长期过夜配戴角膜塑形镜对中小学生的近视进展及眼部安全性影响的临床观察
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摘要
目的探讨长期过夜配戴角膜塑形镜对中小学生的近视进展及眼部安全性的影响。方法选择2013年8月在我院验配角膜塑形镜的近视者20例(40只眼),平均年龄(10. 99±1. 43)岁,平均等效球镜(-3. 46±1. 85) D,总体平均随访期为(4. 76±0. 23)年。于配镜前、配戴1 d、配戴1周、配戴1月及以后每3个月复查1次。每次检查内容包括:(1)裸眼视力、(2)裂隙灯(含镜片配适)、(3)角膜地形图。每戴镜满6个月,加做IOLMaster;每戴镜满1年,加做角膜内皮细胞计数、泪液分泌试验、眼压。比较戴镜前和戴镜(4. 76±0. 23)年后各检查项目的差异。结果 (1)所有试验眼的平均眼轴增长量为(0. 20±0. 019) mm/年,(4. 76±0. 23)年的总体平均眼轴增长量为(0. 95±0. 09) mm;(2)所有试验眼白天的裸眼视力均较好,平均为0. 86±0. 13;(3)浅层点状角膜病变的发生率为35%,均在短期使用人工泪液后消失;(4)镜片偏位的发生率为15%,均未引起明显裸眼视力异常,在换片时通过调整镜片参数得以改善;(5)相比戴镜前,其角膜内皮细胞计数(t=-0. 546,P=0. 59)、泪液分泌试验结果(t=0. 547,P=0. 59)及眼压(t=-0. 154,P=0. 88)均没有统计学意义的改变。结论本文的研究结果,在一定程度上提示了长期配戴角膜塑形镜的近视控制效果及眼部安全性,如何进一步探讨影响其发挥近视控制效果的因素、对比研究其针对不同地区青少年近视者的长期配戴的效果及安全性、及对比角膜塑形镜与其他近视控制措施的作用高低等,都是未来的研究方向。
Objective To investigate effect of long-term( 4. 5-5 years) overnight wearing of orthokeratology lenses on progression of myopia and ocular safety in adolescents. Methods Twenty patients( 40 eyes) with myopia who underwent orthokeratology in our hospital in August 2013 were selected. The average age was( 10. 99 ± 1. 43) years and the average equivalent spherical lens(-3. 46 ± 1. 85) D. The average follow-up period was( 4. 76 ± 0. 23) years. All the 40 eyes received examinations before wearing orthokeratology lens,wearing 1 day,1 week,I month and every 3 months after then,included:( 1) vision acuity( 2) slit lamp( including lens fit)( 3) corneal topography. IOL Master was tested every6 months,corneal endothelial cell counting,tear secretion test and intraocular pressure were added every 1 year of wearing.Results( 1) The average axial growth was( 0. 20 ± 0. 019) mm/per year,with a total axial growth of( 0. 95 ± 0. 009)mm in( 4. 76 ± 0. 23) year;( 2) The visual acuity of all eyes was good,with an average of 0. 86 ± 0. 13;( 3) The incidence of superficial punctate keratopathy was 35%,which disappeared after short-term use of artificial tears;( 4) The incidence of lens deviation was 15%,which did not cause obvious visual acuity loss and was improved by adjusting lens parameters during the lens replacement;( 5) There was no statistically significant change in the corneal endothelial cell count( t=-0. 546,P = 0. 59),results of tear secretion test( t = 0. 547,P = 0. 59) and intraocular pressure( t =-0. 154,P= 0. 88). Conclusions To some extent,the results of our study supported the myopia control effect and eye safety of longterm wearing orthokeratology lenses. Furthermore,studying the factors affecting effect of myopia control,comparative studying concerning effect and safety of long-term wearing orthokeratology lenses in myopia adolescents living in different areas,and comparison of orthokeratology lenses and other myopia control measures,are the future research directions.
Objective To investigate effect of long-term( 4. 5-5 years) overnight wearing of orthokeratology lenses on progression of myopia and ocular safety in adolescents. Methods Twenty patients( 40 eyes) with myopia who underwent orthokeratology in our hospital in August 2013 were selected. The average age was( 10. 99 ± 1. 43) years and the average equivalent spherical lens(-3. 46 ± 1. 85) D. The average follow-up period was( 4. 76 ± 0. 23) years. All the 40 eyes received examinations before wearing orthokeratology lens,wearing 1 day,1 week,I month and every 3 months after then,included:( 1) vision acuity( 2) slit lamp( including lens fit)( 3) corneal topography. IOL Master was tested every6 months,corneal endothelial cell counting,tear secretion test and intraocular pressure were added every 1 year of wearing.Results( 1) The average axial growth was( 0. 20 ± 0. 019) mm/per year,with a total axial growth of( 0. 95 ± 0. 009)mm in( 4. 76 ± 0. 23) year;( 2) The visual acuity of all eyes was good,with an average of 0. 86 ± 0. 13;( 3) The incidence of superficial punctate keratopathy was 35%,which disappeared after short-term use of artificial tears;( 4) The incidence of lens deviation was 15%,which did not cause obvious visual acuity loss and was improved by adjusting lens parameters during the lens replacement;( 5) There was no statistically significant change in the corneal endothelial cell count( t=-0. 546,P = 0. 59),results of tear secretion test( t = 0. 547,P = 0. 59) and intraocular pressure( t =-0. 154,P= 0. 88). Conclusions To some extent,the results of our study supported the myopia control effect and eye safety of longterm wearing orthokeratology lenses. Furthermore,studying the factors affecting effect of myopia control,comparative studying concerning effect and safety of long-term wearing orthokeratology lenses in myopia adolescents living in different areas,and comparison of orthokeratology lenses and other myopia control measures,are the future research directions.
引文
[1]Javitt JC,Chiang YP.The socio-economic aspects of laser refractive surgery[J].Arch Ophthalmol,1994,112:1526-1530.
[2]Dandona R,Dandona L.Refractive error blindness[J].Bull World Health Organ,2001,79(3):237-243.
[3]Mc Carty CA.Uncorrected refractive error[J].Br J Ophthalmol,2006,90:521-522.
[4]Holden BA,Fricke TR,Wilson DA,et al.Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through2050[J].Ophthalmol,2016,123(5):1036-1042.
[5]MH Nowroozzadeh.School-based myopia porevention effort[J].AMA,2016,15(8):819.
[6]Liu HH,Xu L,ang YX,et al.revalence and progression of myopic retinopathy in Chinese adults:the Beijing Eye Study[J].Ophthalmol,2010,117(9):1763-1768.
[7]Wang TJ,Chiang TH,Wang TH,et al.Changes of the ocular refraction among freshmen in National Taiwan University between 1988and 2005[J].Eye(Lond),2009,23(5):1168-1169.
[8]Aller TA,Wildsoet C.Bifocal soft contact lenses as a possible myopia control treatment:a case report involving identical twins[J].Clin Exp Optom,2008,91(4):394-399.
[9]Katz J,Schein OD,Levy B,et al.A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia[J].Am J Ophthalmol,2003,136(1):82-90.
[10]Walline JJ,Jones LA,Mutti DO,et al.A randomized trial of the effects of rigid contact lenses on myopia progression[J].Arch Ophthalmol,2004,122(12):1760-1766.
[11]Leung JT,Brown B.Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses[J].Optom Vis Sci,1999,76(6):346-354.
[12]Yang Z,Lan W,Ge J,et al.The effectiveness of progressive addition lenses on the progression of myopia in Chinese children[J].Ophthalmic Physiol Opt,2009,29(1):41-48.
[13]Chia C,Chua WH,Cheung YB,et al.Atropine for the treatment ofchildhood myopia:safety and efficacy of 0.5%,0.1%and0.01%doses(atropine for the treatment of myopia 2)[J].Ophthalmol,2012,119:347-354.
[14]Siatkowski RM,Cotter SA,Crockett RS,et al.Two-year multicenter,randomized,double-masked,placebo-controlled,parallel safety and efficacy study of 2%pirenzepine ophthalmic gel in children with myopia[J].J AAPOS,2008,12(4):332-339.
[15]Tan DT,Lam DS,Chua WH,et al.One-year multicenter,doublemasked,placebo-controlled,parallel safety and efficacy study of2%pirenzepine ophthalmic gel in children with myopia[J].Ophthalmology,2005,112(1):84-91.
[16]Swarbrick HA.Orthokeratology review and update[J].Clin Exp Optom,2006,89(3):124-143.
[17]Lee YC,Wang JH,Chiu CJ.Effect of Orthokeratology on myopia progression:twelve-year results of a retrospective cohort study[J].BMC Ophthalmol,2017,17(1):243.
[18]Caroline PJ.Contemporary orthokeratology[J].Cont Lens Anterior Eye,2001,24(1):41-46.
[19]Cheung SW,Cho P,Chui WS,et al.Refractive error and visual acuity changes in orthokeratology patients[J].Optom Vis Sci,2007,84(5):410-416.
[20]Walline JJ,Jones LA,Sinnott LT.Corneal reshaping and myopia progression[J].Br J Ophthalmol,2009,93(9):1181-1185.
[21]Kakita T,Hiraoka T,Oshika T.Influence of overnight orthokeratology on axial elongation in childhood myopia[J].Invest Ophthalmol Vis Sci,2011,52(5):2170-2174.
[22]Fan Q,Teo YY,Saw SM.Application of advanced statistics in ophthalmology[J].Invest Ophthalmol Vis Sci,2011,52(9):6059-6065.
[23]Donovan L,Sankaridurg P,Ho A,et al.Myopia progression rates in urban children wearing single-vision spectacles[J].Optom Vis Sci,2012,89(1):27-32.
[24]He M,Du Y,Liu Q,et al.Effects of orthokeratology on the progression of low to moderate myopia in Chinese children[J].BMCOphthalmol,2016,16:126.
[25]Hiraoka T,Kakita T,Okamoto F,et al.Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia:a 5-year follow-up study[J].Invest Ophthalmol Vis Sci,2012,53(7):3913-3919.
[26]Gwiazda J,Hyman L,Hussein M,et al.A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children[J].Invest Ophthalmol Vis Sci,2003,44(4):1492-1500.
[2]Dandona R,Dandona L.Refractive error blindness[J].Bull World Health Organ,2001,79(3):237-243.
[3]Mc Carty CA.Uncorrected refractive error[J].Br J Ophthalmol,2006,90:521-522.
[4]Holden BA,Fricke TR,Wilson DA,et al.Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through2050[J].Ophthalmol,2016,123(5):1036-1042.
[5]MH Nowroozzadeh.School-based myopia porevention effort[J].AMA,2016,15(8):819.
[6]Liu HH,Xu L,ang YX,et al.revalence and progression of myopic retinopathy in Chinese adults:the Beijing Eye Study[J].Ophthalmol,2010,117(9):1763-1768.
[7]Wang TJ,Chiang TH,Wang TH,et al.Changes of the ocular refraction among freshmen in National Taiwan University between 1988and 2005[J].Eye(Lond),2009,23(5):1168-1169.
[8]Aller TA,Wildsoet C.Bifocal soft contact lenses as a possible myopia control treatment:a case report involving identical twins[J].Clin Exp Optom,2008,91(4):394-399.
[9]Katz J,Schein OD,Levy B,et al.A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia[J].Am J Ophthalmol,2003,136(1):82-90.
[10]Walline JJ,Jones LA,Mutti DO,et al.A randomized trial of the effects of rigid contact lenses on myopia progression[J].Arch Ophthalmol,2004,122(12):1760-1766.
[11]Leung JT,Brown B.Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses[J].Optom Vis Sci,1999,76(6):346-354.
[12]Yang Z,Lan W,Ge J,et al.The effectiveness of progressive addition lenses on the progression of myopia in Chinese children[J].Ophthalmic Physiol Opt,2009,29(1):41-48.
[13]Chia C,Chua WH,Cheung YB,et al.Atropine for the treatment ofchildhood myopia:safety and efficacy of 0.5%,0.1%and0.01%doses(atropine for the treatment of myopia 2)[J].Ophthalmol,2012,119:347-354.
[14]Siatkowski RM,Cotter SA,Crockett RS,et al.Two-year multicenter,randomized,double-masked,placebo-controlled,parallel safety and efficacy study of 2%pirenzepine ophthalmic gel in children with myopia[J].J AAPOS,2008,12(4):332-339.
[15]Tan DT,Lam DS,Chua WH,et al.One-year multicenter,doublemasked,placebo-controlled,parallel safety and efficacy study of2%pirenzepine ophthalmic gel in children with myopia[J].Ophthalmology,2005,112(1):84-91.
[16]Swarbrick HA.Orthokeratology review and update[J].Clin Exp Optom,2006,89(3):124-143.
[17]Lee YC,Wang JH,Chiu CJ.Effect of Orthokeratology on myopia progression:twelve-year results of a retrospective cohort study[J].BMC Ophthalmol,2017,17(1):243.
[18]Caroline PJ.Contemporary orthokeratology[J].Cont Lens Anterior Eye,2001,24(1):41-46.
[19]Cheung SW,Cho P,Chui WS,et al.Refractive error and visual acuity changes in orthokeratology patients[J].Optom Vis Sci,2007,84(5):410-416.
[20]Walline JJ,Jones LA,Sinnott LT.Corneal reshaping and myopia progression[J].Br J Ophthalmol,2009,93(9):1181-1185.
[21]Kakita T,Hiraoka T,Oshika T.Influence of overnight orthokeratology on axial elongation in childhood myopia[J].Invest Ophthalmol Vis Sci,2011,52(5):2170-2174.
[22]Fan Q,Teo YY,Saw SM.Application of advanced statistics in ophthalmology[J].Invest Ophthalmol Vis Sci,2011,52(9):6059-6065.
[23]Donovan L,Sankaridurg P,Ho A,et al.Myopia progression rates in urban children wearing single-vision spectacles[J].Optom Vis Sci,2012,89(1):27-32.
[24]He M,Du Y,Liu Q,et al.Effects of orthokeratology on the progression of low to moderate myopia in Chinese children[J].BMCOphthalmol,2016,16:126.
[25]Hiraoka T,Kakita T,Okamoto F,et al.Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia:a 5-year follow-up study[J].Invest Ophthalmol Vis Sci,2012,53(7):3913-3919.
[26]Gwiazda J,Hyman L,Hussein M,et al.A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children[J].Invest Ophthalmol Vis Sci,2003,44(4):1492-1500.