青少年近视眼配戴RGPCL、Ortho—K及框架眼镜一年后调节滞后的差异

Comparison of accommodative lag in pre-adolescent myopes one year after wearing rigid gas permeable contact lenses, orthokeratology lenses or spectacles

目的探讨青少年近视眼配戴硬性透气性角膜接触镜（rigid gas permeable contact lens，RGPCL）、角膜塑型镜（orthokeratology，Ortho—K，OK镜）及框架眼镜后调节滞后的差异。方法70名（70眼）9～14岁中低度青少年近视眼患儿，行医学验光、角膜曲率、角膜地形图检查后，根据检查结果、患儿及家长依从性等综合评估，对其中25名患儿选择配戴RGPCL，25名患儿配戴Ortho—K，其余20名患儿配戴框架眼镜。配戴期间每3个月复查1次，1年以后测定RGPCL组戴镜屈光度、Ortho—K组脱镜后的残余屈光度及框架眼镜组的屈光度．并使用开放视野型红外验光仪测量其在2～5D调节刺激下的调节反应．计算相对应的调节滞后和调节反应／刺激（AR／AS）斜率。对相关数据采用单因素方差分析的LSD检验。结果总共有57人完成测量。在2D调节刺激水平下，RGPCL、Ortho—K和框架眼镜组的调节滞后值间差异无统计学意义（P〉0．05）；在3D、4D、5D调节刺激水平下，3组问的调节滞后值差异均具有统计学意义（F=4．373，P〈0．05；F=5．833，P〈0．01；F=6．157，P〈0．01），Ortho—K组的调节滞后值最小，RGPCL组次之，而框架眼镜组的调节滞后值最大。调节反应／刺激（AR／AS）斜率也呈现同样趋势，但3组间差异无统计学意义（P〉0．05）。结论配戴RGPCL和Ortho—K1年后，患儿在高调节需求时的调节滞后值明显低于框架眼镜组，其在延缓青少年近视进展中可以起到积极的作用。

Objective To discuss the differences in accommodative lag between pre-adolescent myopes who wore rigid gas pernleable contact lenses （RGPCL）, orthokeratology （Ortho-K） lenses or spectacles for a year. Methods Seventy pre-adolescent myopes aged 9 to 14 years were enrolled in the study. Every subject was measured for refraction with MPMVA, corneal curvature radius and corneal topography. Twenty-five subjects were selected to wear RGPCL, 25 subjects were chosen to wear Ortho-K lenses and the other 20 subjects wore spectacles. According to the above measurements and the compliance of children and their parents. Regular after-care visits were made at 3-month intervals. Accommodative response （AR） was measured with an open field infrared autorefractor （WAM- 5500） in accommodative stimulus （AS） level of 2-5 D after one year. Accommodative lag and the AR/ AS slope were calculated by statistical methods. Results Fifty-seven subjects completed the experiment. The resuhs demonstrate no significant difference in accommodative lag between RGPCL, Ortbo- K lens and spectacle wearers for the 2 D AS level （P〉0.05）, while for the 3 D, 4 D and 5 D AS levels, there were significant differences in accommodative lag among the three groups （F=4.373, P〈 0.05; F=5.833, P〈0.01; F=6.157, P〈0.01）, the smallest for Ortho-K, then RGPCL. The AR/AS slope demonstrated the same trend with accommodative lag, but the differences were not significant （P〉0.05）. Conclusion Compared to spectacles, there is an obvious decrease in accommodative lag in pre-adolescent myopes one year after wearing RGPCL and Ortho-K lenses, which strongly suggests that RGPCL and Ortho-K lenses can control the development of myopia in pre-adolcscents.