基于体检中心的中小学生“小瞳检影筛查近视+后续佩戴角膜塑形镜”流程效果分析

Effect of“noncycloplegic retinoscopy for screening myopia+subsequent wearing orthokeratology lens”process for primary and secondary school students based on physical examination center

目的探讨基于体检中心的中小学生"小瞳检影筛查近视+后续佩戴角膜塑形镜"流程的效果。方法将2017年1月—2018年12月于西安交通大学第二附属医院健康管理部(即体检中心)进行视力检查的172例中小学生作为研究对象,受试者首先于健康管理部接受小瞳检影,随后于眼科接受散瞳检影,比较2种检影结果的一致性。将小瞳检影及散瞳检影均诊断为近视的93例随机分为对照组46例及试验组47例,分别配戴框架眼镜和角膜塑形镜,比较两组配镜前的屈光度、眼轴长度、角膜曲率及玻璃体腔深度,以及配镜后3、6、12个月时的屈光度增量、眼轴长度增量、角膜曲率及玻璃体腔深度,并比较两组并发症的发生情况。结果以散瞳检影为金标准,小瞳检影的阳性预测值为88.6%,灵敏度为96.9%,特异度为84.2%,与散瞳检影存在一致性(kappa=0.821,P<0.001)。配镜前,两组双眼的屈光度、眼轴长度、角膜曲率及玻璃体腔深度差异均无统计学意义(P>0.05);配镜后3、6、12个月时,试验组左眼屈光度增量分别为(0.48±0.07)、(0.69±0.13)、(0.88±0.11)D,左眼眼轴长度增量分别为(0.18±0.05)、(0.22±0.04)、(0.27±0.05)mm,右眼屈光度增量分别为(0.46±0.10)、(0.71±0.12)、(0.90±0.10)D,右眼眼轴长度增量分别为(0.17±0.04)、(0.23±0.04)、(0.26±0.05)mm,对照组上述指标分别为(0.73±0.08)、(1.04±0.11)、(1.13±0.11)D,(0.26±0.04)、(0.36±0.04)、(0.40±0.05)mm,(0.73±0.09)、(1.04±0.10)、(1.17±0.11)D,(0.24±0.04)、(0.37±0.04)、(0.42±0.05)mm,组间差异均有统计学意义(P<0.05)。试验组配镜后3、6、12个月时双眼角膜曲率及玻璃体腔深度的变化趋势与对照组不同(P交互<0.05),其各时点双眼角膜曲率均低于配镜前且均低于对照组,差异均有统计学意义(P<0.05),其各时点双眼的玻璃体腔深度与配镜前比较差异均无统计学意义(P>0.05)但均低于对照组(P<0.05)。两组常见并发症的发生率差异无统计学意义(P>0.05)。结论在体检中心采用小瞳检影普查中小学生近视准确性较高,随后于专科应用散瞳检影确诊后采用角膜塑形镜治疗能够有效控制近视进展,"体检中心小瞳检影筛查近视+后续专科佩戴角膜塑形镜"这一流程具备可行性。

Objective To investigate the effect of"noncycloplegic retinoscopy for screening myopia+subsequent wearing orthokeratology lens"process for primary and secondary school students based on physical examination center.Methods A total of 172 primary and secondary school students undergoing vision examination in the Health Management Department(i.e.physical examination center)of the Second Affiliated Hospital of Xi’an Jiaotong University between January 2017 and December 2018 were selected as the research objects.After examination by noncycloplegic retinoscopy in the health management department,they were examined by mydriatic retinoscopy in the ophthalmology department,and then the consistency of the results of the two methods was analyzed.Then 93 students with myopia diagnosed by both methods were randomly divided into control group(n=46)and trial group(n=47),wearing frame glasses and orthokeratology lenses respectively.The diopter,eye axial length,corneal curvature and vitreous cavity depth before wearing glasses,as well as the increment of the above indicators at 3,6 and 12 months after wearing glasses/lenses were compared between the two groups,and the incidence of complications of the two groups were compared.Results Compared with mydriatic retinoscopy,the positive predictive value of noncycloplegic retinoscopy was 88.6%,the sensitivity was 96.9%and the specificity was 84.2%,and the consistency kappa coefficient was 0.821(P<0.001).Before wearing glasses/lenses,there was no significant difference in diopter,eye axial length,corneal curvature or vitreous cavity depth of both eyes between the two groups(P>0.05);at 3,6 and 12 months after wearing glasses/lenses,the diopter increment and eye axial increment of both eyes of the trial group were less than those of the control group[left eye diopter increment:(0.48±0.07)vs.(0.73±0.08)D,(0.69±0.13)vs.(1.04±0.11)D,(0.88±0.11)vs.(1.13±0.11)D;left eye axial increment:(0.18±0.05)vs.(0.26±0.04)mm,(0.22±0.04)vs.(0.36±0.04)mm,(0.27±0.05)vs.(0.40±0.05)mm;right eye diopter increment:(0.46±0.10)vs.(0.73±0.09)D,(0.71±0.12)vs.(1.04±0.10)D,(0.90±0.10)vs.(1.17±0.11)D;right eye axial increment:(0.17±0.04)vs.(0.24±0.04)mm,(0.23±0.04)vs.(0.37±0.04)mm,(0.26±0.05)vs.(0.42±0.05)mm](P<0.05).At 3,6 and 12 months after wearing glasses/lenses,the changing trends of corneal curvature and vitreous cavity depth in both eyes of the trial group were different from those of the control group(PInteraction<0.05),and the corneal curvature of both eyes at each time point was lower than that before wearing lenses and that of the control group(P<0.05),while the vitreous cavity depth of both eyes was not statistically different from that before wearing lenses(P>0.05)but lower than that of the control group(P<0.05).There was no statistical difference in the incidence of common complications between the two groups(P>0.05).Conclusion In the physical examination center,the accuracy of noncycloplegic retinoscopy for general survey of myopia in primary and secondary school students is high,and then after the diagnosis by mydriatic retinoscopy in the special department,the use of orthokeratology lens can effectively control the progress of myopia,so the process of"noncycloplegic retinoscopy for screening myopia in physical examination center+subsequent wearing orthokeratology lens in specialty"is feasible.