青少年近视性屈光参差患者配戴角膜塑形镜后脉络膜厚度及眼轴的变化

Changes in choroidal thickness and axial length in adolescents with myopic anisometropia after orthokeratology treatment

目的:观察青少年近视性屈光参差患者配戴角膜塑形镜(OK镜)前后脉络膜厚度(CT)及眼轴长度的变化。方法:回顾性病例对照研究。收集2020-06/2021-09期间于深圳市第二人民医院眼科验配OK镜并夜戴6mo以上,且能够按时随访的71例近视青少年患者数据,其中双眼戴镜的非屈光参差近视青少年患者31例为A组(右眼为A1组,左眼为A2组),双眼戴镜的屈光参差近视青少年患者18例为B组(高度数眼为B1组,低度数眼为B2组),单眼戴镜的屈光参差近视青少年患者22例为C组(高度数眼为C1组,低度数眼C2组)。测量戴镜前及戴镜后6mo的眼轴长度及黄斑中心凹下(SF)以及距中心凹0.5、1.0、1.5mm处上方(S0.5、S1.0、S1.5)、下方(I0.5、I1.0、I1.5)、颞侧(T0.5、T1.0、T1.5)、鼻侧(N0.5、N1.0、N1.5)13个位点的CT值。结果:戴镜6mo后,A1组患者各位点CT均较戴镜前增厚(均P<0.05);A2组患者各位点CT均较戴镜前增厚,除SF、S1.5、T0.5、T1.5位点CT较戴镜前比较无差异,其余各位点戴镜前后均有差异(均P<0.05)。B1组患者戴镜后T1.0、N1.5、S1.5位点CT均较戴镜前增厚(均P<0.05);B2组患者戴镜前后各位点CT均无差异(均P>0.05),其中SF、S0.5、S1.0、S1.5、I0.5、I1.0、I1.5、N0.5、N1.0、N1.5位点CT较戴镜前变薄,但无统计学意义。C1组患者各位点CT戴镜前后比较均有差异(均P<0.05);C2组患者除S1.5、T1.5位点CT较戴镜前比较无差异,其余各位点CT均较戴镜前显著增厚(均P<0.05)。B2组和C2组患者戴镜后6mo眼轴较戴镜前增长0.12±0.14、0.20±0.17mm(均P<0.001)。B组和C组双眼眼轴差值由戴镜前0.54±0.27、0.88±0.39mm下降到戴镜6mo后0.47±0.20、0.62±0.39mm(均P<0.05),A1组和A2组双眼眼轴差值戴镜前后无差异(P>0.05)。结论:青少年近视性屈光参差患者长期配戴OK镜后高度数眼CT增厚,低度数眼CT无增厚,甚至出现变薄,同时配戴OK镜可延缓眼轴增长,减小屈光参差双眼间眼轴差值,对控制屈光参差的发展具有良好效果。

·AIM:To observe the changes of choroidal thickness(CT)and axial length(AL)in adolescents with myopic anisometropia before and after orthokeratology(OK lenses)treatment.·METHODS:In this retrospective case-control study,71 myopic participants who insisted on using OK lenses more than 6mo at night from June 2020 to September 2021 in Second People’s Hospital of Shenzhen were enrolled.They were divided into three groups,including group A consisted of 31 myopic participants with non-anisometropic myopia with binocular lenses(A1 group:the right eyes,A2 group:the left eyes),group B consisted of 18 bilateral myopic anisometropes(B1 group:the eyes with high degree,B2:the eyes with low degree)and group C consisted of 22 unilateral myopic anisometropes(C1:the eyes with high degree,C2:the eyes with low degree).The length of axis,the CT values of subfoveal(SF)and the superior(S0.5,S1.0,S1.5),inferior(I0.5,I1.0,I1.5),temporal(T0.5,T1.0,T1.5)and nasal(N0.5,N1.0,N1.5)at 0.5,1.0 and 1.5mm from the fovea before and after wearing lenses at 6mo were measured.·RESULTS:After wearing lenses at 6mo,CT of all sites in group A1 was all thickening compared with that before wearing lenses(all P<0.05),CT of all sites in group A2 was all thickening compared with that before wearing lenses,there was no difference compared with that before wearing lenses except for the SF,S1.5,T0.5 and T1.5 sites of the CT,the rest of the sites were different before and after wearing lenses(all P<0.05),CT of T1.0,N1.5 and S1.5 sites in B1 group was thicker than that before wearing lenses(all P<0.05),there was no difference in CT of all sites of the patients in group B2 before and after wearing lenses(all P>0.05).Among them,the CT at SF,S0.5,S1.0,S1.5,I0.5,I1.0,I1.5,N0.5,N1.0 and N1.5 was thinner than before wearing lenses,but it was not statistically significant.There were differences in all sites of CT in group C1 compared with that before and after wearing lenses(all P<0.05),for the CT of group C2,all the other sites except the points T1.5 and S1.5 was significantly thickened compared with that before wearing lenses(P<0.05).The axis of patients in group B2 increased by 0.12±0.14mm after wearing lenses at 6mo compared with that before wearing lenses(all P<0.001).The axis of group C2 increased by 0.20±0.17mm after wearing lenses at 6mo compared with that before wearing lenses(all P<0.001).The interocular axial difference in group B and C decreased from 0.54±0.27,0.88±0.39mm before wearing lenses to 0.47±0.20,0.62±0.39mm after wearing lenses at 6mo(all P<0.05).There was no significant in the interocular axis difference of group A1 and A2 before and after wearing lenses(P>0.05).·CONCLUSION:For adolescents with myopic anisometropia patients after long-term wearing OK lenses have CT thickening in high degree eyes,but no thickening in low-degree eyes,and even thinning.At the same time,wearing OK lenses can slow axis elongation and reduce interocular anisometropia difference in axis,which is an effective clinical method to control the development of anisometropia.