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

Corneal thickness and endothelial observation for youth myopia patients fitted with ortho-k lens for seven years

目的观察青少年近视眼患者长期配戴角膜塑形镜总体角膜厚度及角膜内皮的变化。方法回顾性病例系列研究。对2000年到2005年间在北京北医眼视光学研究中心验配角膜塑形镜且连续配戴7年及以上并可按时复查的30例青少年近视眼患者，均选择右眼进行研究统计（共30只眼），使用A超、角膜内皮显微镜等进行连续追踪检查，采集角膜厚度，角膜内皮细胞的细胞密度、平均细胞面积、变异系数、六角形细胞比率，角结膜并发症发生率等检测数据。选取其中22例患者分为两组，中低度组12例（24只眼），屈光度数≤-4．00D；偏高度组10例（20只眼），屈光度数≥-5．00D，比较两组间各项指标的差异。对戴镜前及戴镜后6个月、1年、3年、5年和7年的各参数进行单因素方差分析，同时对中低度和偏高度患者之间各参数进行方差分析。结果戴镜前角膜中央厚度检测值平均为（549．45±33．72）μm，戴镜7年后为（538．97±34．28）μm，差异无统计学意义（F=1．749，P=0．076）。鼻侧、上方、颞侧、下方的角膜厚度初诊与戴镜7年检测值比较，差异均无统计学意义。戴镜前角膜内皮细胞密度检测值为（3188．53±272．25）个／mm2，戴镜7年后为（3186．64±278．69）个／mm。，差异无统计学意义（F=2．204，P=0．088）。戴镜前六角型细胞比率检测值为66．18％±6．42％，戴镜7年后为64．65％±8．03％，差异无统计学意义（F=2．097，P=0．085）。戴镜7年期间平均细胞面积、变异系数变化均无统计学意义（F=2．143，2．114；P〉0．05）。中低度和偏高度近视眼患者长期配戴角膜塑形镜内皮细胞及总体角膜厚度亦无明显差异。戴镜期间1或2级角膜表层点染（发生率〈7％）等轻度角结膜并发症发生率较低，无严重并发症发生。结论青少年近视眼患者长期科学配戴设计合理的高透氧系数角膜塑形镜对角膜厚度及角膜内皮各项指标无明显影响，是一种安全的治疗方法。

Objective To observe the changes of the corneal thickness and ednothelial cell for youth myopia patients fitted with long-term orthokeratology （Ortho-K, OK）. Methods Retrospective case series study. During 2000 to 2005, 30 patients with OK lens wearing more than seven years in the Bei Yi Optometry ＆ Ophthalmology Center had been chose in this study, and all the right eye of each person was selected for retrospective case statistics （30 eyes）, the measure instruments, including A scan pachymeter and endothelium microscope, were used to the long-term continuous supervise, which involved the central and para-peripheral corneal thickness, corneal endothelium and corneal conjunetival complications rate. Then the 30 patients were divided into two groups ： the moderate-low myopia group is less than -4.00 D with 12 patients （24 eyes）, and the high myopia group is more than -5.00 D with 10 patients （20 eyes）. And the difference between two groups was involved in this research. The one-way analysis of variance was used to compare before, after six months, after one year, after three years, after five years and after seven years OK lens wearing for the patients. And the variance analysis was used to compare between moderate-low and high myopia groups. Results Corneal thickness analysis during these seven years： the average central corneal thickness before and after seven-years wearing are （ 549. 45 ＋ 33.72 ） and （ 538.97 ＋ 34. 28 ） μm, respectively, and the central corneal thickness had no significant changes （ F = 1. 749, P = 0. 076 ） ; Thecorneal thickness of nasal, superior, temporal and inferior also had no significant changes （ P 〉 0. 05 ）. The average corneal endothelial cell densities before and after seven-years wearing are （3188.53 -＋ 272. 25 ） and （3186. 64 ＋ 278.69） num/mm2, respectively, and the corneal endothelial cell density had no significant changes during seven years wearing （ F = 2. 204, P = 0. 088 ）. The average hexagonal cell ratio before and after seven-years wearing are 66. 18% -＋ 6.42% and 64. 65% ＋ 8.03% , respectively, and the hexagonal cell ratio had no significant changes during seven-years wearing （ F = 2. 097, P = 0. 085 ）. The average cell area and coefficient of variation also had no significant change during seven-years wearing （ F = 2. 143, 2. 114;P 〉0. 05）. There was also no statistics significance between moderate-low and high myopia of the endothelial cell and the corneal thickness change with long-term OK lens wearing. The slight corneal eonjunetival complication was occurred during seven-year wearing, such as corneal fluorescence stain （ less than 7% ）, and no serious complication was happened during seven-year wearing. Conclusions In generally, it is safety for youth with long-term scientific and standardized wearing high Dk material orthokeratology contact lens.