角膜塑形镜控制青少年近视进展效果的相关因素

Factors preventing myopia progression with orthokeratology correction

目的 观察近视青少年配戴夜戴型角膜塑形镜后眼轴增加量的相关因素。方法 前瞻性非随机对照研究。166例（均取右眼数据）近视患者分别配戴全矫单焦框架眼镜（82例）和角膜塑形镜（84例），收集其性别、年龄、基础眼轴长度和戴镜2年后眼轴增加量等参数。单因素线性回归分析2组各参数对眼轴增加量的影响。结果 2年后，框架镜组和角膜塑形镜组完成随访的病例数分别为70例和73例。框架镜组2年的眼轴增加量的影响因素包括：年龄（β=-0.073，P〈0.01）、角膜散光（β=0.05，P〈0.05）、基础眼轴长度（β=-0.07，P〈0.05）。角膜塑形镜组2年的眼轴增加量的影响因素包括：性别［男女眼轴增加量分别为（0.34±0.29）mm，（0.21±0.31）mm，t=0.69，P〈0.05］、年龄（β=-0.066，P〈0.01）、近视发生年龄（β=-0.073，P〈0.05）、基础近视度数（β=0.052，P〈0.05）、入选研究前2年每年增加的近视度数（β=-0.043，P〈0.05）、瞳孔直径（β=-0.04，P〈0.05）、基础眼轴长度（β=-0.06，P〈0.05）。经协方差分析，年龄、近视发生年龄、入选研究前2年增加的近视度数、基础近视度数、眼轴、角膜散光、瞳孔直径与眼轴增加量的回归系数在2组间差异有统计学意义（P〈0.05）。结论 女性、年龄越小、近视发生越早、基础近视度数越高、入选研究前2年每年增加的近视度数越大、角膜散光越大、瞳孔直径越大和基础眼轴越长的近视患者配戴角膜塑形镜的效果较框架镜好。

Objective To examine which baseline predictive factors for axial length （AL） elongation over 2 years in children wearing orthokeratology lenses and single-vision （SV） spectacles. Methods This was a prospective non-randomized study. Eighty-two and eighty-four myopia patients （only took the right eye data） wore full correction SV spectacles and orthokeratology lenses, respectively. Gender, age, AL at baseline and 2 years after, and other parameters were collected. Univariate analysis was used to estimate the relationship between change in AL and baseline date of two groups. Results Two years later, 70 and 73 subjects finished follow-up in SV group and orthokeratology group, respectively. After univariate analysis, AL elongation was associated with the following factors in orthokeratology group. Change in AL was 0.34±0.29 mm and 0.21±0.31 mm for male and female, respectively （t=0.69, P〈0.05）. The regression coefficient between age （？茁=-0.066, P〈0.01）, age of myopia onset （？茁=-0.073, P〈0.05）, baseline myopia （？茁=0.052, P〈0.05）, myopia progression 2 years before baseline （？茁=-0.043, P〈0.05）, pupil diameter （？茁=-0.04, P〈0.05）, baseline AL （？茁=-0.06, P〈0.05）. AL elongation was associated with the following factors in SV group. The regression coefficient between age （？茁=-0.073, P〈0.01）, corneal astigmatism （？茁=0.05, P〈0.05）, baseline AL （？茁=-0.07, P〈0.05）. The regression coefficients of two groups between age, age of myopia onset, myopia progression 2 years before baseline, baseline myopia, corneal astigmatism, pupil diameter and AL were statistically significant after covariance analysis（P〈0.05）. Conclusion Orthokeratology was a successful treatment option in controlling AL elongation compared to SV spectale in children of female, younger age, had earlier onset of myopia, had greater corneal astigmatism and pupil diameter, had quicker rate of myopia progression before baseline, had higher myopia at baseline.