0~6岁儿童近视预防及干预措施效果评价的研究

Study on the prevention and effect evaluation of intervention measures for myopia in children aged 0-6 years

目的 对国内外0~6岁儿童近视预防及干预措施效果进行系统评价,为开展相关领域研究和实践提供理论依据。方法 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台等数据库自建库至2021年10月发表的国内外文献中有关0~6岁儿童近视预防或干预的随机对照试验研究,对纳入文献质量进行评价,并系统分析预防及干预措施的效果。结果 检索到共3 002篇文献,经逐层筛选最终纳入6篇文献进行分析,其中有3篇采用行为干预方式,2篇采用药物干预方式,1篇采用手术联合角膜接触镜干预方式。(1)在行为干预中:对照组均采取常规健康宣教方式,试验组在其基础上,由医护人员联合幼儿园或家庭进行综合干预;3篇文献的结局指标中包含近视发生率,其中2篇文献试验组近视发生率低于对照组(P<0.05);2篇文献的结局指标中包含屈光异常率,2篇文献试验组屈光异常率均低于对照组(P<0.05)。(2)在药物干预中:2篇药物干预试验均选用阿托品,1篇结果显示高浓度(0.1%)阿托品的近视治疗有效率高于低浓度(0.01%),但不良反应发生率更高;另1篇结果同样提示随着阿托品浓度升高(由0.01%至0.025%至0.05%),儿童近视控制效果更佳,并且发现低浓度阿托品相较于高浓度阿托品对低龄儿童的治疗效果差。(3)在手术干预中:1篇手术干预文献中,试验组采用后巩膜加固术(PSR)联合硬性透气性角膜接触镜控制学龄前儿童的高度近视,效果优于单纯使用角膜接触镜。结论 目前已有行为干预、药物干预、PSR手术矫治三类措施用于干预0~6岁儿童近视。行为干预可减少近视发生率及屈光异常率。阿托品可用于抑制学龄前儿童近视的进展,但适用年龄范围及最适浓度尚待确定。PSR手术矫治可与角膜接触镜联合应用于治疗学龄前儿童的高度近视。

Objective To systematically evaluate the effect of the preventions and interventions for myopia children aged 0-6 years at home and abroad, and to provide theoretical basis for research and practice in related fields.Methods The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang database were searched for literature published until October 2021 on randomized controlled trial(RCT) studies for the preventions or interventions of myopia in children aged 0-6 years.The quality of the included literature was evaluated, and the effects of prevention and intervention measures were systematically analyzed.Results A total of 3002 literatures were retrieved, and 6 studies were finally included in the systematic review, among which 3 were treated with behavioral intervention, 2 with drug intervention, and 1 with surgery combined with contact lens intervention.(1) In behavioral intervention: the control groups received routine health education, and the experimental groups received comprehensive intervention based on it by medical staff in combination with kindergartens or families.The incidence of myopia was included in the outcome indexes of all the 3 literatures, and the incidence of myopia in the experimental groups were lower than that in the control groups in 2 literatures(P<0.05).Abnormal refractive rate was included in the outcome indexes of 2 literatures, and in 2 literatures, the abnormal refractive rate of the experimental group was lower than that of the control group(P<0.05).(2) In drug intervention: Atropine was used in 2 drug intervention trials.The results of 1 study showed that high concentration(0.1%) atropine was better than low concentration(0.01%) in myopia treatment, but the incidence of adverse reactions was higher than low concentration one.Another study also suggested that with the increase of atropine concentration(from 0.01% to 0.025 to 0.05%),the inhibitory effect on the development of myopia in children was enhanced, and it was found that atropine at low concentrations was less effective in younger children compared with high concentration.(3)In surgical intervention: In 1 surgical intervention literature, the combination of posterior scleral reinforcement(PSR) and rigid gas permeable contact lens was used in the experimental group to control the high myopia of preschool children, and the effect was better than that of contact lens alone.Conclusion Behavioral intervention, drug intervention and PSR surgical correction have been used for the intervention of myopia in children aged 0-6 at present.Behavioral intervention can reduce the incidence of myopia and refractive abnormalities.Atropine can be used to inhibit the progression of myopia in preschool children, but the appropriate age range and optimal concentration have not been determined.PSR can be used in combination with contact lens for preschoolers with high myopia.