共焦显微镜观察长期佩戴角膜接触镜对中学生高度近视眼角膜形态及屈光状态的影响

Effects of long-term contact lens wearing on the morphology of corneal epithelium and refrection in middle school students with high myopia

目的共焦显微镜观察长期佩戴不同类型角膜接触镜对中学生高度近视眼角膜上皮形态及屈光状态的影响。方法选取西安某中学16~19岁中学生81例162眼进行临床随诊观察,均为双眼高度近视戴镜矫正。以不同类型矫正方法的自然状态分为三组：框架眼镜SP（28例56眼）组为实验对照组;软性角膜接触镜SCL组（24例48眼）;高透氧性硬性角膜接触镜RGPCL组（29例58眼）;共焦显微镜分别于戴镜后1月、6月、1年、3年观察患眼角膜上皮形态,同时记录其眼屈光度及眼轴长度变化情况。数据采用SPSS 19.0统计软件处理。结果 1两种角膜接触镜长期佩戴均存在角膜上皮细胞密度减低,上皮厚度变薄的情况,其中RGPCL戴镜半年后与同时间段SCL组存在显著统计学差异（P〈0.05）;2框架眼镜及软性角膜接触镜组患者屈光度及眼轴显著增加,硬性角膜接触镜佩戴者屈光度及眼轴长度增加不明显,结果有显著差异（P〈0.05）。3硬性角膜接触镜佩戴半年后,眼球屈光度及眼轴控制效果显著（P〈0.05）。结论 1长期佩戴角膜接触镜会对角膜上皮形态产生一定影响,主要表现为角膜上皮密度降低,厚度变薄;2高透气性硬性角膜接触镜对角膜上皮形态影响较小,且可有效控制眼轴增长,对青春期近视发展有一定防治作用;3硬性角膜接触镜在佩戴半年后对屈光度的控制更为有效。

Objective To make a confocal microscopic observation of the effects of long-time wearing of different type of contact lens on the morphology of corneal epithelium and refraction in middle school students with high myopia.Methods A total of 81 young students（162 eyes）,who were aged16 to 19 years old wearing different type of contact lens for correcting high myopia of both eyes,were chosen for the clinical observation.They were divided into three groups in nature：SP group who wore spectacles（28 cases with 56 eyes）,SCL group（24 cases wearing soft contact lens）,and RGPCL group（29 cases with high rigid permeable contact lens）.Confocal microscope was used to observe the modality of corneal epithelium at the 1st month,6th month,1st year and3 rd year after contact lens wearing.The diopter and axis oculi were recorded at the same time.Results 1 Cell density and thickness of corneal layers decreased in SCL and RGPCL groups,but there was a significant difference between the two groups（P〈0.05）.2In SCL group and SP group the diopter and axis oculi increased markedly,but not in RGPCL group（P〈0.05）.3 RGPCL effectively controlled diopter increase at half a year after wearing（P〈0.05）.Conclusion 1 Long-time wearing contact lens can influence the morphology of corneal epithelium,and the cell density and thickness of corneal layers decrease.2 RGPCL has a mild effect on corneal morphology,and the diopter can be controlled effectively by wearing RGPCL in youth.3 Significant controlling effect on the diopter is found half a year after RGPCL wearing in youth.