角膜塑形镜联合0.01%阿托品滴眼液对青少年中低度近视的控制疗效

Clinical observation of orthokeratology combined with 0.01%Atropine for controlling low to moderate myopia in adolescents

目的:探究角膜塑形镜联合0.01%阿托品滴眼液对青少年近视控制的疗效及安全性。方法:前瞻性非随机对照研究。选择2017-10/2018-11我院收治的青少年近视患者120例120眼为研究对象,对照组60眼采用角膜塑形镜治疗,联合组60眼采用角膜塑形镜联合0.01%阿托品治疗。治疗前和治疗1a测定患者最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、屈光度、眼轴、调节幅度、亮瞳直径、暗瞳直径、泪膜脂质层厚度(LLT)、泪膜破裂时间(BUT),观察不良反应发生情况。结果:两组患者治疗前后BCDVA和BCNVA组内和组间均无差异(P>0.05)。与治疗前相比,治疗后联合组和对照组等效球镜度均明显进展(P<0.01),分别进展0.21(0.03,0.53)、0.40(0.15,0.74)D;治疗后联合组和对照组眼轴长度均显著增加(P<0.01),分别增加0.13±0.19、0.22±0.21mm。治疗前后对照组调节幅度、亮瞳和暗瞳直径均未见明显差异(P>0.05),但治疗后联合组调节幅度显著下降,亮瞳和暗瞳直径显著增加(均P<0.01),且治疗后联合组调节幅度低于对照组,而亮瞳和暗瞳直径高于对照组(均P<0.01)。治疗后两组患者LLT、BUT均显著降低(P<0.01),且降低幅度均无差异(P>0.05)。治疗期间,联合组和对照组总不良反应发生率无差异(26.7%vs 15.0%,P>0.05)。结论:角膜塑形镜联合0.01%阿托品可协同增强青少年的近视控制效果,并且具有良好的安全性。

AIM:To investigate the efficacy and safety of orthokeratology combined with 0.01%atropine in controlling low to moderate myopia in adolescents.METHODS:A prospective non-randomized controlled study was conducted among 120 eyes of 120 adolescents with low to moderate myopia.60 eyes in the control group were treated with orthokeratology,and 60 eyes in the combined group were treated with orthokeratology combined with 0.01%atropine.The best corrected distant visual acuity(BCDVA),best corrected near visual acuity(BCNVA),refraction,axial length,accommodative amplitude,photopic pupil diameter,mesopic pupil diameter,lipid layer thickness(LLT),tear film break up time(BUT)and complications were determined before treatment and at 1a after treatment.RESULTS:There were no significant differences in BCDVA and BCNVA within and between the two groups before and after treatment(P>0.05).After treatment,the spherical equivalents of both groups progressed significantly(P<0.01),and the average changes of spherical equivalent refractive error in the combined group and the control group were 0.21(0.03,0.53)D and 0.40(0.15,0.74)D respectively(P<0.01).The axial lengths of both groups were increased significantly(P<0.01),and the axial length elongations of the combined group and the control group were(0.13±0.19)mm and(0.22±0.21)mm respectively(P<0.01).There were no significant differences in the accommodative amplitude,photopic and mesopic pupil diameters of the control group before and after treatment(P>0.05).After treatment,the accommodative amplitude of the combined group decreased significantly,while the photopic and mesopic pupil diameters significantly increased,respectively(P<0.01).The accommodative amplitude of the combined group was smaller than that of the control group,while the photopic and mesopic pupil diameters were larger than those of the control group at 1a after treatment(P<0.01).The LLT and BUT in both groups were significantly reduced from baseline(P<0.01),but both showed no significant differences between the two groups at baseline and at 1a after treatment(P>0.05).During the treatment period,there was no difference in the incidence of total adverse reactions between the combined group and the control group(26.7%vs 15.0%,P>0.05).CONCLUSION:Combined treatment with 0.01%atropine and orthokeratology would be a safe and more effective choice of treatment to control the development of myopia in adolescents.