角膜塑形镜控制中小学生近视有效性和安全性Meta分析

Meta-analysis of the effectiveness and safety of orthokeratology in controlling myopia in primary and middle school students

目的 系统评价角膜塑形镜对中小学生轻中度近视延缓的有效性和安全性。方法 检索The Cochrane Library、PubMed、EMbase、CBM、CNKI、WanFang Data和VIP等数据库,语言限定为中英文。采用Cochrane手册提供的偏倚风险评价工具和改良JADAD评分量表评价纳入文献质量;采用漏斗图检测纳入文献的发表偏倚;采用RevMan5.4软件进行Meta分析。结果 共有12篇文献符合纳入排除标准,包含1 908例研究对象。Meta分析结果显示:佩戴角膜塑形镜后,裸眼视力有所提高[1年:MD=0.40,95%CI(0.05~0.74),P=0.02];角膜曲率有所下降[1年:MD=-3.21,95%CI=(-3.64~-2.79),P<0.01];屈光度增长得到了有效控制[1年:MD=-3.19,95%CI=(-4.42~-1.95),P<0.01;2年:MD=-3.61,95%CI=(-5.78~-1.43),P<0.01];眼轴增长有所控制[1年:MD=-0.73,95%CI=(-1.43~-0.03),P=0.04;2年:MD=-1.15,95%CI=(-2.25~-0.06),P=0.04];眼轴变化量有所下降[1年:MD=-0.42,95%CI=(-0.64~-0.21),P<0.01;2年:MD=-0.53,95%CI=(-0.96~-0.11),P=0.01]。结论 角膜塑形镜能够延缓中小学生轻中度近视的进展,且较为安全。

Objective To systematically review the effectiveness and safety of orthokeratology in the treatment of mild to moderate myopia in primary and middle school students.Methods The Cochrane Library,PubMed,Embase,CBM,CNKI,WanFang Data and VIP database were searched and the language was limited to Chinese and English.The risk of bias evaluation tool was provided by the Cochrane manual and the quality of the included studies was evaluated by the modified JADAD score scale.The included studies were assessed with funnel plot.Meta-analysis was performed with RevMan5.4 software.Results A total of 12 studies met the inclusion and exclusion criteria,including 1 908 subjects.The Meta-analysis showed that after wearing the orthokeratology lens for 1 year,the uncorrected visual acuity improved [MD = 0.40,95%CI =(0.05 to 0.74),P = 0.02];keratometry results decreased [MD =-3.21,95 %CI =(-3.64 to-2.79),P < 0.01)].After wearing the orthokeratology lens for 1 and 2 years,the increase in diopter was effectively controlled [1 year:MD =-3.19,95%CI =(-4.42 to-1.95),P < 0.01;2 years:MD =-3.61,95%CI =(-5.78 to-1.43),P < 0.01];the length of ocular axis decreased [1 year:MD =-0.73,95%CI =(-1.43 to-0.03),P = 0.04;2 years:MD =-1.15,95%CI =(-2.25 to-0.06),P = 0.04];the amount of ocular axis change decreased [1 year:MD =-0.42,95%CI =(-0.64 to-0.21),P < 0.01;2 years:MD =-0.53,95%CI =(-0.96 to-0.11),P = 0.01].Conclusion Orthokeratology can delay the progression of mild to moderate myopia in primary and middle school students,and which is relatively safe.