观察近视性屈光参差青少年患者双眼视功能障碍的情况。

横断面研究。选取2022年12月至2023年11月于重庆大学附属江津医院眼科就诊的近视性屈光参差患者142例(284只眼)。其中，男性70例(140只眼)，女性72例(144只眼)；年龄10～18岁，平均年龄(14.9±2.2)岁。根据双眼等效球镜差值将其分为低度屈光参差组和高度屈光参差组；根据近视程度将其分为低度近视眼组、中度近视眼组及高度近视眼组。检测全部患者的屈光度、调节幅度、集合近点、远距眼位、近距眼位、远距融像性聚散功能、近距融像性聚散功能及立体视功能。屈光度、调节幅度、集合近点、远距眼位、近距眼位、远距融像性聚散功能、近距融像性聚散功能及立体视功能等计量资料经Kolmogorov－Smirnov正态性检验，均为非正态分布，使用中位数和四分位间距[M(IQR)]进行描述，屈光参差与双眼视功能的相关性采用Spearman秩相关分析。双眼视功能障碍类型和患病率采用例数和百分比描述，组间比较采用卡方检验。双眼视功能障碍的影响因素采用Logistic回归分析。

本研究全部患者平均屈光参差屈光度、立体视、集合近点、调节幅度、调节灵敏度、远距隐斜角度及近距隐斜角度分别为－1.50(0.85)D、40(48.75)"、5.25(2.22)cm、11.10(2.85)D、12(7)cmp、0(2)^△及0(3)^△。远距基底朝内破裂点及恢复点分别为6(2)^△及4(2)^△；远距基底朝外模糊点、破裂点及恢复点分别为6(4)^△、18(8)^△及14(8)^△；近距基底朝内模糊点、破裂点及恢复点分别为8(4)^△、14(5.5)^△及12(6)^△；近距基底朝外模糊点、破裂点及恢复点分别为14(8)^△、25(10)^△及20(9)^△。全部患者142例(284只眼)中，低度屈光参差和高度屈光参差患者分别有117例(234只眼)和25例(50只眼)，分别占82.39%和17.61%。双眼视功能障碍共计70例(140只眼)，占49.29%。其中，调节功能异常、集合功能异常、合并2种及以上功能异常者分别为23例(46只眼)、23例(46只眼)及18例(36只眼)，分别占为16.20%、16.20%及12.66%。经Spearman相关性分析，屈光参差度与近距离隐斜视呈正相关，且有统计学意义(r＝0.192，P<0.05)。双眼视功能障碍者男性38例(76只眼)和女性32例(64只眼)，分别占54.29%和44.44%；双眼视功能正常者男性32例(64只眼)和女性40例(80只眼)，分别占44.44%和55.55%，差异无统计学意义(χ²＝1.375，P>0.05)。高度屈光参差双眼视功能障碍者20例(40只眼)，低度屈光参差双眼视功能障碍者50例(100只眼)，分别占80.00%和42.73%。高度屈光参差双眼视功能正常者5例(10只眼)，低度屈光参差双眼视功能正常者67例(134只眼)，分别占20.00%和57.27%，差异有统计学意义(χ²＝11.444，P<0.05)。低度近视眼组、中度近视眼组及高度近视眼组35例(70只眼)、70例(140只眼)及37例(74只眼)，分别占24.65%、49.30%及26.06%。低中高度近视性双眼视功能障碍者分别为21例(42只眼)、34例(68只眼)及15例(30只眼)，分别占60.00%、48.57%及40.54%；低中及高度近视性双眼视功能正常者分别为14例(28只眼)、36例(72只眼)及22例(44只眼)，分别占40.00%、51.43%及59.46%，差异无统计学意义(χ²＝2.754，P>0.05)。经Logistic回归分析，屈光参差程度是双眼视功能情况的危险因素，有统计学意义(OR＝6.69，95%CI：2.25～19.88；P<0.05)；而近视程度是双眼视功能情况的保护因素，有统计学意义(OR＝0.56，95%CI：0.34～0.93；P<0.05)。

青少年近视性屈光参差中双眼视功能障碍患病率较高，且随着屈光参差屈光度的增加，近距离隐斜角度增大；低度近视眼伴高度屈光参差患者更易患双眼视功能障碍，而屈光参差程度是影响双眼视功能的重要影响因素。

The aim of this study is to observe the binocular visual dysfunction in myopic anisometropia adolescents.

This was a cross-sectional study. A total of 142 patients (284 eyes) with myopic anisometropia who were seen in the Ophthalmology Department of Chongqing University Jiangjin Hospital from December 2022 to November 2023 were selected. Among them, 70 cases (140 eyes) were male, 72 cases (144 eyes) were female, with a mean age of (14.9±2.2) years (ranging from 10 to 18 years). Anisometropia was divided into low anisometropia and high anisometropia groups based on the change of spherical equivalent between two eyes values. According to the degree of myopia, they were divided into low myopia group, moderate myopia group, and high myopia group. The refractive power, adjustment amplitude, convergence near point, far and near distance eye positions, far and near distance fusion and dispersion function, and stereoscopic vision function between individuals with binocular visual impairment and normal individuals with myopic anisometropia were compared. Quantitative data such as refractive power, adjustment amplitude, convergence near point, far and near distance eye position, far and near distance fusion and dispersion function, and stereoscopic function after Kolmogorov-Smirnov normality testing conformed non normal distributions and were described by the median and interquartile range[M(IQR)]. The correlation between binocular visual function and anisometropia was used by Spearman rank correlation analysis. The types and prevalence of binocular visual impairment were described using case numbers and percentages, and compared by chi-square tests. The influencing factors of binocular vision function was performed by multiple logistic regression analysis.

The average refractive error, stereoscopic vision, convergence of near points, amplitude of adjustment, sensitivity of adjustment, distance and near distance deviation in adolescents with myopic anisometropia were -1.50 (0.85) D, 40 (48.75) " , 5.25 (2.22) cm, 11.10 (2.85) D, 12 (7) cmp, 0 (2)^△, and 0 (3)^△, respectively. The distance base inward rupture point and recovery point in adolescents with myopic anisometropia were 6 (2)^△ and 4 (2)^△, respectively. The distance base outward blurred point, rupture point, and recovery point in adolescents with myopic anisometropia were 6 (4)^△, 18 (8)^△ and 14(8)^Δ, respectively. The blurry points, rupture points, and recovery points with the base facing inward at close range in adolescents with myopic anisometropia were 8 (4)^Δ, 14 (5.5)^Δ, and 12 (6)^Δ, respectively. The blurry points, rupture points, and recovery points with the base facing outward at close range in adolescents with myopic anisometropia were 14 (8)^Δ, 25 (10)^Δ, and 20 (9)^Δ, respectively. Among of 142 cases (284 eyes), there were 117 cases (234 eyes) in the low degree anisometropia group and 25 cases (50 eyes) in the highly anisometropic group, accouting for 82.39% and 17.61%. There were a total of 70 cases (140 eyes) of binocular visual impairment, accounting for 49.29%. Among them, there were 23 cases (46 eyes), 23 cases (46 eyes) and 18 cases (36eyes) with abnormal regulation function, abnormal collective function, and abnormal combination of two or more functions, accounting for 16.20%, 16.20%, and 12.66%, respectively. According to Spearman correlation analysis, there was a positive correlation between anisometropia and close range esotropia, with statistical significance (r=0.192, P<0.05). There were 38 males (76 eyes) and 32 females (64 eyes) with binocular visual impairment, accounting for 54.29% and 44.44%, respectively; 32 males (64 eyes) and 40 females (80 eyes) with normal binocular vision function, accounting for 44.44% and 55.55%, respectively. The difference was not statistically significant between two groups (χ²=1.375, P>0.05). There were 20 cases (40 eyes) and 50 cases (100 eyes) of high anisometropia and low anisometropia with binocular visual impairment , accounting for 80.00% and 42.73%, respectively. There were 5 cases (10 eyes) and 67 cases (134 eyes) with normal binocular visual function in high degree anisometropia and low degree anisometropia, accounting for 20.00% and 57.27%, respectively. The difference was statistically significant (χ²=11.444, P<0.05). There were 35 cases (70 eyes), 70 cases (140 eyes), and 37 cases (74 eyes) in the low-grade myopia group, moderate myopia group, and high myopia group. There were 21 cases (42 eyes), 34 cases (68 eyes), and 15 cases (30 eyes) with low, medium, and high myopic binocular visual impairment, accounting for 60.00%, 48.57%, and 40.54%, respectively. There were 14 cases (28 eyes), 36 cases (72 eyes), and 22 cases (44 eyes) with normal binocular vision function in the low, medium, and high myopia group, accounting for 40.00%, 51.43%, and 59.46%, respectively. The difference was not statistically significant between them (χ²=2.754, P>0.05). After multiple logistic regression analysis, the degree of anisometropia was a statistically significant risk factor for binocular vision function (OR=6.69, 95%CI: 2.25 to 19.88; P<0.05). The degree of myopia was a protective factor for binocular visual function, with statistical significance (OR=0.56, 95%CI: 0.34 to 0.93; P<0.05).

The incidence of binocular visual dysfunction is higher in adolescents with myopic anisometropia, and with the increase of anisometropia, the close range deviation increases. Patients with low myopia and high anisometropia are more prone to binocular visual dysfunction, and the degree of anisometropia is an important influencing factor on binocular visual function.