臨床案例Clinicalcase病理性近視致低視力康復(fù)Rehabilitationoflowvis

臨床案例Clinicalcase病理性近視致低視力康復(fù)Rehabilitationoflowvisionduetopathologicalmyopia目錄Contents病歷摘要Abstractofmedicalrecord第一部分Part1病例分析Caseanalysis第二部分Part2疾病介紹Introductiontodisease第三部分Part3教學(xué)病例討論Teachingcases教學(xué)病例討論Teachingcases病例摘要第一部分Part1Abstractofmedicalrecord一、患者基本信息Basicinformationofpatient患者，男性，51歲。Patient,male,51yearsold.主訴：自幼雙眼視物模糊，加重近5年。Blurredvisioninbotheyessincechildhood,aggravatedfornearly5years.既往史：患者既往體健，否認(rèn)高血壓、糖尿病等病史，否認(rèn)藥物過敏史，否認(rèn)眼部及其他全身手術(shù)病史。Previoushistory:Thepatientwasingoodhealthanddeniedmedicalhistoryofhypertension,diabetes,drugallergy,andeyeandothersystemicoperations.現(xiàn)病史：患者自幼視物模糊，診斷為“雙眼近視”,一直堅(jiān)持配戴眼鏡，近5年來自覺雙眼戴鏡視力明顯下降。發(fā)病以來，神志清，精神可，生命體征平穩(wěn)，二便正常。Historyofpresentdisease:Thepatienthadblurredvisionsincechildhoodandwasdiagnosedas"binocularmyopia".Healwaysinsistedonwearingglassesandfeltthathisbinocularvisionhaddecreasedsignificantlyinthepast5years.Sincetheonset,themindisclear,thespiritcan,thevitalsignsarestable,andthebowelisnormal.體格檢查：體健，全身及一般狀態(tài)未見明顯異常。Physicalexamination:healthy,noobviousabnormalityingeneralbodyandgeneralstate.一、患者基本信息Basicinformationofpatient眼科檢查Eyeexamination檢查項(xiàng)目

主要內(nèi)容

OD(D)OS(D)OU(D)檢查項(xiàng)目Checkitem

主要內(nèi)容Maincontents

OD(D)OS(D)OU(D)原遠(yuǎn)用處方

遠(yuǎn)距-12.00D=4.0(0.1)

-12.00D=4.0(0.1)

4.0(0.1)Originalfarsightednessprescription近距-12.00D=4.0(0.1)

-12.00D=4.0(0.1)

4.0(0.1)主覺驗(yàn)光

遠(yuǎn)距-19.00/-1.00×90=4.3(0.2)-14.00/2.50×90=4.3(0.2)4.3(0.2)Subjectiverefraction近距-17.00/-1.00×90=4.3(0.2)-12.00/2.50×90=4.3(0.2)4.4(0.25)眼壓Intraocularpressure16.3mmHg15.2mmHg對(duì)比敏感度視力0.640.64Contrastsensitivityvision對(duì)比視野Contrastfieldofview

視野縮窄Narrowingofvisualfield

視野縮窄Narrowingofvisualfield角膜映光法檢查keratoscopy

正位Rightposition遮蓋試驗(yàn)Coveringtestexo,-8△@N&D眼球運(yùn)動(dòng)EyemovementSAFE裂隙燈檢查Slit-lampexamination雙眼瞼形態(tài)正常，啟閉可，結(jié)膜清，角膜透明，前房深清，虹膜紋理清，

瞳孔圓，對(duì)光反射正常，晶狀體輕度混濁，玻璃體混濁

Normaleyelidshape,openandclose,conjunctivaclear,corneatransparent,anteriorchamberdeepclear,iristextureclear,

Thepupilisround,thelightreflexisnormal,thelensisslightlycloudy,thevitreousbodyiscloudy眼底檢查Fundusexamination

視網(wǎng)膜豹紋狀改變，C/D約0.2，視盤周圍及黃斑區(qū)見脈絡(luò)膜縮，

斑中心凹反光未見(圖1-1)Leopardpatternchangesinretina,C/Dabout0.2,choroidalcontractionaroundopticdiscandmaculararea,Noreflectioninfovea(Figure1-1)一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

(1)眼軸檢查；OD31.86mm;

OS30.16mm。(1)Ocularaxisexamination;OD31.86mm;OS30.16mm.(2)眼底OCT:雙眼黃斑區(qū)視網(wǎng)膜走行不平，局部表面反射粗糙。神經(jīng)上皮層可見無反射區(qū)，部分視網(wǎng)膜萎縮且層次不清，RPE/CCL反射紊亂,不均勻增寬。(2)fundusOCT:theretinainthemacularareaofbotheyesisuneven,andthelocalsurfacereflectionisrough.Non-reflectiveareascanbeseenintheneurocorticallayer,someretinalatrophyandunclearlayers,RPE/CCLreflexdisorder,unevenwidening.(3)B超：雙眼玻璃體輕度混濁，后鞏膜葡萄腫。(3)B-ultrasound:slightopacityofvitreousbodyinbotheyesandposteriorscleralstaphyloma.一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

特殊檢查Specialexamination

(4)視野檢查：雙眼生理盲點(diǎn)擴(kuò)大，右眼鼻側(cè)下方視野縮小，左眼下方及顳側(cè)視野縮小。(4)Visualfieldexamination:thephysiologicalblindspotofbotheyesisenlarged,thevisualfieldbelowthenoseoftherighteyeisnarrowed,andthevisualfieldbelowthelefteyeandthetemporalfieldisnarrowed.一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

二、診斷判定疾病過程Diagnosisanddeterminationofthediseaseprocess【診斷】【Diagnosis】①二級(jí)低視力①Grade2lowvision②雙眼病理性近視②Pathologicalmyopiaofbotheyes③并發(fā)性白內(nèi)障③Complicatedcataract【治療】【Treatment】

病理性近視眼目前尚無特異性治療方法，主要進(jìn)行屈光矯正及低視力康復(fù)，如出現(xiàn)并發(fā)癥則對(duì)癥治療。

Atpresent,thereisnospecifictreatmentforpathologicalmyopia,mainlyrefractivecorrectionandlowvisionrehabilitation,andsymptomatictreatmentifcomplicationsoccur.

病理性近視的治療思路，首先是矯正屈光不正，可以通過配戴框架眼鏡、角膜接觸鏡、角膜屈光手術(shù)或有晶體眼人工晶體植入

手術(shù)。

Thetreatmentideaofpathologicalmyopia,thefirstistocorrecttherefractiveerror,canbebywearingframeglasses,cornealcontactlenses,cornealrefractivesurgeryorintraocularlensimplantationsurgery.

對(duì)于進(jìn)展性近視，如有需要可以行后鞏膜加固手術(shù)。

Forprogressivemyopia,posteriorscleralreinforcementsurgerymaybeperformedifnecessary.

另外，病理性近視患者，容易發(fā)生并發(fā)性白內(nèi)障，如發(fā)生白內(nèi)障，可以行白內(nèi)障手術(shù)治療；發(fā)生視網(wǎng)膜脫離，可以行激光治療或

視網(wǎng)膜脫離修復(fù)手術(shù)治療；對(duì)視網(wǎng)膜下新生血管膜及黃斑出血者，采取抗VEGF治療、激光治療及光動(dòng)力學(xué)治療等。

Inaddition,patientswithpathologicmyopiaarepronetocomplicatedcataract,suchascataract,cataractsurgerycanbeperformed;Retinaldetachmentcanbetreatedwithlasertherapyorretinaldetachmentrepairsurgery.Thepatientswithsubretinalneovascularizationmembraneandmacularhemorrhageweretreatedwithanti-VEGFtherapy,lasertherapyandphotodynamictherapy.二、診斷判定疾病過程Diagnosisanddeterminationofthediseaseprocess康復(fù)Rehabilitation1.康復(fù)需求及日常生活能力評(píng)估1.Assessmentofrehabilitationneedsanddailylivingability患者為51歲男教師，通過溝通和交流，得知患者在工作中需要批改學(xué)生作業(yè)，且平時(shí)有閱讀紙質(zhì)書本，喜歡用手機(jī)瀏覽新聞，因?yàn)榻嚯x看不清晰，影響工作效率；遠(yuǎn)距離不能看清楚學(xué)生的上課反應(yīng)等前來就診。患者希望能夠借助康復(fù)手段，讓自己近距離工作更加順利，并能更清楚地看清遠(yuǎn)距離物體。另外，患者還有一個(gè)困擾覺得自己配戴的鏡片太厚重，影響外觀和舒適度，希望能改善外觀。Thepatientisa51-year-oldmaleteacher.Throughcommunicationandcommunication,Ilearnedthatthepatientneedstocorrectstudents'homeworkatwork.Besides,heusuallyreadspaperbooksandlikestobrowsenewsbymobilephone,becausehecannotseeclearlyatcloserange,whichaffectsworkefficiency.Hecametoseeadoctorbecausehecouldnotseehisstudents'reactionsinclassfromadistance.Patientshopetobeabletouserehabilitationmethodstomaketheircloseworkmoresmoothlyandtoseedistantobjectsmoreclearly.Inaddition,thepatientalsohasaproblemthatthelenshewearsistooheavy,affectingtheappearanceandcomfort,andhopestoimprovetheappearance.2.康復(fù)計(jì)劃2.Rehabilitationplan(1)解釋病史和康復(fù)計(jì)劃(1)Explainmedicalhistoryandrehabilitationplan(2)視覺功能康復(fù)(2)Visualfunctionrehabilitation患者主覺驗(yàn)光：OD-19.00/-1.00×90=4.3(02)；OS-14.00/-2.50×90=4.3(0.2)；OU4.3(0.2)@D，ADD：+2.00DS，遠(yuǎn)距離給予全矯試戴略感頭暈，無法適應(yīng)。由于其左右眼也存在較大的屈光參差，且患者有看近需求，因此采用單眼視，將右眼球鏡屈光度降低5.0D。此時(shí)，患者配戴舒適度增加，且自覺遠(yuǎn)近清晰度均可。

Patient'smainoptometry:OD-19.00/-1.00×90=4.3(02);OS-14.00/-2.50×90=4.3(0.2);OU4.3(0.2)@D,ADD:+2.00DS,slightlydizzyandunabletoadaptwhengivenfullcorrectionatadistance.Duetothelargeanisometropiaintheleftandrighteyes,andtheneedtoseeclosely,monocularvisionwasadopted,andtherighteyesphericaldiopterwasreducedby5.0D.Atthistime,thepatient'swearingcomfortincreases,andtheawarenessofdistanceandclaritycanbe.處方一：0D-14.00/-1.00×90=4.0(0.1);OS-14.00/-2.50×90=4.3(0.2)。Prescription1:0D-14.00/-1.00×90=4.0(0.1);OS-14.00/-2.50x90=4.3(0.2).處方二：配RGP鏡片OD-15.5DS=4.4(0.25);OS-12.00DS=4.4(0.25)、0U4.4(0.25)。Prescription2:WithRGPlensOD-15.5DS=4.4(0.25);OS-12.00DS=4.4(0.25),0U4.4(0.25).

康復(fù)Rehabilitation

近視力康復(fù)：患者雙眼的最佳矯正近視力均為0.2,考慮患者需要經(jīng)常批改作業(yè)及閱讀需求，由于患者舒適閱讀的視力需求為4.5(0.3)-4.6(0.4),40cm視力為4.3(0.2),如提高到4.6(0.4),則閱讀距離移到20cm,則需要5.0D的調(diào)節(jié)。Nearvisionrehabilitation:Thebestcorrectednearvisioninbotheyesofthepatientswas0.2.Consideringthatthepatientsneededtocorrecthomeworkandreadfrequently,andsincethevisualrequirementforcomfortablereadingis4.5(0.3)-4.6(0.4),andthevisualacuityof40cmis4.3(0.2),ifthereadingdistanceisimprovedto4.6(0.4),5.0Dadjustmentisrequiredwhenthereadingdistanceismovedto20cm.康復(fù)Rehabilitation因此，提高近視力的方法有以下幾種：Therefore,thereareseveralwaystoimprovenearvision:①雙眼近用處方OD-14.00/-1.00×90；OS-9.00/-2.50×90,視力可以達(dá)到0.5。②采用上述提及的單眼視屈光矯正(一只眼看遠(yuǎn)，一只眼看近):OD-14.00/-1.00×90;OS-14.00/-2.50×90。③雙眼仍然在40cm處看近，OD-14.00/-1.00×90；OS-14.00/-2.50×90(遠(yuǎn)用處方)，此時(shí)左右眼近視力均4.3(0.2),再采用4x鎮(zhèn)紙式放大鏡視力可以達(dá)到4.8(0.6)；或者采用帶超長(zhǎng)臂自由活動(dòng)放大鏡視力可達(dá)4.6(0.4)。①PrescriptionOD-14.00/-1.00×90fornearuseofbotheyes;OS-9.00/-2.50×90,visioncanreach0.5.②Usethemonocularrefractivecorrectionmentionedabove(oneeyefar,oneeyenear):OD-14.00/-1.00×90;OS-14.00/-2.50x90.③Botheyesarestilllookingcloseat40cm,OD-14.00/-1.00×90;OS-14.00/-2.50×90(distantprescription),atthistime,thenearvisionoftheleftandrighteyesare4.3(0.2),andthevisionofthe4xpaperweightmagnifyingglasscanreach4.8(0.6);Oruseafreemovingmagnifyingglasswithanextralongarmtoachieveavisionof4.6(0.4).建議患者近用眼鏡式助視器(批改作業(yè)、閱讀等)、鎮(zhèn)紙式放大鏡(閱讀)、帶長(zhǎng)臂放大鏡(批改作業(yè))配合使用。對(duì)于電子產(chǎn)品的閱讀，可以使用手機(jī)或電腦本身的放大軟件APP,以及手機(jī)設(shè)置中的字體大小，選擇特大字體。Itisrecommendedthatpatientsusecloseglasses(correctinghomework,reading,etc.),paperweightmagnifyingglass(reading),andmagnifyingglasswithlongarm(correctinghomework)together.Forthereadingofelectronicproducts,youcanusetheenlargingsoftwareAPPofthemobilephoneorcomputeritself,aswellasthefontsizeinthemobilephoneSettings,selectalargefont.康復(fù)Rehabilitation

3)遠(yuǎn)視力康復(fù)：患者遠(yuǎn)視力4.3(0.2),自覺日常生活中行走等沒有問題，但無法看清楚課堂上學(xué)生的課堂表現(xiàn)，給予患者4x單筒望遠(yuǎn)鏡，視力可達(dá)4.8(0.6),用于看遠(yuǎn)處細(xì)節(jié)時(shí)使用。

3)Farvisionrehabilitation:Thepatienthasafarvisionof4.3(0.2)andnoproblemsinwalkingindailylife,butcannotseethestudents'classroomperformanceclearly.Thepatientisgiven4xmonocularswithavisionupto4.8(0.6),whichisusedforseeingdistantdetails.4)視野康復(fù)：由于周邊視網(wǎng)膜變性，周邊視野略有縮小，可考慮擴(kuò)大視野康復(fù)。予以倒置望遠(yuǎn)鏡試戴，患者覺視力下降明顯，看不清眼前細(xì)節(jié)，自覺目前沒有這樣的需求，建議暫時(shí)不采用增大視野的裝置，告知獨(dú)立行走時(shí)務(wù)必小心周邊，需要頻繁轉(zhuǎn)動(dòng)頭位來留意周邊視野情況，避免碰撞。

4)Visualfieldrehabilitation:Duetoperipheralretinaldegeneration,theperipheralvisualfieldisslightlyreduced,andyoucanconsiderexpandingvisualfieldrehabilitation.Totryontheinvertedtelescope,thepatientfeelsthatthevisualacuityhasdecreasedsignificantly,cannotseethedetailsinfrontoftheeyes,consciousthatthereisnosuchneed,itisrecommendednottousethedevicetoincreasethevisualfieldforthetimebeing,informedthatwhenwalkingindependently,becarefulaboutthesurrounding,needtofrequentlyturntheheadtopayattentiontotheperipheralvision,toavoidcollision.5)其他康復(fù)措施：由于近距離戴框架眼鏡時(shí)工作距離相對(duì)較近(20cm),長(zhǎng)時(shí)間工作會(huì)導(dǎo)致肩頸部酸痛，建議使用閱讀架或調(diào)整桌面高度，改善舒適度；同時(shí)，建議近距離工作時(shí)，使用較強(qiáng)的照明，并且推薦使用長(zhǎng)燈臂、亮度可調(diào)節(jié)的落地?zé)?/p>

5)Otherrehabilitationmeasures:Becausetheworkingdistanceisrelativelyclose(20cm)whenwearingframeglassesatcloserange,theshoulderandneckwillbesorewhenworkingforalongtime.Itisrecommendedtouseareadingrackoradjusttheheightofthedesktoimprovecomfort;Atthesametime,itisrecommendedtousestronglightingwhenworkingincloseproximity,anditisrecommendedtouseafloorlampwithalonglamparmandadjustablebrightness康復(fù)Rehabilitation6)康復(fù)訓(xùn)練：首先在康復(fù)護(hù)士和醫(yī)師的幫助下，教會(huì)患者使用助視器，并告知每種助視器的優(yōu)點(diǎn)及局限性，以及適用于何種距離場(chǎng)景，并分別對(duì)每一種助視器的使用進(jìn)行培訓(xùn)。6)Rehabilitationtraining:Firstofall,withthehelpofrehabilitationnursesanddoctors,teachpatientstousevisualAIDS,andinformeachoftheadvantagesandlimitationsofvisualAIDS,aswellassuitableforwhatdistancescenes,andconducttrainingontheuseofeachkindofvisualAIDS.7)心理康復(fù)：通過對(duì)患者的心理問卷的自評(píng)法及醫(yī)師、護(hù)士在康復(fù)過程中的他評(píng)法，初步判斷患者的心理健康情況，該患者有輕度焦慮傾向，主要問題在于擔(dān)心自己的視力會(huì)進(jìn)一步下降，影響生活和工作。針對(duì)患者的顧慮，通過對(duì)高度近視可能導(dǎo)致的并發(fā)癥進(jìn)行進(jìn)一步的解釋，告知患者定期做眼底檢查，如有問題積極處理，打消患者的顧慮。7)Psychologicalrehabilitation:Throughtheself-evaluationofthepatient'spsychologicalquestionnaireandtheotherevaluationofdoctorsandnursesintherehabilitationprocess,thepatient'smentalhealthwasinitiallyjudged.Thepatienthadamildanxietytendency,andthemainproblemwasthathewasworriedthathisvisionwouldfurtherdeclineandaffecthislifeandwork.Inviewoftheconcernsofpatients,throughfurtherexplanationofthecomplicationsthatmaybecausedbyhighmyopia,patientsareinformedtodofundusexaminationregularly,andifthereisaproblem,activelydealwithittodispeltheconcernsofpatients.康復(fù)Rehabilitation【隨訪】【Follow-up】(1)低視力?？泼?個(gè)月隨訪1次。(1)Lowvisionspecialistfollowupatevery3months.(2)眼底內(nèi)科每半年隨訪1次，散瞳檢查眼底情況。(2)fundusmedicalfollow-uponceeverysixmonths,mydriasisexaminationfundusconditions.隨訪Follow-upvisit教學(xué)病例討論Teachingcases

病例分析Caseanalysis第二部分Part2分析Analysis【病例特點(diǎn)】【CaseCharacteristics】患者為雙眼病理性近視導(dǎo)致的視覺功能障礙，視覺功能發(fā)生了不可逆轉(zhuǎn)的損害。患者為中年男性，在職教師，目前仍在工作，有明顯的看近與看遠(yuǎn)的視覺康復(fù)需求。Thepatienthasvisualdysfunctioncausedbypathologicalmyopiaofbotheyes,andthevisualfunctionhasbeenirreversiblydamaged.Thepatientisamiddle-agedmale,ateacher,whoisstillworkingatpresent,andhasobviousvisualrehabilitationneedsforseeingnearandfar.【診斷思路】【Diagnosticthinking】患者病史、?？茩z查和輔助檢查資料均明確，無須鑒別。Thepatient'shistory,specialtyexaminationandauxiliaryexaminationdatawereclearanddidnotneedtobeidentified.【治療思路】【Therapeuticidea】病理性近視的治療思路，首先是矯正屈光不正，可以通過配戴框架眼鏡、角膜接觸鏡(如RGP)、角膜屈光手術(shù)或ICL晶體植入手術(shù)，如有需要可以進(jìn)行后鞏膜加固手術(shù)。另外，病理性近視患者，容易發(fā)生并發(fā)性白內(nèi)障，如發(fā)生白內(nèi)障，可以行白內(nèi)障手術(shù)治療；發(fā)生視網(wǎng)膜脫離，可以行激光治療或視網(wǎng)膜脫離修復(fù)手術(shù)治療；發(fā)生脈絡(luò)膜新生血管，則需要進(jìn)行抗新生血管治療。Thetreatmentideaofpathologicalmyopiaistocorrecttherefractiveerrorfirst,bywearingframeglasses,cornealcontactlenses(suchasRGP),cornealrefractivesurgeryorICLlensimplantationsurgery,ifnecessary,posteriorscleralreinforcementsurgery

canbeperformedtostrengthenthesclera.Inaddition,patientswithpathologicmyopiaarepronetocomplicatedcataract,suchascataract,cataractsurgerycanbeperformed;Retinaldetachmentcanbetreatedwithlasertherapyorretinaldetachmentrepairsurgery.Ifchoroidalneovascularizationoccurs,antineovascularizationtherapyisrequired.康復(fù)思路Rehabilitationthinking(1)根據(jù)患者的年齡、職業(yè)、目前的眼部情況及康復(fù)需求，給予患者看遠(yuǎn)、看近的視覺功能康復(fù)，來滿足患者批改作業(yè)、看書、使用手機(jī)的需求，以及看清楚遠(yuǎn)處細(xì)節(jié)的需求。(1)Accordingtothepatient'sage,occupation,currenteyeconditionandrehabilitationneeds,givepatientsthevisualfunctionrehabilitationofseeingfarandneartomeettheneedsofpatientstocorrecthomework,readbooks,usemobilephones,andseeclearlydistantdetails.(2)由于周邊視網(wǎng)膜變性，周邊視野損害，如有需要，可以安排視野康復(fù)和行走技能的康復(fù)。(2)Duetoperipheralretinaldegenerationandperipheralvisualfielddamage,visualfieldrehabilitationandwalkingskillsrehabilitationcanbearrangedifnecessary.(3)由于近距離閱讀距離較近，可以使用閱讀架改善舒適度，并提供帶長(zhǎng)臂的強(qiáng)照明。(3)Duetotheclosereadingdistance,readingstandscanbeusedtoimprovecomfortandprovidestronglightingwithlongarms.(4)通過心理問卷自評(píng)法和他評(píng)法，發(fā)現(xiàn)該患者為輕度焦慮，針對(duì)患者的擔(dān)心問題，醫(yī)師給予詳細(xì)的講解，打消其顧慮。(4)Throughthepsychologicalquestionnaireself-assessmentandotherassessmentmethod,itwasfoundthatthepatientwasmildlyanxious,andthedoctorgaveadetailedexplanationtothepatient'sworriestodispelhisconcerns.(5)患者經(jīng)常需要使用電腦、手機(jī)等電子產(chǎn)品，可以使用電腦和手機(jī)的放大軟件及使用大字體來幫助改善視覺效果。(5)Patientsoftenneedtousecomputers,mobilephonesandotherelectronicproducts,theycanusethecomputerandmobilephonemagnificationsoftwareanduselargefontstohelpimprovethevisualeffect.教學(xué)病例討論Teachingcases

疾病介紹Introductiontodisease第三部分

Part3三、疾病介紹Diseaseintroduction病理性近視是因眼軸過度增長(zhǎng)而造成的眼底后極部損害為特征的高度近視，它有以下幾個(gè)特征：眼軸不斷增長(zhǎng)，眼球后極部向后擴(kuò)張形成后鞏膜葡萄腫；近視度數(shù)隨年齡增長(zhǎng)不斷增加；造成眼球后極部視網(wǎng)膜與脈絡(luò)膜的損害。Pathologicalmyopiaisahighmyopiacharacterizedbydamagetotheposteriorpoleofthefunduscausedbyexcessivegrowthoftheaxisoftheeye.Ithasthefollowingcharacteristics:theaxisoftheeyecontinuestogrow,andtheposteriorpoleoftheeyeballexpandsbackwardtoformposteriorscleralstaphyloma;Thedegreeofmyopiaincreasedwithage,

causingdamagetotheretinaandchoroidoftheposteriorpoleoftheeyeball.視力的減退可因并發(fā)性白內(nèi)障、視網(wǎng)膜脫離、脈絡(luò)膜新生血管等引起。病理性近視是我國(guó)引起低視力的主要病因之一，患者屈光度多在-10.00D以上甚至達(dá)-40.00D。我國(guó)是世界上近視眼最多的國(guó)家之一，目前我國(guó)高中生近視患病率達(dá)80%以上，病理性近視在人群中的患病率為1%～2%、隨著兒童青少年近視發(fā)病年齡提前、進(jìn)展增快，病理性近視的比率仍將上升，病理性近視導(dǎo)致的低視力風(fēng)險(xiǎn)也隨之增加。Thelossofvisioncanbecausedbycomplicatedcataract,retinaldetachment,choroidalneovascularizationandsoon.PathologicalmyopiaisoneofthemaincausesoflowvisioninChina,andthediopterofpatientsismorethan-10.00Doreven-40.00D.Chinaisoneofthemostnearsightedcountriesintheworld,atpresent,theprevalenceofmyopiainhighschoolstudentsinourcountryismorethan80%,theprevalenceofpathologicalmyopiainthepopulationis1%~2%,withtheonsetofmyopiainchildrenandadolescents,therateofpathologicalmyopiawillcontinuetorise,andtheriskoflowvisioncausedbypathologicalmyopiawillalsoincrease.低視力特點(diǎn)Characteristicsoflowvision這些患者由于戴高屈光度的負(fù)透鏡，而使得視網(wǎng)膜成像顯著縮小、看遠(yuǎn)處物體時(shí)似乎更遠(yuǎn)一些，屈光不正-10.00D以上時(shí)，視網(wǎng)膜成像顯著縮小、發(fā)生辨認(rèn)困難，因而有些患者不愿意接受眼鏡。若出現(xiàn)眼底等病變，矯正視力無法提高。Thesepatientsworenegativelenseswithhighdiopter,whichmadetheretinalimagesignificantlysmallerandappearedfartherawayfromdistantobjects,refractiveerrorsexceeding-10.00Dresultinsignificantretinalimagingreduction,leadingtodifficultiesinrecognition.病理性近視后期，各種并發(fā)癥導(dǎo)致矯正視力無法提高。Advancedstagesofpathologicalmyopiacancausecomplicationsthatpreventimprovementincorrectedvision.不戴鏡可獲得較好的近視力，但患者的遠(yuǎn)點(diǎn)太近，如-15.00D的近視，遠(yuǎn)點(diǎn)在眼前6.7cm,長(zhǎng)時(shí)間在6.7cm距離近讀易發(fā)生疲勞和工作不便。Goodmyopiamightbeattainablewithoutglasses,farpointsintheaffectedeyearetooclose.Forinstance,with-15.00Dmyopia,thefarpointisapproximately6.7cminfrontoftheeye,causingfatigueandinconvenienceduringprolongedclosereadingwithadistanceof6.7cminfrontoftheeye.屈光矯正原則Theprincipleofrefractivecorrection病理性近視所致的低視力在康復(fù)方面的首要措施是仔細(xì)進(jìn)行屈光檢查，配戴合適的眼鏡，改善遠(yuǎn)視力。Thefirststepsinrehabilitationoflowvisionduetopathologicalmyopiaaretaking