圆锥角膜患者就诊和确诊过程分析

摘要:目的 回顾性研究圆锥角膜患者的就诊及确诊过程.方法 对2009年6月至2012年12月在郑州大学第一附属医院眼科就诊的74例圆锥角膜患者的病历资料进行回顾性分析,统计患者的基本资料、就诊原因和确诊过程.结果 男性55例,女性19例;确诊年龄10~42岁,平均(20.5±4.3)岁.根据角膜地形图分为四组:可疑组18例(24%),轻度组29例(39%),中度组14例(19%),重度组13例(18%).就诊原因分为9类:配戴框架眼镜视力未能矫正至正常27例(36%),初诊验光散光度数较大或复诊验光散光度数增加较大12例(16%),配戴框架眼镜单眼视物重影9例(12%),近视度数增长过快8例(11%),准分子激光角膜屈光手术术前检查发现5例(7%),验配硬镜前检查发现5例(7%),准分子术后近视反弹用框架眼镜无法矫正视力3例(4%),眼痒等不适3例(4%),角膜移植后视力渐下降2例(3%).根据常规眼科检查,首次确诊63例(85%),多次检查误诊11例(15%).结论 圆锥角膜多见于20岁左右的男性,初诊为轻度的圆锥角膜患者稍多.就诊的主要原因是视力下降而戴框架眼镜不能矫正至正常或有重影、散光较大、近视度数增加过快.应综合评估,警惕误诊的发生.
Objective Retrospective study the treatment reasons and diagnosis process of patients with keratoconus.Methods The basic information,treatment reasons and diagnosis process of 74 patients with keratoconus were investigated.Results There were 55 males and 19 females.The treatment age was an average of (20.5 ± 4.3) years old (range from 12 to 42 years).It was divided into four groups based on corneal topography:suspicious group (18 patients,24%); mild group (29 patients,39%); moderate group (14 patients,19%); severe group (13 patients,18%).Nine categories treatment reasons were divided.Twenty-seven patients (36%) had an abnormal spectacle corrected vision.Twelve patients (16%) had high astigmatism in the first diagnosed optometry or increased astigmatism quickly in the short term.Nine patients (12%) wearing glasses were monocular depending on the material ghosting.Eight patients (11%) had a rapid growth of myopia diopter.Five patients (7%) were found preoperative examination of the excimer laser corneal refractive surgery.Five patients (7%) were revealed before the rigid contact lens fitting examination.Three patients (4%) had not a spectacle corrected vision postoperative myopic excimer surgery.Three spectacle (4%) felt eye itching and other discomfort.Two patients (3%) had a bad vision gradually after corneal transplantation.There were 63 cases (85%) first diagnosed based on routine eye examination and 11 cases (15%) misdiagnosed with multiple inspections.Conclusions Keratoconus most appear in male patients around 20 years old and mild patients are slightly more.The main reason for treatment is decreased vision but can not be corrected to normal by glasses or ghosting,astigmatism,myopia diopter increased too fast.We should assess comprehensively,alert to the occurrence of misdiagnosis.

英文标题Investigation of treatment reasons and diagnosis process of patients with keratoconus
关键字圆锥角膜,就诊原因,确诊,角膜地形图
作者符爱存,李秀红,尚丽娜,吕勇,朱豫
所属期刊栏目经验体会,Experience and Realization
刊名中国实用眼科杂志,Chinese Journal of Practical Ophthalmology
作者单位符爱存:郑州大学第一附属医院眼科,河南省,450000,朱豫:郑州大学第一附属医院眼科,河南省,450000,尚丽娜:郑州大学第一附属医院眼科,河南省,450000,李秀红:郑州大学第一附属医院眼科,河南省,450000,吕勇:郑州大学第一附属医院眼科,河南省,450000
DOI10.3760/cma.j.issn.1006-4443.2013.10.020
SSSN1006-4443

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