棱镜组合式透镜对中国儿童近视发展的影响作用

The effectiveness of prisms combined with plus lenses on the progression of myopia in Chinese children

目的研究棱镜组合式透镜对中国儿童近视发展的影响及其安全性与适应性。方法前瞻性研究。招募171例7—13岁广州市近视儿童（基础等效球镜度在-0．50D至-3．00D范围内、无近视家族史），分为单光镜组89例、棱镜1组（下加＋1．5D）40例、棱镜2组（下加＋2．0D）42例3组。所有实验对象在配戴初、6、12、18、24个月后进行电脑验光、散瞳检影、A超眼轴长度测定及眼位测量，棱镜1组与棱镜2组进行相关眼动参数的测量。对所得数据进行t检验、方差分析、Kruskal-Wallis H检验、多重线性回归及Logistic回归等统计学分析。结果共有78．4％患者（134例）完成2年随访。3组病人远隐斜改变量依次为（0．22±1．97）△、（0．29±3．01）△、（0．13±2．16）△（F=2．00，P组间〈0．01；F=0．71，P时间〉0．05）。3组病人屈光度增长数值依次为（-1．50±0．67）D、（-1．18±0．60）D、（-1．04±0．66）D（F=6．43，P〈0．01），棱镜2组的组别是具有统计学意义的影响因素。眼轴增长值依次为（0．74±0．43）mm、（0．44±0．38）mm、（0．42±0．30）mm（H=17．43，P〈0．01），棱镜1组与棱镜2组组别及年龄是具有统计学意义的影响因素。结论与单光镜相比，下加＋2．00D的棱镜组合式透镜在控制近视增长方面有显著性差异，这种差异与眼轴长度相关。棱镜组合式透镜对远近眼位无明显影响，但患者的依从性较单光镜差。棱镜组合式透镜的长期作用有待于进一步的临床观察。

Objective To evaluate the effectiveness, safety and adaptability of prisms combined with plus lenses （PCPLs） on the progression of myopia in Chinese children. Methods One hundred seventy-one myopic Chinese children （ages 7-13, -0.50 to -3.00 D spherical refractive error） in the city of Guangzhou city whose parents did not have moderate or high myopia were enrolled in a 2 year prospective study. The children were assigned to 1 of 3 treatments： （1）single vision lens （SVLs） （n=89）; （2）PCPLs 1 （with ＋1.5 D add） （n=40） or （3）PCPLs 2 （with ＋2.00 D add） （n=42）. The primary outcomes, that included myopic progression, ocular biometry and heterophoria status, were assessed every 6 months. Results 75/89 children in the SVL group, 28/40 in the PCPL 1 group and 31/42 in the PCPL 2 group completed the two-year study. The changes in phoria at distance were 0.22±1.97△, 0.29±3.01△ and 0.13±2.16△ （P gorup =0.17, P time 〈0.01）, respectively. The SER changes in the respective groups with SVLs, PCPLs 1 and PCPLs 2 were -1.50±0.67 D, -1.18±0.60 D and -1.04±0.66 D （P〈0.01）, with axial length elongations of 0.74±0.43 mm, 0.44±0.38 mm and 0.42±0.30 mm （P〈0.01）. Conclusion The results of the two-year study show that, compared with SVLs, PCPLs can slow myopia progression and reduce the elongation of axial length. The adaptability to PCPLs is lower than SVLs and has no clinical effect on distance phoria. However, the long-term effect of PCPLs needs further study.