角膜塑形镜对不同屈光度青少年近视患者的疗效分析
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摘要
目的探索夜戴型角膜塑形镜(orthokeratology,OK镜)对不同屈光度青少年近视患者的临床效果及安全性。方法收集眼科视光门诊162例(其中单眼佩戴患者23例,共301只眼),按等效球镜度数分为3组,分别为A组(98眼,-0.50~-2.00 D)、B组(155眼,-2.25~-4.00 D)及C组(48眼,-4.25~-6.00 D)。观察患者每晚配戴7.5~10 h OK镜后临床效果,记录、分析戴镜前及戴镜6、12个月后3组裸眼视力、眼轴、角膜曲率、角膜中央厚度、角膜内皮细胞密度变化及裂隙灯检查眼部情况。结果 3组患者戴镜6、12个月后,裸眼视力均较戴镜前显著提高(P<0.001)。戴镜12个月后,3组间视力增加值差异有统计学意义(P<0.001);戴镜后6、12个月后,各组中央角膜曲率平K值(flat kerotometry,FK)、陡K值(steep kerotometry,SK)较戴镜前差异均有统计学意义(P<0.001)。戴镜12个月后,A组中央角膜FK、SK值与B组及C组相比,差异有统计学意义(P<0.001),而B组与C组间FK、SK值差异无统计学意义(P>0.05);戴镜6、12个月后,A组眼轴与戴镜前比较,差异有统计学意义(P<0.001),而B与C组眼轴与戴镜前比较,差异无统计学意义(P>0.05)。戴镜12个月后,B、C组眼轴增长值与A组差异均有统计学意义(P<0.001),而B组与C组差异无统计学意义(P>0.05)。戴镜6、12个月后,3组患者角膜中央厚度、内皮细胞密度较戴镜前无明显变化(P>0.05);A、B、C组轻度角膜点状着染分别为3例(3.06%)、21例(13.46%)、10例(20.83%)。结论OK镜控制青少年近视发展是有效且安全的,对屈光度在-2 D以上青少年患者近视发展控制效果较好。
Objective To evaluate the efficacy and the safety of orthokeratology( OK) in adolescent myopia with different diopter. Methods One hundred and sixty-two adolescents with myopia( 301 eyes),68 males and 94 females were enrolled in the study. According to the equivalent spherical degree,there were 98 eyes with-0. 50--2. 00 D( group A),155 eyes with-2. 25--4. 00 D( group B) and 48 eyes with 4. 25--6. 00 D( group C). The patients wore OK lens 7. 5-10 h every night.The uncorrected eyesight,axial length,corneal keratometry,corneal thickness,corneal endothelial cell change and slit lamp examination before and 6,12 months after wearing OK lens were documented and analyzed. Results The uncorrected visual acuity was significant increased after wearing lenses for6 and 12 months in all three groups( P < 0. 001); while there was significant difference in the increased value of visual acuity among three groups( P<0. 001). There were significant differences in central corneal flat keratometry( FK) and steep keratometry( SK) before and 6,12 months after wearing OK lens in all three groups( P<0. 001). There were significant differences in FK and SK 12 months after wearing OK lens between group A and group B,between group A and group C( P< 0. 001); while but there was no significant difference between group B and group C( P >0. 05). There was significant difference in eye axis of group A before and after wearing OK lens for 6 and 12 months( P<0. 001); but there was no significant difference in group B and group C( P>0. 05). There was significant difference in the increase of axial length after wearing OK lens between group A and group B,between group A and group C( P < 0. 001),but no difference between group B and group C( P > 0. 05). There was no significant difference in central corneal thickness and corneal endothelial cell change before and after wearing OK lens in all three groups( P > 0. 05). There were 34 cases of positive corneal fluorescein staining after 12 months of wearing OK lens: 3 cases in group A( 3. 06%),21 in group B( 13. 46%) and 10 in group C( 20. 83%). Conclusion Wearing OK lens is effective and safe to control the development of adolescent myopia,and it has better effect for myopia patients with the diopter over-2D.
Objective To evaluate the efficacy and the safety of orthokeratology( OK) in adolescent myopia with different diopter. Methods One hundred and sixty-two adolescents with myopia( 301 eyes),68 males and 94 females were enrolled in the study. According to the equivalent spherical degree,there were 98 eyes with-0. 50--2. 00 D( group A),155 eyes with-2. 25--4. 00 D( group B) and 48 eyes with 4. 25--6. 00 D( group C). The patients wore OK lens 7. 5-10 h every night.The uncorrected eyesight,axial length,corneal keratometry,corneal thickness,corneal endothelial cell change and slit lamp examination before and 6,12 months after wearing OK lens were documented and analyzed. Results The uncorrected visual acuity was significant increased after wearing lenses for6 and 12 months in all three groups( P < 0. 001); while there was significant difference in the increased value of visual acuity among three groups( P<0. 001). There were significant differences in central corneal flat keratometry( FK) and steep keratometry( SK) before and 6,12 months after wearing OK lens in all three groups( P<0. 001). There were significant differences in FK and SK 12 months after wearing OK lens between group A and group B,between group A and group C( P< 0. 001); while but there was no significant difference between group B and group C( P >0. 05). There was significant difference in eye axis of group A before and after wearing OK lens for 6 and 12 months( P<0. 001); but there was no significant difference in group B and group C( P>0. 05). There was significant difference in the increase of axial length after wearing OK lens between group A and group B,between group A and group C( P < 0. 001),but no difference between group B and group C( P > 0. 05). There was no significant difference in central corneal thickness and corneal endothelial cell change before and after wearing OK lens in all three groups( P > 0. 05). There were 34 cases of positive corneal fluorescein staining after 12 months of wearing OK lens: 3 cases in group A( 3. 06%),21 in group B( 13. 46%) and 10 in group C( 20. 83%). Conclusion Wearing OK lens is effective and safe to control the development of adolescent myopia,and it has better effect for myopia patients with the diopter over-2D.
引文
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[10]郭曦,谢培英.青少年近视眼患者配戴角膜塑形镜七年的角膜厚度和内皮观察[J].中华眼科杂志,2014,50(1):9-13.
[11]NIETO-BONA A,GONZALEZ-MESA A,NIETOBONA M P,et al.Short-term effects of overnight orthokeratology on corneal cell morphology and corneal thickness[J].Cornea,2011,30(6):646-654.
[12]韦丽娇,谢祥勇,何碧华,等.配戴角膜塑形镜的并发症及其安全性的观察[J].临床眼科杂志,2013,21(5):461-464.
[13]张进,冯江松.角膜塑形镜矫正近视的疗效及并发症情况[J].国际眼科杂志,2017,17(4):724-726.
[2]LIU Y,WILDSOET C.The effect of two-zone concentric bifocal spectacle lenses on refractive error development and eye growth in young chicks[J].Invest Ophthalmol Vis Sci,2011,52(2):1078-1086.
[3]郭曦,杨丽娜,谢培英.角膜塑形镜治疗青少年近视的远期效果[J].眼科,2012,21(6):371-374.
[4]肖宏,柯新.青少年近视患者配戴夜戴型角膜塑形镜的疗效观察[J].国际眼科杂志,2015(7):1230-1233.
[5]WALLINE J J.Myopia control:a review[J].Eye Contact Lens,2016,42(1):3-8.
[6]ZHONG Y,CHEN Z,XUE F,et al.Corneal power change is predictive of myopia progression inorthokeratology[J].Optom Vis Sci,2014,91(4):404-411.
[7]褚仁远,谢培英.现代角膜塑形学[M].北京:北京大学医学出版社,2006.
[8]WANG B,NAIDU R K,QU X.Factors related to axial length elongation and myopia progression in orthokeratology practice[J].PLoS One,2017,12(4):e0175913.
[9]杜亚茹,梁秀玮,于靖,等.角膜塑形镜对青少年中低度近视患者角膜厚度和角膜内皮的影响[J].同济大学学报(医学版),2017,38(3):66-69.
[10]郭曦,谢培英.青少年近视眼患者配戴角膜塑形镜七年的角膜厚度和内皮观察[J].中华眼科杂志,2014,50(1):9-13.
[11]NIETO-BONA A,GONZALEZ-MESA A,NIETOBONA M P,et al.Short-term effects of overnight orthokeratology on corneal cell morphology and corneal thickness[J].Cornea,2011,30(6):646-654.
[12]韦丽娇,谢祥勇,何碧华,等.配戴角膜塑形镜的并发症及其安全性的观察[J].临床眼科杂志,2013,21(5):461-464.
[13]张进,冯江松.角膜塑形镜矫正近视的疗效及并发症情况[J].国际眼科杂志,2017,17(4):724-726.