夜戴角膜塑形镜对青少年角膜内皮细胞的影响

The Effect of Overnight Orthokeratology Lens Wear on Corneal Endothelial Cells in Adolescents

目的:探讨夜戴型角膜塑形镜对青少年角膜内皮细胞数量和形态的影响。方法:回顾性自身对照研究。以2015-2017年在北京大学第三医院验配角膜塑形镜且连续戴镜1年以上的20例单眼近视青少年为研究对象。配戴角膜塑形镜的20只近视眼纳入研究组;未配戴角膜塑形镜的20只对侧眼纳入对照组。戴镜前及戴镜1年,使用角膜内皮镜检查双眼角膜内皮。采用配对t检验比较2组中央角膜内皮细胞密度(ECD)、六角形细胞百分比(HEX)和细胞面积变异系数(CV)的差异。结果:对照组与研究组戴镜前ECD、HEX和CV差异无统计学意义(P>0.05)。对照组ECD呈下降趋势(t=2.490,P=0.022),每年下降1.99%;HEX亦呈下降趋势(t=4.096,P=0.001),每年下降4.23%。研究组ECD亦呈下降趋势(t=5.802,P<0.001),每年下降1.64%;HEX呈下降趋势(t=3.728,P=0.001),每年下降4.82%。研究组和对照组CV在随访期间差异无统计学意义(P>0.05)。对照组与研究组治疗1年后ECD、HEX和CV变化值的差异均无统计学意义(t=-0.453、0.258、-0.392,均P>0.05)。结论:夜戴角膜塑形镜1年对角膜内皮细胞数量和形态没有显著性影响。

Objective: To investigate the effect of overnight orthokeratology (ortho-k) lens wear on the number and morphology of corneal endothelial cells in adolescents. Methods: This was a retrospective self-control study. Twenty adolescents with monocular myopia who had been wearing ortho-k lenses overnight for more than one year from 2015 to 2017 were included in this study at Peking University Third Hospital. Twenty eyes prescribed to wear ortho-k lenses overnight were the experimental group, and 20 contralateral eyes without treatment were the control group. The corneal endothelium was examined with specular microscopy to calculate mean endothelial cell density (ECD), percentage of hexagonal cells (HEX) and the coefficient of variation (CV) before and after wearing the lenses for 1 year. A paired t-test was used to analyze the data between the two groups. Results: There were no significant differences in baseline ECD, HEX or CV between the two groups (P>0.05). In the control group, ECD also decreased (t=2.490,P=0.022) with an annual decrease of 1.99%;HEX decreased (t=4.096, P=0.001) with an annual decline of 4.23%. There was no significant difference in CV between the two groups (P>0.05). In the experimental group, ECD showed a downward trend (t=5.802, P<0.001) with an annual decrease of 1.64%;HEX showed a downward trend (t=3.728, P=0.001) with an annual decline of 4.82%. There were no significant differences in changes of ECD, HEX or CV between the two groups one year after treatment (t=-0.453, 0.258,-0.392, P>0.05). Conclusions: The number and morphology of corneal endothelial cells are not significantly affected by wearing overnight ortho-k lenses for one year.