目的：探究学龄前期早产儿视网膜病变(ROP)近视患儿屈光参数及晶状体调节参数的变化特点及其临床意义。

方法：回顾性分析2018-10/2019-09于我院门诊随访未经治疗自然消退的1～6岁ROP受检者98例192眼作为观察对象，依据屈光筛查结果分为近视组(41例80眼)与非近视组(57例112眼)，并选取同期门诊体检的1～6岁屈光正常无ROP的早产儿40例80眼作为对照组，比较各组屈光参数\〖等效球镜度(SE)、角膜曲率(CR)、眼轴长度(AL)、前房深度(ACD)、玻璃体腔深度(VITR)、晶状体厚度(LT)\〗和晶状体调节参数\〖散瞳前后SE、LT及其变化值\〗的差异，分析不同年龄段ROP近视患儿屈光参数的特点，明确学龄前期ROP近视患儿SE与屈光参数及晶状体调节参数的关系。

结果：近视组SE值(-3.95±1.31D)、LT(4.21±0.34mm)高于非近视组(1.32±0.36D、4.08±0.21mm)和对照组(1.39±0.42D、3.71±0.41mm)，ACD(2.42±0.39mm)低于非近视组(2.61±0.24mm)和对照组(3.11±0.32mm)，且非近视组LT高于对照组，ACD低于对照组(均P<0.001)。近视组散瞳前后SE值(-3.95±1.31、-3.02±0.97D)均高于非近视组(1.32±0.36、2.67±0.81D)和对照组(1.39±0.42、2.61±0.76D)，差值(0.93±0.30D)均低于非近视组(1.31±0.31D)和对照组(1.25±0.19D)(P<0.001)； 散瞳前后LT(4.21±0.34、3.95±0.22mm)高于非近视组(4.08±0.21、3.71±0.37mm)和对照组(3.71±0.41、3.35±0.16mm)，LT差值(0.26±0.08mm)低于非近视组(0.37±0.12mm)和对照组(0.36±0.11mm)，且非近视组散瞳前后LT高于对照组(均P<0.001)。年龄<3岁受检者中，近视组SE值、CR、LT均高于非近视组，ACD低于非近视组，3～6岁受检者中，近视组SE值、LT均高于非近视组(均P<0.05)。年龄<3岁的ROP近视患儿SE与CR、LT均呈正相关，与散瞳前后LT差值呈负相关(P<0.05)； 3～6岁ROP近视患儿SE与LT呈正相关，与散瞳前后LT差值呈负相关(P<0.05)。

结论：学龄前期ROP近视患儿屈光改变以晶状体增厚、浅前房为特征，3岁以前伴角膜曲率陡峭，3岁以后呈现为晶状体增厚。3岁以前角膜曲率与ROP近视发生有关，晶状体厚度及调节能力为1～6岁ROP近视发生的主导因素。

METHODS: A retrospective study was conducted in 98(192 eyes)1-6 year-old children with ROP who recovered spontaneously without treatment during outpatient follow-up between October 2018 and September 2019. According to the refractive screening results, the subjects were divided into myopia group(41 cases with 80 affected eyes)and non-myopia group(57 cases with 112 affected eyes). Meanwhile, 40 emmetropic premature infants(80 eyes)of the same age and without ROP were selected as the control group. Refractive parameters \〖spherical equivalent(SE), corneal curvature(CR), axial length(AL), anterior chamber depth(ACD), vitreous depth(VITR), lens thickness(LT)\〗 and lenticular accommodation parameters(SE and LT before and after mydriasis and their change values)in different groups were compared. Refractive parameters in myopic children with ROP in different age groups were analyzed, and the relationship among SE, refractive parameters and lens adjustment parameters in preschool myopic children with ROP was discussed.

RESULTS: SE and LT of myopia group(-3.95±1.31D, 4.21±0.34mm)were higher/larger than those of non-myopia group(1.32±0.36D, 4.08±0.21mm)and control group(1.39±0.42D, 3.71±0.41mm), while ACD(2.42±0.39mm)was lower than that of non-myopia group(2.61±0.24mm)or control group(3.11±0.32mm). Besides, LT of non-myopia group was larger than control group, and ACD was lower than control group(all P<0.001). SE of myopia group before and after mydriasis(-3.95±1.31, -3.02±0.97D)were higher than those of non-myopia group(1.32±0.36, 2.67±0.81D)or control group(1.39±0.42, 2.61±0.76D). and the difference value of SE(0.93±0.30D)was lower than that of non-myopia group(1.31±0.31D)or control group(1.25±0.19D)(P<0.001). LT before and after mydriasis(4.21±0.34, 3.95±0.22mm)were larger than those of non-myopia group(4.08±0.21, 3.71±0.37mm)or control group(3.71±0.41, 3.35±0.16mm), and the difference value of LT(0.26±0.08mm)was lower than non-myopia group(0.37±0.12mm)or control group(0.36±0.11mm). Moreover, LT of non-myopia group before and after mydriasis were larger than those of control group(all P<0.001). For subjects under 3 years old, SE, CR and LT of myopia group were higher and ACD was lower than those of non-myopia group. For subjects between 3 and 6 years old, SE and LT of myopia group were higher than those of non-myopia group(all P<0.05). SE was positively correlated with CR and LT in myopic children with ROP under 3 years old, but it was negatively correlated with the difference value of LT before and after mydriasis(P<0.05); SE was positively correlated with LT in myopic children with ROP between 3 and 6 years old, but was negatively correlated with the difference value of LT before and after mydriasis(P<0.05).

CONCLUSION: Refractive changes of preschool myopic children with ROP are characterized by lens thickening and shallow anterior chamber. Patients under 3 years old are accompanied by steep CR, and lens thickening appears after the age of three. CR is related to the occurrence of myopia of ROP in children under 3 years old. LT and lenticular accommodation are leading factors for myopia of ROP in children between 1 and 6 years old.