角膜塑形镜对近视儿童视力的影响

Influence of orthokeratology on the eyesight of children with myopia

目的探讨长期佩戴角膜塑形镜对近视儿童的视力改善效果和安全性。方法选取近视儿童37例，验配角膜塑形镜进行治疗，分别于佩戴前、佩戴后1周、6个月及1年3个时间点进行指标观察；测定项目包括视力、眼内压、屈光度、眼轴长度、角膜厚度、角膜曲率、角膜细胞密度及佩戴不良情况等。结果佩戴角膜塑形镜后，患者裸眼视力可得到显著改善（F：6．221，P=0．000）；矫正视力略有波动，眼内压和眼轴长度有升高趋势，角膜曲率和屈光度有降低趋势，但差异均无统计学意义（F=0．553—1．917，P：0．471—0．063）。患者角膜周边上皮层厚度有增加趋势，基质层厚度及角膜中央上皮层、基质层厚度均呈下降趋势，但与戴镜前相比差异均无统计学意义；（F=0．953—1．957，P=0．107～0．061）；然而周边上皮层与中央上皮层的差值，显著升高（F=2．479，P=0．021）。周边角膜上皮细胞密度有所上升，其他各层组织细胞密度均有所下降，但与戴镜前相比，差异均无统计学意义（F=0．0．365～1．904，P=0．684～0．066）。结论角膜塑形镜对儿童近视具有较好的纠正作用，虽然对角膜组织有一定刺激性，但对其生理形态影响小，具有较高的应用价值。

Objective To explore the long-term effect and safety of orthokeratology on children with myopia. Methods 37 cases of children with myopia were selected and treated with orthokeratology. The visual acuity, intra-ocular pressure, dioptric, axial length, corneal thickness, corneal curvature, cornea cell density and adverse reaction rate were detected be- fore and after treatment. Results After treatment, the uncorrected visual acuity of children increased significantly （ F = 6.221 ,P = 0. 000） ;the corrected visual acuity fluctuated slightly, the intra-ocular pressure and axial length increased while dioptdc and cornea/curvature decreased ,but there was no significant difference compared to before treatment（ F = 0.553- 1. 917,P =0.471 -0. 063 ）. The corneal thickness of surrounding epithelium increased slightly,while substrate layer and the central corneal thickness decreased, but there was no significant difference compared to before treatment （ F = 0. 953 - 1. 957, P = 0. 107 - 0.061 ） ; However, the Ts-diff of surrounding and central epithelium thickness increased significantly（ F =2.479, P = 0. 021 ）. The peripheral corneal epithelial cell density increased slightly,while others de- creased, with no significant difference too （ F = 0.0.365 - 1. 904, P = 0. 684 - 0.066 ）. Conclusion Our research showed that orthokeratology had high corrective ability on children myopia and little effect on the physiomorphology of cornea, which was worthy of application.