儿童配戴角膜塑形镜后近视眼控制效果的影响因素分析

The influencing factors and the effect of myopia control in children treated with orthokeratology

目的:分析儿童配戴角膜塑形镜后近视眼控制效果的相关影响因素。方法:回顾性病例系列研究。收集2016年6月至2020年7月在温州医科大学附属眼视光医院完成验配并坚持配戴角膜塑形镜24个月的137例近视眼儿童的资料,均选取右眼进行分析。通过计算机随机法随机选取其中91例为建模组[男性53例,女性38例;年龄(11.24±1.69)岁],其余46例为验证组[男性22例,女性24例;年龄(11.09±1.66)岁]。记录戴镜前的情况,包括年龄、等效球镜度数、瞳孔面积及角膜形态学参数,并测量角膜塑形镜偏心及戴镜前和戴镜24个月眼轴长度。分析建模组儿童基线情况和戴镜稳定后的变化与戴镜24个月后眼轴长度变化的关系并构建回归方程,将验证组相关因素导入回归方程中计算期戴镜后24个月的眼轴长度,并与实际测量值进行配对 t检验。 结果:戴镜前和戴镜后24个月,建模组眼轴长度分别为(25.16±0.90)和(25.56±082)mm( t=-10.12, P<0.001),验证组分别为(25.29±0.71)和(25.67±0.69)mm,差异均有统计学意义( t=-10.12,-8.79;均 P<0.001)。戴镜24个月后眼轴长度变化量与基线年龄( r=-0.37, P<0.001)、基线等效球镜度数( r=0.31, P=0.003)、偏心距离( r=-0.35, P=0.001)和瞳孔面积( r=-0.26, P=0.013)相关。回归分析结果显示,基线年龄( β=-0.056, P=0.001)、偏心距离( β=-0.315, P=0.001)、瞳孔面积( β=-0.009, P=0.004)、基线等效球镜度数( β=0.054, P=0.021)均与戴镜24个月眼轴长度变化有关,构建回归方程 y=1.609-0.056 a-0.315 b-0.009 c+0.054 d( y为眼轴变化, a为基线年龄, b为偏心距离, c为瞳孔面积, d为基线等效球镜度数;R2=0.31)。将验证组对应参数导入方程,得到戴镜24个月眼轴长度变化量为(0.40±0.20)mm,与实际眼轴长度变化量(0.40±0.32)mm相比,差异无统计学意义( t=-0.04, P=0.971)。 结论:近视眼儿童的年龄、等效球镜度数、瞳孔面积以及戴镜稳定后的偏心距离对其配戴角膜塑形镜后的近视眼控制效果影响较大,可以通过这些因素预测戴镜后的近视眼控制效果。

Objective To analyze the influencing factors and the effect of myopia control in children treated with orthokeratology.Methods It was a retrospective case series study.Data of 137 children from June 2016 to July 2020 in the Optometry Hospital of Wenzhou Medical University who were fitted with orthokeratology lenses and kept wearing them for 24 months were retrospectively reviewed.These children were divided into the modeling group(n=91)and verification group(n=46).The baseline conditions were recorded before they wore the orthokeratology lenses,including age,spherical equivalent refractive power(SER)and pupil area.The decentration distance was measured with a tangential difference map.Axial length(AL)changes of all children during 24 months were calculated.The influencing factors and the effect of myopia control were analyzed,and a regression equation was formulated with the modeling group.Then the influencing factors were imported with the verification group to compare the AL change differences between prediction and measurement.Results There was statistical difference in AL between baseline and after wearing orthokeratology lenses for 24 months both in the modeling group[(25.16±0.90)mm vs.(25.56±0.82)mm;t=-10.119,P<0.001]and verification group[(25.29±0.71)mm vs.(25.67±0.69)mm;t=-8.785,P<0.001].The AL changes in the modeling group showed significant correlations with baseline age(r=-0.365,P<0.001),baseline SER(r=0.308,P=0.003),pupil area(r=-0.260,P=0.013)and decentration distance(r=-0.352,P=0.001).The regression equation was as follows:y=1.609-0.056a-0.315b-0.009c+0.054d(y:AL changes,a:baseline age,b:decentration distance,c:pupil area,d:baseline SER).There was no statistical difference between prediction and measurement[(0.40±0.20)mm vs.(0.40±0.32)mm;t=-0.036,P=0.971].Conclusion Baseline age,decentration distance,baseline SER and pupil area contributed to predict the effect of myopia control after orthokeratology treatment.