 42.80 ± 1.47 −1.930 0.847 OD CT Ks 44.15 ± 1.56 44.13 ± 1.57 0.182 0.856 OS CO Kf 42.58 ± 1.44 42.46 ± 2.23 1.017
0.309 OS CO Ks 43.90 ± 1.70 43.87 ± 1.61 0.283
0.777 OS CT Kf 42.76 ± 1.47 42.73 ± 1.38 0.409 0.683 OS CT Ks 44.15 ± 2.53 44.24 ± 1.59 −0.647 0.518 Kf ：平坦K ，KS ： 陡峭K ，CO：电脑验光仪， CT：角膜地形图。
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表 5 散瞳前后角膜曲率在角膜地形图与电脑验光仪差异比较（D）
Table 5. Comparison of keratometry between computer optometry and corneal topography before and after pupil dilation （Diopters）
眼别 CO CT t P 右眼散瞳前Kf 42.61 ± 1.41 42.78 ± 1.40 −1.878 0.061 右眼散瞳前Ks 43.78 ± 1.58 44.15 ± 1.56 −3.664 < 0.001 左眼散瞳前Kf 42.58 ± 1.44 42.76 ± 1.47 −1.986 0.047 左眼散瞳前Ks 43.90 ± 1.70 44.15 ± 2.53 −1.788 0.074 右眼散瞳后Kf 42.61 ± 1.39 42.80 ± 1.47 −2.078
0.038 右眼散瞳后Ks 43.85 ± 1.57 44.13 ± 1.57 −2.815
0.005 左眼散瞳后Kf 42.46 ± 2.23 42.73 ± 1.38 −2.270 0.023 左眼散瞳后Ks 43.87 ± 1.61 44.24 ± 1.59 −3.551 < 0.001
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