屈光参差儿童单眼配戴角膜塑形镜的临床效果

Clinical Observation on the Effect of Monocular Orthokeratology in Anisometropic Children

目的：评估屈光参差儿童单眼配戴角膜塑形镜控制近视、矫正屈光参差的临床效果。方法：回顾性自身对照病例研究。收集2014 年1 月至2016 年12 月在温州医科大学附属眼视光医院单眼接受角膜塑形镜治疗的屈光参差儿童40 例，年龄9～15 岁，随访时间1 年。双眼根据是否配戴角膜塑形镜分为配戴角膜塑形镜眼组（戴镜眼组）和未配戴角膜塑形镜眼组（未戴镜眼组）。戴镜眼组40眼，等效球镜度（-2.51±0.95）D；未戴镜眼组40眼，等效球镜度（0.10±0.52）D。双眼屈光度数差异范围1.00～4.38 D，平均（2.61±1.04）D。观察戴镜前及戴镜1 年后的双眼裸眼视力（UCVA）、屈光度数、眼轴、前房深度及角膜形态参数等变化，并对数据进行配对t检验和Pearson相关分析。结果：单眼配戴角膜塑形镜1年后，双眼UCVA（LogMAR）差值由0.77±0.29下降至0.17±0.22（t=-15.865，P 〈 0.001），双眼屈光度数的差值由（2.61±1.04）D下降至（2.07±1.05）D（t=-7.366，P 〈 0.001），双眼眼轴的差值由（0.97±0.66）mm降至（0.67±0.63）mm（t=-5.995，P 〈 0.001），双眼前房深度的差值由（0.47±0.11）mm下降至（0.01±0.13）mm（t=-2.704，P=0.027）。相关性分析发现戴镜后屈光参差减少量仅与双眼眼轴差值变化量、双眼UCVA差值变化量具有相关性（r=0.539、0.418，P 〈 0.001）。结论：单眼配戴角膜塑形镜对屈光参差儿童是一种安全、有效的控制近视进展、矫正屈光参差的临床方法。

Objective： To evaluate the clinical effect of controlling myopia and correcting anisometropia by monocular orthokeratology in anisometropic children. Methods： In this retrospective, self-controlled, clinical study, 40 anisometropic children, aged 9 to 15 years, who wore an orthokeratology lens in only one eye were enrolled from January 2014 to December 2016, and followed for about 1 year. The eyes with an orthokeratology lens had a mean spherical equivalent refraction of -2.51 ± 0.95 diopter （D）, and fellow eyes without a lens had a refraction of 0.10 ± 0.52 D. The average level of anisometropia was 2.61 ± 1.04 D, ranging from 1.00 to 4.38 D. During the follow-up period, we measured changes in binocular visual acuity, spherical equivalent refraction, ocular axial length, anterior chamber depth, and corneal topography parameters. The data were analyzed by paired t-tests and Pearson correlation analysis. Results： After 1 year of wearing an orthokeratology lens, the interocular difference in visual acuity （log minimum angle of resolution） between the treated and untreated eyes decreased from 0.77 ± 0.29 to 0.17 ± 0.22 （t=-15.865, P〈0.001）. Other interocular differences between the treated and untreated fellow eyes included the following： Anisometropia difference decreased from 2.61 ± 1.04 D to 2.07 ± 1.05 D （t=-7.366, P〈0.001）, axial length difference decreased from 0.97 ± 0.66 mm to 0.67 ± 0.63 mm （t=-5.995, P〈0.001）, and anterior chamber depth difference decreased from 0.47 ± 0.11 mm to 0.01 ± 0.13 mm （t=-2.704, P=0.027）. Correlation analysis showed that the reduction of anisometropia between the treated and untreated eyes was correlated with only the decreases in interocular difference for axial length and uncorrected visual acuity （r=0.539, 0.418, P〈0.001）. Conclusions： Monocular orthokeratology is a safe and effective clinical method to control the progression of myopia and to treat anisometropia.