8~15岁青少年配戴角膜塑形镜对角膜基底神经丛和角膜透明度的影响

Effects of Orthokeratology on Corneal Sub-Basal Plexus and Corneal Transparency in Adolescents Aged 8-15 Years Old

目的:探讨8~15岁青少年配戴角膜塑形镜后角膜基底神经丛和角膜透明度的变化。方法:前瞻性临床研究。采用随机抽样法收集2020年11月至2021年8月在青岛大学附属医院眼科就诊并配戴角膜塑形镜的8~15岁近视青少年,于戴镜前及戴镜后1、3、6个月在激光共聚焦显微镜下观察角膜中央、上方以及颞侧上皮下的神经纤维密度(NFD)、神经纤维长度(NFL)、神经纤维走向(NFO)和神经纤维宽度(NFW)。采用Pentacam眼前节分析仪对角膜不同直径范围内的光密度进行检测。神经形态学参数、角膜光密度在戴镜前后的比较采用随机区组方差分析。结果:共16例(32眼)近视患者纳入研究,其中4例丢失,最终12例(28眼)完成随访。角膜中央区,NFD戴镜后较戴镜前1个月显著增加(P=0.003),3个月和6个月逐渐减低至戴镜前,差异无统计学意义(P>0.05);NFL在戴镜前后差异无统计学意义(P>0.05);NFO在戴镜后1个月和6个月均显著大于戴镜前(P=0.015,0.047)。NFW戴镜6个月较戴镜前显著增宽(P=0.029)。角膜颞侧,NFD戴镜后6个月内均与戴镜前差异无统计学意义(P>0.05);NFL戴镜6个月内差异无统计学意义(P>0.05);NFO戴镜后逐渐增大,至戴镜6个月时和戴镜前相比差异有统计学意义(P<0.001);NFW戴镜3个月后显著增加(P=0.002),6个月进一步增加(P<0.001)。角膜上方,NFD戴镜1~3个月轻度增加,6个月降低,均与戴镜前差异无统计学意义(均P>0.05);NFL戴镜3个月时较戴镜前增加显著(P<0.001),6个月缩短至与戴镜前无明显差异(P>0.05);NFO戴镜3个月和6个月与戴镜前相比显著增大(P<0.001,P=0.022)。角膜前层0~2 mm和2~6 mm范围的角膜光密度值在戴镜后6个月后较戴镜前显著升高(P=0.011,P<0.001)。结论:青少年配戴角膜塑形镜后角膜上皮下神经丛的形态和角膜光密度发生了明显变化。戴镜后角膜NFD先增加后降低,NFO弯曲程度增加,NFW普遍增粗。角膜透明度戴镜后6个月内稳定降低。

Objective:To investigate the changes of corneal sub-basal nerve and corneal transparency in adolescents aged 8 to 15 years with orthokeratology lenses.Methods:In this prospective clinical study,myopic adolescents aged 8-15 years old ftted with orthokeratology lens in the Affiliated Hospital of Qingdao University from November 2020 to August 2021 were randomly selected.Nerve fiber density(NFD),nerve fiber length(NFL),nerve fiber orientation(NFO),and nerve fiber width(NFW)were assessed by confocal laser microscopy before and 1,3 and 6 months after wearing lens.The optical density of cornea in different diameters was evaluated by Pentacam anterior segment analyzer.Pre-and post-wear comparisons of neuromorphological parameters and corneal optical density were performed using randomized zone group ANOVA.Results:A total of 16 patients(32 eyes)with myopia were included in the study,of which 4 were lost and 12(28 eyes)eventually completed the follow-up.In the central cornea,the NFD was significantly increased at 1-month(P-0.003)after wearing and gradually decreased to the baseline level at 3-and 6-month(P>0.05).The difference in NFL shows no significant difference after lens wear(P>0.05).NFO was significantly higher at 1 and 6 months(P=0.015 and 0.047,respectively).NFW increased significantly at 6-month(P=0.029).In the temporal cornea,there was no statistical difference during 6-month wearing(P>0.05).NFL did not differ significantly during 6 months(P>0.05).NFO increased gradually after wearing lens and showed statistical significance at 6 months(P<0.001).NFW increased significantly at 3 months(P=0.002)and further increased at 6 months(P<0.001).In the upper cornea,NFD increased slightly in the early stage and decreased at 6-month,showing no statistical difference(all P>0.05).NFL increased significantly at 3-month(P<0.001),and decreased to the baseline level at 6-month(P>0.05).NFO significantly increased at 3 and 6 months(P<0.001,P=0.022).The corneal optical density of the anterior corneal layer≤2 mm and 2-6 mm increased at 6 months after wearing the lens,with statistical significance(P=0.011,P<0.001).Conclusions:The morphology of the corneal sub-basal nerve and corneal densitometry changed significantly in the myopic adolescents after wearing orthokeratology lens.The nerve fiber density increased and then decreased after lens wearing,the degree of nerve course curvature increased,and the nerve fibers were generally thickened.The corneal transparency decreased steadily for 6 months afterlens wearing.