摘要
目的探讨儿童高眼压症和成人高眼压症患者长期随访后的临床特点与转归。方法收集2014年3月至2015年3月就诊于胜利油田中心医院眼科门诊及病房且符合入选标准的57例高眼压症患者为研究对象。按照年龄分为儿童组和成人组:儿童组患者24例(48眼),年龄9～18岁;成人组患者30例(60眼),年龄21～66岁。对两组患者进行3～4a的随访,按照每个季度(4月为春节、7月为夏季、10月为秋季、1月为冬季)复诊监测患者不同季节下的视力、眼压、视盘C/D比值、视野变化及视神经纤维层厚度变化。结果儿童组患者眼压水平与眼压波动幅度均大于成人组(均为P<0.05)。儿童组首诊门诊连续3次检测眼压≥21mmHg(1kPa=7.5mmHg)者48眼、≥30mmHg者17眼;成人组≥21mmHg者54眼(4例均单眼高眼压)、≥30mmHg者11眼。儿童组24h眼压高峰为早晨8∶00～10∶00,低谷为晚上22∶00～2∶00,眼压差为2.9～22.0(8.95±3.38)mmHg;成人组眼压高峰为夜间2∶00～4∶00,低谷为晚上18∶00～20∶00,眼压差为1.0～8.5(5.75±1.46)mmHg。儿童组患者的24h眼压峰值与谷值均明显受季节影响,冬天显著高于夏天(P<0.05);与成人组患者相比差异均有统计学意义(均为P<0.05)。儿童组患者四季眼压波动有差异,冬天显著高于夏天(P<0.05)。儿童组中男孩与女孩性别之间四季眼压波动差异无统计学意义(P>0.05)。成人组中四季眼压波动差异有统计学意义(均为P<0.05),性别之间差异无统计学意义(P>0.05);与儿童组相比眼压差均减小,差异均有统计学意义(均为P<0.05)。随访3～4a,儿童组患者有1例发展为青光眼,其神经纤维层厚度变薄,视野出现鼻侧阶梯,且患者近视进展比较快;有12例眼压趋于下降,神经纤维层厚度未见明显变化,视野未见明显异常;成人组患者有2例发展为青光眼,其神经纤维层厚度变薄,视野出现鼻侧阶梯,有1例伴发视网膜分支静脉阻塞。结论儿童高眼压症患者眼压常呈波动性,眼压高峰值多数超过30mmHg,其明显受季节影响;成人高眼压症患者眼压受季节影响小。
Objective To investigate the clinical characteristics and outcomes of long-term follow-up of juvenile ocular hypertension(JOHT)and adult ocular hypertension(AOHT).Methods From March 2014 to March 2015,57 patients with ocular hypertension who met the criteria in ophthalmology clinic and ward of Shengli Oilfield Central Hospital were selected.According to their ages,they were divided into children group and adult group.There were 24 patients(48 eyes)in children group,aged 9-18 years,and 30 patients(60 eyes)in adult group,aged 21-66 years.The two groups of patients were followed up for 3 to 4 years.Visual acuity,intraocular pressure(IOP),C/D ratio of optic disc,visual field,thickness of nerve fibers layers were observed according to quarterly visits(April included in spring,July in summer,October in autumn and January in winter).Results The IOP of children group was higher than that of adults group,and the fluctuation range of IOP was also greater than that of adults group(P<0.05).In the children group,IOP was measured 3 times in the first clinic,48 eyes IOP≥21 mmHg(1 kPa=7.5 mmHg)and 17 eyes IOP≥30 mmHg.In the adult group,IOP≥21 mmHg in 54 eyes(4 eyes were monocular ocular hypertension)and IOP≥30 mmHg in 11 eyes.The peak period of IOP was 8 GA6FA 00-10 GA6FA 00 am in the child group,the trough period was 22 GA6FA 00 pm-2 GA6FA 00 am,and the IOP difference was 2.9-22.0(8.95±3.38)mmHg.The peak period of IOP in adult group was 2 GA6FA 00-4 GA6FA 00 am,the trough period was 18 GA6FA 00-20 GA6FA 00 pm,and the IOP difference was 1.0-8.5(5.75±1.46)mmHg.The peak and valley values of 24-hour IOP in children group were significantly affected by seasons and significantly higher in winter than those in summer(P<0.05).Compared with the adult group,the difference was statistically significant(all P<0.05).There was no significant difference in IOP fluctuation between boys and girls(P >0.05).The difference of IOP fluctuation in the four seasons in the adult group was statistically significant(all P<0.05),and there was no statistically significant difference between the males and females(P >0.05).Compared with the children group,the IOP difference was smaller and the difference was statistically significant(P<0.05).During the follow-up of 3-4 years,1 child patient developed juvenile glaucoma,with a thinner nerve fiber layer,a reduced contrast sensitivity in the nasal side of the visual field,and a faster progression of myopia.In 12 child patients,the IOP gradually decreased,the thickness of nerve fiber layer did not change significantly,and the visual field did not show any obvious abnormality.In the adult group,2 patients developed glaucoma,the thickness of nerve fiber layer became thinner,and the contrast sensitivity of visual field decreased on the nasal side.One patient later developed retinal branch vein occlusion.Conclusion In children with ocular hypertension,the IOP is often fluctuating.The peak value of IOP is usually more than 30 mmHg,which is obviously affected by seasonal changes.In adults with ocular hypertension,the IOP is less affected by seasonal changes.
作者
陈春丽
牛臣昌
王俊恩
贾新国
CHEN Chun-Li;NIU Chen-Chang;WANG Jun-En;JIA Xin-Guo(Department of Ophthalmology,Shengli Oilfield Central Hospital,Dongying 257000,Shandong Province,China;Department of Ophthalmology,Tianjin Medical University Eye Hospital,Tianjin 300000,China)
出处
《眼科新进展》
CAS
北大核心
2019年第2期172-175,共4页
Recent Advances in Ophthalmology
关键词
儿童高眼压症
成人高眼压症
临床特点
转归
juvenile ocular hypertension
adult ocular hypertension
clinical characteristics
clinical outcomes
