目的 研究眼压在近视自然病程中的变化规律,以及对近视性眼底改变和眼轴的影响.方法 门诊就诊近视患者489例(976只眼),进行眼底照相、A/B超、眼压、验光、矫正视力、角膜曲率等相关眼科检查,记录并归纳整理.结果 (1)在20岁前高度近视的眼压呈现2个高水平,以豹纹状改变阶段的6～15岁之间形成第一个高眼压高峰,和以出现病理改变的10～15岁之间第二个高眼压高峰,眼压的高水平维持至20岁,这一阶段的眼球尚未扩张、眼轴相对短;(2)以后各年龄组高度近视伴随眼轴的增长、眼底呈现病理性改变,并不呈现高眼压状态.结论 (1)在20岁前近视形成发展过程中,眼压具有眼球扩张的内动力作用.(2)青春期后已经扩张的眼球,控制眼压在正常平均值16 mm Hg以下1至2个标准差,即13 mm Hg以下,对终生维持-7 D、27 mm眼轴和监测豹纹状眼底改变、预防病理性改变的发生具有积极意义.%Objective To observe the intraocular pressure ( IOP ) changes in high myopia' s natural course and the influence to myopic fundus and ocular axial length. Methods The enrolled included clinical 489 patients 976 eyes of 5 to 85 years old, their refraction error were over - 6 D ( - 4 D below 10-year-old ), and the eyeball axis were over 25 mm ( 24 mm below 10-year-old ). They were divided 14 groups with the internal 5 year-old. The fundus appearances were divided into 4 groups, negative, tessellation, focal lesions, and pathologic changes, according to the KOWA fundus camera and Heidelberg HRA2 fluoreceine /indocraine angiophotography. At the meantime, myopic severity was checked with cyclople-gic objective refraction by NIKON SPEEDY-K automatic optometry and retinoscopy, ocular axis and shape of eye ball were measured and recorded by BVI A/B-scan. Their IOPs were measured by auto-applanation tonometry of Topcon CT60. The collected data were analyzed statistically by SPSS12. 0. Results ( 1 )There were 2 high levels IOP under 20 year-old ages, the first peak of IOP appeared with tessellation fundus changes of 6 to 15 years old, and the second one appeared with pathologic fundus changes of 10 ~ 15 years old. The high level IOP maintained till to 20 year-old with less expanded axial length.( 2 )The other groups older than 20 showed average IOP of 16 mm Hg, even with the pathologic changes keeping deteriorated and the axial length increasing. Conclusion ( 1 )The IOP has the inner motive power in the ocular expansion during the myopic development under 20 years old. ( 2 )ln the adolescence when the ocular expansion had developed, it is clinical significance to have IOP maintained lower 1 standard error ( of 3 mm Hg ) than average ( 16 mm Hg ) to keep the degree of myopia stable at -7 D, ocular axis 27 mm. In this way, we may have tessellation appearance not to evolve to pathologic one.
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