- 學位論文
高度近視併發症與眼軸長之關聯性：一項回顧性橫斷式研究
The correlations between high myopic complications and axial length：a retrospective cross-sectional study
摘要
目的： 台灣近視率居世界之冠，年齡層更是日漸下降。當眼軸長度被拉長，眼球整體結構改變時容易造成合併症。本研究想了解不同眼軸長度的成年人口，眼球前段生理參數是否會隨之改變，以及各近視合併症的發生風險和影響程度與眼軸長間的關聯性。 方法： 本研究採回溯性設計，納入中部某大型醫學中心，2017年1月1日至2022年12月31日，曾接受眼軸長及眼球相關的生理參數測量之病患。研究共分三大面向：眼球生理參數、近視合併症及白內障手術相關風險。共收2587位病患，納入4762隻眼睛，依不同眼軸長度進行分組，依據不同併發症進行研究分析。 結果： 眼球參數，所有參數皆與各眼軸長分組呈顯著差異（p<.001），眼軸長與前房深度（r=0.57，p<.001）、角膜水平直徑（r=0.38，p<.001）呈顯著正相關，與平均角膜曲率（r=-0.36，p<.001）、水晶體厚度（r=-0.34，p<.001）呈顯著負相關。合併症方面，近視性黃斑部病變（總體發生率18.28%），以極高眼軸長組罹病風險最高（OR比23.48；95%CI 16.86-33.08）。視網膜剝離（發生率3.57%），以高眼軸長組罹病風險最高（OR比3.49；95%CI 2.47-4.97）。青光眼（發生率19.11%），則是以低眼軸長組罹病風險最高（OR比1.8；95%CI 1.49-2.16），若排除低眼軸長患者，各眼軸長罹病率無顯著差異（r=0.299）。白內障首次開刀年齡與眼軸長度呈顯著負相關（r=-0.49，p<.001）。術後合併症，以後囊混濁發生比例最高（11.68%），眼軸每增加1mm，發生風險增加為1.079倍（p<.05）。暫時性高眼壓發生率次之（3.71%），後囊破裂（0.26%）和視網膜剝離（0.16%）則發生機率最低。 結論： 在這個針對中部地區人口進行的回溯性研究中，隨著眼軸長越長，近視及白內障術後合併症發生風險越高，發病年齡更早，許多甚至提前至中壯年時期，視力即開始有嚴重受損。未來應從醫療端、近視控制、衛教著手，以期能減少近視帶來的許多傷害。
並列摘要
Purpose: Myopia ishighlyprevalent and increasing globally, especially in Taiwan,withdeclining ageof onset. When the axial length is elongated and the overall structure of the eyeball changes, it is easy to cause complications. This study aimsto investigate, the correlations between axiallength,myopic complications,and other ocular biometric parameters. Methods: This study is a retrospective design andcollected data fromthe patients those who have undergone measurement of ocular axial length and eyeball-related parameters during 2017/01/01-2022/12/31. The research was divided into three aspects:ocular biometric parameters, myopia complications and the riskassociated with cataract surgery. Total 2,587 patients and 4,762 eyeswere includedand dividedfour groups：low axial lengthgroup：< 23mm, normal axial length group：23-26mm,high axial length group26-30mmand extremely high axial length group>30mm,according to their axial lengths. The data wereanalyzed depending onfield studies. Results: All biometricparameters were significantly different between theaxial length groups(p<.001). Axial length was significantly positively correlated with anterior chamber depth (r=0.57,p<.001) and horizontal corneal diameter(r=0.38,p<.001), and significantly negatively correlated with average corneal curvature(r=-0.36,p<.001) and lens thickness(r=-0.34,p<.001). Compared with the normal axial length group, the risk of myopicmacular degeneration(Incidence:18.28%)was highest in the extremely high axial length group (OR,23.48;95%CI 16.86-33.08). In theretinal detachment(Incidence:18.28%), the risk of disease was highest in the group with high axial length (OR,3.49;95%CI 2.47-4.97). For glaucoma(Incidence:19.11%), the group with lowaxial length had the highest risk (OR, 1.8;95%CI 1.49-2.16),if excluded low axial length group , there is no significant difference in the incidence of each axial length（r=0.299）. The age of the first cataract operation was significantly negatively correlated with the axial length of the eye (r=-0.49, p<.001). Among all thepostoperative complications, PCO(11.68%)had the highest incidence, with every 1mm increase in axial length, the risk increased 1.079 times (p<.05). The second complication was transient high intraocular pressure (3.71%), and thenPCR (0.26%) and the lowest was RD (0.16%). Conclusion: The longer axial length of the eye, the higher the riskof myopic complications, and the earlier the age of onset. In the future, we should focus on the eye care system, myopia controlmeans, ocular health examination and patienteducation, to reduce the prevalence of high myopia and thus avoid the injuries caused by high myopia.