角膜塑形镜矫治低中度近视的临床观察

Clinical observation of orthokeratology lens in the treatment of mild and moderate myopia

目的观察角膜塑形镜矫治低中度近视的临床效果和安全性，并评价其控制近视度数增长的效果。方法选择嘉兴市中医医院2014年1～12月门诊就诊低中度近视儿童83例（166眼），采用随机数字表法分为两组，观察组43例（86眼）选用台湾亨泰角膜塑形镜，用试戴法予以规范的角膜塑形镜验配；对照组40例（80眼）配戴普通光学镜片。观察期为2年，观察观察组裸眼视力、角膜曲率变化及眼表情况，观察两组屈光度和眼轴长度的变化。结果观察组裸眼视力戴镜后1d即有明显提高，1周后视力趋于稳定，1年内视力基本稳定，2年左右视力有下降趋势。戴镜后3个月平均角膜曲率为（41．93±1．12）D，与戴镜前的（43．56±1．44）D比较明显降低，差异有统计学意义（t=11．539，P〈0．05）；停戴1个月以上与戴镜前差异无统计学意义。观察组与对照组比较，屈光度增长及眼球轴长增长速度明显变缓，差异有统计学意义（t=16．784，P〈0．05；t=5．623，P〈0．05）。戴镜初期观察组34％发生角膜上皮损伤，且多不超过Ⅱ级，通过及时停戴及适当用药后均能明显改善并继续配戴。随配戴时间增长，损伤比例降低。结论低中度近视儿童配戴角膜塑形镜戴镜后1d裸眼视力即有明显提高，1年内视力基本稳定，2年左右视力有下降趋势，需要及时更换镜片。长期配戴可有效、安全地控制近视度数发展。

Objective To observe the clinical effects and safety of orthokeratology （OK） lens in the treatment of mild and moderate myopia, and to evaluate the effects on the myopia control. Methods The study included a total of 166 eyes in 83 myopia children who were treated in Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University from January 2014 to December 2014. They were randomly divided into two groups according to the digital table, 43 cases （86 eyes） in the observation group underwent standard OK lens, and the other 40 cases （80 eyes） in the control group were given common spectacles. The patients were followed up for two years. The uncorrected visual acuity, corneal curvature and ocular surface in the, observation group were examined, and diopter, axial length were examined in the two groups. Results The visual acuity of the observation group improved significantly at 1 day, trended to be stable at 1 week, and then was basically stable within 1 year, but decreased at 2 years. After 3 months, the mean corneal curvature [ （41.93 ±1.12） D ] was significantly lower than before orthokeratology[ （43.56 ±1.44 ） D ], and the difference was statistically significant （ t = 11. 539, P 〈 0.05 ）. However, the effect didn＇ t persist without continued OK lens wear 1 month later. Compared with the control group, the growth of the diopter and axial length in the observation group were significantly slower（ t = 16. 784, P 〈 0.05;t = 5. 623,P 〈 0.05 ）. At the initial wearing,34% of the observation group occurred corneal epithelial injury, but they all recovered by stop wearing and appropriate medication. With the prolong of wear time, the proportion of injury reduced. Conclusion Uncorrected visual acuity of mild and moderate myopia children wearing OK lens can significantly improve at 1 day, then is basically stable after 1 year, hut declines within 2 years, which indicates the need for timely replacement of the lens. Long - term wearing is effective and safe to control the development of myopia.