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15.05.2014, 10:04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Резюме УДК 617.753.2+617.726-073/.-076 65061, Украина, г. Одесса, Французский бульвар, 49/51. ГУ "Институт глазных болезней и тканевой терапии им. В.П.Филатова НАМН Украины" 65061, Ukraine, Odessa, Frantsuzskii Bulvar, 49/51 SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine” In recent decades in developed countries appeared threatening trend progression of myopia. Given the variety of factors of myopia and the diversity of the existing classifications suggests that myopia is not a single disease. E.Z. Tron (1947) carried out a series of biometric measurements of anatomical and optical parameters and studied the nature of their variability on the basis of which identified four types of clinical refraction: axial, refractive, mixed and combination. According to A.I Dashevsky ( 1968), refractive ametropia and mixed is not observed, and almost only found axial and combination ametropia. Many authors have shown that myopia is associated with changes in the anatomical parameters of the eye and the result of a combination of anatomical and optical parameters of the eye. Proved that when the expanding myopia anterior chamber angle, increased anterior chamber flattening lens. Not fully defined ratio of morphometric parameters in different types of myopia and their role in the development and progression of myopia. The aim. To study of differential diagnostic the eye’s morphometric parameters in patients with refractive and axial myopia. Materials and methods. The observation involved 264 patients (502 eyes) with varying degrees of myopia (myopic refraction of -2.75 diopters), age - 18.41 year. Of them - 178 female patients (338 eyes - 67.42%) and 86 males (163 eyes - 32.58%). Patients allocated to the group by type of myopia: refractive (RM) - 133 eyes, axial (OM) - 217 eyes, mixed (SM) - 91 eyes, and combined (CM) - 61 eyes. Methods: visometry for distance, after cycloplegic avtokeratorefraktometriya with cyclomed 1%, (Accuref-K 9001, Shin Nippon), the definition of the horizontal pupil diameter (LD) (keratotopograf PCT-110, Optopol) and horizontal corneal diameter (DR) (KR-8900 Topcon and HRK-7000 Huvitz), ultrasound ehobiometriya anterior and posterior segment of the eye, the measurement of intraocular pressure (IOP) (Reichart-AT555) adjusted for pachymetry (Desmin M). Results and observation: Table 1 shows the comparative evaluation of the average of the total group, consisting of 502 myopic eyes and a group of 121 myopic eyes with these OCT. Table 1. Mean values of myopic eye М±s
In some patients (121 eyes) of the total group (502 eyes) to determine the width of the angle of anterior chamber on optical coherence tomography (OCT). This group included patients with axial myopia - 65 eye and refractive - 28 eyes. Sample of persons tested for OST (121 eyes) is representative with respect to the group of myopia (502 eyes) because no significant differences in mean values for patients in these groups (p> 0,05). For identification of special differential diagnostic characteristics of patients with axial myopia on 217 eyes and refractive myopia on 133 eyes studied the mean values of morphometric parameters eyes, presented in Table 2. Table 2 Dates of the myopic eyes with axial and refractive myopia ( M, standard deviation ± σ.)
As a result, the comparative evaluation revealed no significant differences (p> 0,1) in the average values of thickness of lens and anterior chamber depth between the groups of patients with axial myopia and a refractive myopia. The mean values of the length of the vitreous body, and the axis of the radius of the cornea in patients with axial myopia were significantly different compared to such indicators in patients with refractive myopia (p <0,01). Indicators of pupil size tonometry essentially did not differ significantly in patients with axial and refractive myopia. The comparison of the data revealed that the axial myopia (-2,61 ± 2,33 diopters) had higher mean myopic refraction (-1,68 ± 0,91 diopters) (P <0.01). With more than half of the RM (75 eyes - 56.39%) accounted for refraction to -1.5 diopters, one-third of cases (46 eyes - 34.36%) is in the range from -1.5 to -3.0 diopters and only slightly less than the tenth part (12 eyes - 9.02%) has a value of -3.0 diopters. With over a quarter of axial myopia the refraction over 3.0 diopters (58 eyes - 26.73%). The largest number of cases and with the axial (89 eyes - 41.01%) and refraction (75 eyes - 56.39%) of myopia accounts for refraction to -1.5 diopters. Showed significant differences (p <0.01) in the mean diameter of the cornea between OM (12,01 ± 0,33 mm) and RM (11,59 ± 0,35 mm). At small values of axial myopia diameter of cornea (11.5 mm) occur in 4.8 times less than the refractive myopia (respectively 15 eyes - 6.91%, and 44 eyes - 33.08%). At RM 80% of cases are within the average (11.5 - 11.9 mm) (67 eyes - 50.37%) and low (11.5 mm) (44 eyes - 33.08%) values. It was noted that patients with axis myopia intraocular pressure was significantly ((р<0,05) lower compared with the refractive myopia (respectively: 15,28 ± 2,77 mm Hg and 16,04 ± 3 , 09mm.rt.st). In patients with axial myopia intraocular pressure values higher than 18 mm Hg there are 2 times less compared with refractive myopia (respectively: 32 eyes - 14.7%, and 36 eyes - 27.0%). The low values (up to 14 mm Hg) at axial myopia occur in one third of patients (76 eyes - 35.02%), while a quarter of the refractive myopia (36 eyes -27.06%). The size of pupil diameter is 5.0 mm and more in 69 eyes (31.79%) are more in axial myopia compared with refractive myopia of 25 eyes (18.79%). The diameter of the pupil in patients with refractive myopia (4,35 ± 0,68) mm was significantly lower ((р<0,05), so that patients with axial myopia (4,54 ± 0,74) mm. In patients with axial myopia low values of the anterior chamber angle is less than 45 º are found in half of the cases (36 eyes - 55.38%) - 2.2 times more often than patients with refractive myopia where low values of a quarter of patients (7 eyes - 25%). When refractive myopia anterior chamber angle 50 º occurs 2.1 times more often (9 eyes - 32.14%) compared to the axial myopia (19 eyes - 15.38%). These medium-sized chamber angle was significantly greater in patients with refractive myopia (44,72 ± 6,57 )mm, than in patients with axial myopia (48,32 ± 4,19)mm (p <0,01). Conclusions: 1. Morphometric parameters of the eye, intraocular pressure in patients with axial and refractive myopia have practical value for early detection and prediction of the development and progression of myopia in patients with the characteristics of a myopia. 2. Analysis of the data showed that the axial myopia is significantly larger average diameter (p <0,01), the radius (p <0,01) and dioptryi cornea (p <0,01), pupil diameter (p <0,05),l length of the vitreous humor (p <0,01), length axis of the eye (p <0,01) and the degree of myopia (p <0,01), compared with refractive myopia. 3. There are in refractive myopia significantly higher mean values of intraocular pressure (p <0,05) and the width of the anterior chamber angle (p <0,01), than with axial myopia. 4. Comparison of the mean values of anterior chamber depth and lens thickness between patients with axial and refractive myopia showed no significant differences (p> 0,1). Литература | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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