S型角膜塑形镜矫正青少年近视的临床观察

Clinical observation of S-Curve design for orthokeratology correcting myopia in adolescents

目的观察并探讨S型角膜塑形镜对近视度数高（-6．00D〈等效球镜≤-8．00D）和角膜曲率低（39．00D≤平坦K〈41．00D）的青少年近视矫正和控制的临床效果。方法将青少年近视患者90例（90只眼）分为高度近视组30例（30只眼）、低角膜曲率组30例（30只眼）和常规型角膜塑形镜矫正组30例（30只眼）。高度近视组和低角膜曲率组配戴S型角膜塑形镜，常规矫正组配戴普通设计的角膜塑形镜，夜间戴镜8～10h。观察戴镜后1d，1周，1个月，3个月，6个月患者裸眼视力（UCVA）、屈光度、角膜曲率和眼轴长度的变化情况。对相关数据进行配对样本f检验和随机区组方差分析。结果三组患者戴镜6个月UCVA比戴镜前均显著提高（t=2．012、3．134、4．221；P均〈0．01），常规矫正组戴镜1个月视力达到稳定，高度近视组和低角膜曲率组戴镜3个月视力达到稳定。三组患者戴镜1周屈光度（等效球镜）均比戴镜前降低，差异有统计学意义（t：5．053、7．235、8．123；P均〈0．01），第1周内常规矫正组比高度近视组和低角膜曲率组屈光度降低快。三组患者戴镜1周角膜曲率均比戴镜前降低（t=5．245、14．332、11．223；P均〈0．01），常规矫正组戴镜第1周内下降最快，1个月后变化趋于稳定，高度近视组和低角膜曲率组戴镜1个月内下降最快，3个月后趋于稳定。三组患者戴镜6个月时眼轴长度的改变量之间差异无统计学意义（F=52．123，P〉0．05）。结论S型角膜塑形镜能够安全有效地矫正高度近视和低角膜曲率青少年的近视状态，并能够在-定程度上控制近视进展。

Objective To observe and evaluate the effect of S-Curve design for orthokeratology on correction of refractive error for adolescents with high myopia （-6.00D〈equivalent sphere lense〈 -8.00D） and low corneal curvature （39.00D~〈flat K〈41.00D）. Methods In this study, 90 teenagers （90 eyes） with myopia were included. They were divided into three groups, high myopia group （30 eyes）, low corneal curvature group （30 eyes） and general design for orthokeratology group （30 eyes）. High myopia group and low corneal curvature group were corrected by S-Curve design for orthokera- tology, general design for orthokeratology group were corrected by general design for orthokeratolo- gy. All patients were fitted with ovemight orthokeratology for 8-10h. UCVA, diopter, corneal curva- ture, axial length （AL） were measured at pre-wear and 1 day, 1 week, 1 month, 3 months, 6 months after orthokeratology. Data were analyzed with a paired t test and randomized block ANO- VA. Results UCVA of three groups increased significantly at 6-month visit （t =2.012, t =3.134, t = 4.221; P 〈0.01）, general design for orthokeratology group became stable after 1-month lens wearing, the other two groups got stable UCVA at 3-month following. Refraction （equivalent sphere lens） of all wearers decreased at 1-week visit （t =5.053, t =7.235, t =8.123; P 〈0.01）, general design for or- thokeratology group decreased more quickly. Corneal curvature of all wearers decreased at 1-weekvisit （t =5.245, t =14.332, t =11.223; P 〈0.01）, general design for orthokeratology group decreased fastest within the first week and almost did not change after 1-month lens wearing. High myopia group and low corneal curvature group decreased fastest within the first month and reached the sta- ble level at 3-month visit. The changes of AL did not show significant differences among three groups at 6 months after wearing orthokeratology lenses （F =52.123, P 〉0.05）. Conclusions S-Curve design for orthokeratology can correct myopia and reduce myopia progression for adoles- cents with high myopia and low corneal curvature effectively and safely.