夜戴型角膜塑形镜对青少年角膜泪膜的影响

Effect of overnight orthokeratology on corneal tear film of juvenile

目的观察不同屈光度青少年近视患者夜间配戴角膜塑形镜后的泪膜变化,了解其对角膜泪膜的影响。方法采用自身对照研究,收集2014年1月—2015年2月在我院配戴夜戴型角膜塑形镜的青少年近视患者81例158只眼,其中男51例,女30例,年龄8~15岁,平均年龄(13.6±2.2)岁,按屈光度的不同分为A组(-1.00^-2.50 D)38例74只眼,B组(-2.75^-4.00 D)32例61只眼,C组(-4.25^-6.50 D)11例23只眼。在戴镜前,戴镜后7 d,1、3、6个月五个时间点对三组进行干眼症状评分、泪膜破裂时间(BUT)、Schirmer I试验(SIT)、角膜荧光素染色检查,比较戴镜前后变化。结果 1.干眼症状评分:三组患者戴镜后7 d时主观症状评分均较戴镜前增高(P<0.05),戴镜后1、3、6个月时的症状评分较戴镜前无明显变化(P>0.05);三组戴镜前后各时间点比较,差异均无统计学意义(P>0.05)。2.BUT:三组患者戴镜后各时间点的BUT均较戴镜前明显缩短(P<0.05),各时间点的组间差异无统计学意义(P>0.05)。3.Schirmer I试验:三组戴镜后各时间点SIT数值较戴镜前未见明显变化(P>0.05),各时间点组间比较亦无统计学意义的差异(P>0.05)。4.角膜荧光素染色评分:三组戴镜后各时间点的角膜荧光素染色评分均较戴镜前明显增加(P<0.05),戴镜后各时间组间差异均无统计学意义(P>0.05)。结论青少年佩戴角膜塑形镜后,泪膜稳定性下降,角膜上皮点状荧光素染色,但不影响泪液的基础分泌量,戴镜前应重视患者的泪膜相关评估,戴镜后要强调定期复查的重要性。

[Abstract] OBJECTIVE To investigate the effect of wearing orthokeratology at night-time on tear film stability in j uvenile with myopia. METHODS From January 2014 to February 2015, 81 juvenile patients （158 eyes） with myopia wearing orthokeratotogy （for overnight wear） were included, in which fifty--one patients were male, thirty were female. The patients aged between 8 and 15 （average age was 13.6±22.2）. All cases were evaluated by dry eye symptoms score, break-up time （BUT） and schiemer I test （SIT） before , and 7 days, 1 month, 3 months and 6 months after wearing. RESULTS Dry eye subjective symptom score of all patients at day 7 after wearing was significantly higher than the pre-wearing score （P〈0.05）. However, the scores of all participants at 1 month, 3 month, 6 month after wearing showed no statistical difference compared with counterparts before wearing （P〉0.05）. Also, there was no significant difference of the score between three groups at every time point （P〉0.05）. In each group, BUT of patients became shorter after wearing the lens regardless of the time point （P〈0.05）. But there were no significant differences between groups at each time point （P〉0.05）. The SIT of all groups did not change statistically after wearing （P〉0.05）. And in- ter-group comparison at all post-wearing time points showed no significant differences （P〉0.05）. The corneal fluorescein staining scores of all groups increased significantly after wearing （P〈0.05） while comparisons between groups at every post-wearing time point indicated no statistical differences （P〈0.05）. CONCLUSIONS Orthokera- portance of regular examination should be emphasized after wearing the lens.