角膜塑形镜治疗我国青少年低中度近视患者短期效果评价

Short-term effects of orthokeratoiogy on the development of low- to- moderate myopia in Chinese children

目的：探讨角膜塑形镜（OK镜）对我国青少年低中度近视控制的有效性。方法：将青少年低中度近视患者271例271眼分为OK镜治疗组（141眼）和单光眼镜治疗组（130眼）。OK镜治疗组平均年龄9.43±1.10岁,等效球镜度数为-2.74±1.15D;戴镜后1、7、30、90d,12mo随访。单光眼镜治疗组平均年龄9.37±1.00岁,等效球镜-2.88±1.39D,戴镜后每6mo随访一次。观察比较OK镜组和单光眼镜治疗组眼轴增长情况。将OK镜组和单光眼镜治疗组分成小年龄组和大年龄组,进一步观察各年龄组儿童的近视发展情况。对相关数据进行配对t检验、独立样本t检验、卡方检验及Spearman相关分析。结果：OK镜组配戴角膜塑形镜1a后,眼轴的增长值为0.27±0.17mm,与戴镜前的眼轴长度有明显统计学差异（P〈0.01）;单光眼镜组1a后的眼轴增长值为0.38±0.13mm（P〈0.01）。两组眼轴增长有统计学差异,且OK镜组儿童眼轴增长比单光眼镜组慢28.9%（P〈0.01,独立样本t检验）。近视初始年龄与1a眼轴增长之间呈负相关（OK镜组：rs=-0.309,P〈0.01;单光眼镜组：rs=-0.472,P〈0.01）。小年龄儿童（7.0~9.4岁）中,眼轴增长较快（每年〉0.36mm）者在OK镜组占38%,而单光眼镜治疗组则增加到76.5%;而眼轴增长较快的大龄儿童（9.4~12.0岁）在OK镜组和单光眼镜治疗组所占比例分别为24.3%和12.9%。当等效球镜（spherical equivalent refractive errors,SER）介于5.00~6.00D时,OK镜组的眼轴增长比单光眼镜组慢57.1%。结论：OK镜对控制青少年低中度近视儿童近视发展有很好的效果,儿童的近视发展随着年龄的增加逐渐减慢,而OK镜对控制小年龄儿和较高度近视发展的效果更好。

AIM：To investigate the short-term effectiveness of orthokeratology（ortho- k） on controlling low- to-moderate myopic in Chinese children.METHODS：There were 271 subjects（271 eyes） enrolled in this study.In total,there were 141 cases aged 9.43±1.10 in the ortho- k group and the spherical equivalent refractive errors（SER） were-2.74±1.15 D.The patients were examined at 1,7,30,and 90 d after they started wearing the ortho-k lenses.There were 130 cases aged9.37±1.00 enrolled in the control group,with the SER-2.88±1.39 D,and the examinations occurred at 6,12 mo after they started wearing single- vision spectacles.Myopic progression was estimated from changes of axial length in both groups.The chi- square test,independent samples t-tests,paired t-tests,Spearman analysis were used to compare the data of the two groups.RESULTS：The axial elongation was 0.27±0.17 mm in the ortho-k group after 1a which was significantly longer than that before wearing（P〈0.01）;the axial elongation was0.38± 0.13 mm in the control groups（P〈0.01）;the difference on axial elongation between the two groups was statistically significant and the increase of axial length of the ortho-k group was significant less by 28.9%than that of the control group（P〈0.01,by independent samples t- test）.There was significant negative correlation between axial elongation and initial age in both groups during the one-year period（ortho-k group：r_s =-0.309,P〈0.01;control group：r_s =-0.472,P〈0.01）.The percentages of younger subjects（aged 7.0-9.4） with fast myopic progression（〉0.36 mm in 1a） were 38%in the ortho- k group and 76.5%in the control group,respectively;whereas those of the older group（aged 9.4-12.0） were lower,reaching 24.3%and 12.9%in the orthok and control groups.In patients with SER 5.00-6.00 D,the axial elongation in ortho-k group was 57.1%lower than that in control group.CONCLUSION：Ortho-k lens is effective to control myopic progression in children with low-to-moderate myopia.In particular,it reduces the percentage of younger children with fast progression and has a better effect of controlling myopic progression with higher degrees of myopia.