青少年近视患者配戴夜戴型角膜塑形镜的疗效观察

Effects of overnight orthokeratology on correction and control of myopia in adolescents

目的:观察青少年近视患者长期配戴夜戴型角膜塑形镜用以矫正近视及控制近视发展的疗效和安全性。方法:回顾性病历分析。抽取于2011-08/2012-02于我院就诊并按要求定期复诊2a以上的青少年近视患者65例。其中配戴夜戴型角膜塑形镜的青少年患者35例67眼作为试验组;30例60眼配戴框架眼镜的青少年患者作为对照组。根据初诊时患者的近视程度将试验组分为A组(35眼)(近视≤-3.00D),B组(32眼)(-3.00D<近视≤-6.00D)。试验组于戴镜前,戴镜后1d;1wk;1,3,6mo;1,1.5,2a定期回门诊复查,检查项目包括裂隙灯检查、裸眼视力、电脑验光、眼压、角膜地形图。于戴镜前和戴镜2a后还需检查眼轴长度、角膜厚度、前房深度、角膜内皮细胞数、主觉验光、干眼分级各项。对照组于戴镜前和戴镜2a后需检查裂隙灯、裸眼视力、电脑验光、主觉验光和眼压各项。戴镜前后各值比较采用配对t检验,各组间比较采用单因素方差分析,以P<0.05为差异有统计学意义。结果:试验组戴镜1d后裸眼视力均明显提高,A组患者提高更为显著。试验组戴镜2a后停戴2wk测得的角膜曲率(包括垂直曲率和水平曲率)均较戴镜前变平;眼轴长度也有所增长,B组的增长速度(0.33±0.31)mm低于A组的增长速度(0.43±0.25)mm;主觉验光的近视度数虽比戴镜前增长(0.68±0.49)D,但较之对照组增长的(2.08±0.57)D,控制近视效果明显。干眼分级检查结果较戴镜前干眼加重,但A、B两组之间比较无统计学差异;角膜厚度、前房深度、角膜内皮细胞密度、眼压各项与戴镜前相比,差异均无显著性。结论:角膜塑形镜是一种安全、有效矫正近视的方法,长期应用还能有效控制近视的发展,控制中度近视比控制低度近视效果更明显。

AIM ： To evaluate the long-term efficiency and safety of overnight orthokeratology in myopia correction and control in adolescents.METHODS： Sixty- five myopia adolescents treated in our hospital from August 2011 to February 2012 were retrospectively analyzed and followed up to 2a. Among them, 35 cases（ 67 eyes） wearing overnight orthokeatology were included as trial group,and 30 cases（ 60 eyes） wearing spectacles were included as control group. The trial group were divided into 2 subgroup according the myopic grading in the initial visit： subgroup A（ 35 eyes,≤-3. 00D）,B subgroup（ 32 eyes,-3. 00 D and ≤- 6. 00D）. In the trial group, slitlamp, visual acuity,refraction,intraocular pressure,corneal tomography were collected before wearing overnight orthokeratology,1d,1wk, 1month, 3m o, and every 6mo after wearing overnight orthokeratology,with axial length, corneal thickness,anterior chamber depth, corneal endothelial cell count,abjective refraction and tear film w ere also collected before and 2a after wearing overnight orthokeratology. In the control group,slitlam p,visual acuity,refraction and intraocular pressure w ere collected before wearing and 2a after wearing spectacles. Paired t test were used to compare the intragroup difference. Oneway analysis of variance（ ANOVA） was used to compare the differences am ong the groups. P〈0. 05 was considered statistically significant. RESULTS： The uncorrected visual acuity of the trial group was improved obviously after wearing Orthokeratology Lens 1d, the visual acuity of a group patients im proved more significantly. The corneal curvature（ including vertical curvature and horizontal curvature） of the trial group became more flat after wearing Orthokeratology Lens 2a and stopped 2 wk; The length of ocular axis was also increased,the grow th rate of B group（ 0. 33±0. 31） mm was lower than that of group A（ 0. 43 ±0. 25） m m; Subjective refraction of m yopia was increased 0. 68±0. 49 D than wearing Orthokeratology Lens before,but compared with the growth（ 2. 08 ± 0. 57） D of the control, the effect of m yopia control was more obviously. Grade of dry eye was more severely than that of w earing Orthokeratology Lens before,but there was no significant difference between groups A and B. Compared with wearing Orthokeratology Lens before, corneal thickness,anterior cham ber depth, corneal endothelial cell num ber and the intraocular pressure were all no significant differences between the trial and control group. CONCLUSION： Orthokeratology is a safe and effective m ethod for the correction of myopia,and long-term use of Orthokeratology Lens can effectively control the developm ent of myopia. Controlling of moderate myopia is more effective than that of low myopia.