Twardówka jako tkanka docelowa w postępującej krótkowzroczności

SUMMARY Introduction: The aim of the study was to study the eye cor- neoscleral shell and connective tissue (CT) system in children with acquired and congenital progressive myopia, and to iden- tify the informative diagnostic criteria of weakened supporting function of the sclera. Material and methods: 155 children aged 9-17 were examined: 18 had emmetropia or hyperopia, 20 - low, 32 - moderate and 85 - high myopia. 32 children had complicated myopia (CM) due to peripheral retinal degeneration (PRD). Corneal hysteresis (CH), scleral acoustic density (SAD), X -ray vertebral topogra- phy, plantography, joint hypermobility, serum cortisol (SC), and autonomic balance were measured. Results: Corneal hysteresis, mmHg and SAD, rel. units (mean ±SE) were lower if myopia was higher: in low myopia, CH was 13.0 ±0.3, in moderate myopia, 11.9 ±0.3#, in high myopia, 10.7 ±0.3#; SAD was resp. 215.9 ±5.2, 204.9 ±3.7# and 192.8 ±5.8# (#: p < 0.05 with regard to low myopia). The lowest CH (10.3 ±0.4) and SAD (186.5 ±7.3) were found in acquired CM. Con- genital myopia with PRD showed CH and SAD greater than in acquired CM (p < 0.05). Serum cortisol (nmol/L) in hyperopia was 335.8 ±40.9 and dropped with higher myopia: in low myo- pia - 290.7 ±58.6, in moderate - 250.9 ±26.4, in high - 243.9 ±20.5. The lowest SC was found in acquired CM, consistent with CH and SAD. Connective tissue dysplasia progressed with higher myopia: it was found in 76.9% of children with low, 82.4% with moderate, 89.2% with high acquired myopia, and 91.7% with congenital myopia. Biomechanical defects of CT and hormonal imbalance were combined with vegetative nervous system (VNS) imbalance: in high myopia only 20.5% of children were eutonic, 61.5% - sympathicotonic and 17.5% parasympathicotonic. Conclusions: School age children with progressive myopia showed biomechanical abnormalities of the corneosclera, along with CT dysplasia, decreased SC and imbalanced VNS, more pronounced in acquired complicated myopia. Our findings con- tribute to the understanding of myopia pathogenesis and to the diagnostic/prognostic evaluation of myopic children, in par- ticular when deciding whether sclera -strengthening interven- tion is needed.