不同年龄患者配戴角膜塑形镜的有效性和安全性

Effectiveness and Safety of Wearing Orthokeratology Lenses in Different Age

目的:分析不同年龄对角膜塑形镜配戴后视力矫正效果和安全性的影响。方法:回顾性临床研究。连续性纳入2021年6—10月于温州医科大学附属眼视光医院进行角膜塑形镜配戴治疗的近视患者176例(176眼)。根据患者年龄进行分组,≤13岁组78例(78眼),>13~<18岁组53例(53眼)、≥18岁组45例(45眼)。收集各组基线和戴镜后1 d、1周、2周及1、3、6、9、12个月的等效球镜度(SE)、裸眼视力(UCVA)、角膜平坦曲率(FK)和角膜陡峭曲率(SK),并对戴镜后的安全性进行评价。取右眼数据用于统计分析,组间基线数据比较采用单因素方差分析或Kruska-WallsH检验方法,组间、组内多时间点的数据比较采用广义估计方程。结果:3组患者戴镜期间的SE、UCVA、FK、SK与其基线比较差异均有统计学意义(均P<0.05)。戴镜后1、3个月,3组间的客观验光SE改变百分比差异均有统计学意义(χ^(2)=9.17,P=0.010;χ^(2)=7.11,P=0.029),其中≥18岁组变化较≤13岁组缓慢(P=0.003、0.009)。戴镜后12个月,3组间的主觉验光SE改变百分比差异有统计学意义(χ^(2)=7.93,P=0.019),≥18岁组变化较≤13岁组更大(P=0.005)。戴镜1 d至6个月期间,3组间的UCVA差异均无统计学意义(均P>0.05);戴镜后9、12个月,3组间的UCVA差异有统计学意义(χ^(2)=6.40,P=0.041;χ^(2)=8.78,P=0.012),其中≥18岁组视力较≤13岁组更好、更稳定(P=0.017、0.003)。3组的FK改变量仅在3、9个月时差异有统计学意义(χ^(2)=6.25,P=0.044;χ^(2)=7.57,P=0.023),≥18岁组的FK改变量均小于≤13岁组(P=0.013、0.006),余时间差异均无统计学意义(均P>0.05)。戴镜1周至9个月期间,3组间的SK改变量差异均有统计学意义(χ^(2)=9.71~15.23,P<0.05),进一步分析发现戴镜后1周、3个月≥18岁组的SK改变量均小于≤13岁组(P=0.001、0.004),而戴镜后2周和1、6、9个月,≥18岁组的SK改变量小于>13~<18岁组和≤13岁组(均P<0.05)。戴镜期间3组患者眼压改变量、角膜厚度改变量及各种并发症组间比较差异均无统计学意义(均P>0.05)。结论:对于不同年龄近视患者,角膜塑形镜均能安全有效地压平角膜,降低屈光度和提升UCVA,但成年患者相较于儿童患者的角膜曲率改变更少,屈光度改变和UCVA更稳定。

Objective:To analyze the effects of different ages on the efficiency of vision correction and safety after wearing orthokeratology lenses.Methods:This was a retrospective clinical study.Totally 176 myopic patients(176 eyes)who underwent orthokeratology treatment in Eye Hospital,Wenzhou Medical University from June to October 2021 were included continuously in this study.Patients were categorized by age:78 patients(78 eyes)were in the≤13 years old group,53 patients(53 eyes)were in the>13-<18 years old group,and 45 patients(45 eyes)were in the≥18 years old group.Data on spherical equivalent(SE),uncorrected visual acuity(UCVA),cornea flat curvature(FK)and cornea steep curvature(SK)were collected at baseline and after 1 day,1 week,2 weeks and 1,3,6,9,12 months of lens wearing,and the safety after wearing lenses was also evaluated.In this study,data from the right eye were used for statistical analysis.One-way ANOVA or Kruska-Walls H test was used for the between-group comparison of the baseline data,and the generalized estimation equation was applied for the between or intra-group data comparison of multi-time point data.Results:The differences of SE,UCVA,FK,SK during lens wearing,and those at baseline were statistically significant in all three groups(all P<0.05).In the first and third month,the percentages of objective optometric SE change differed significantly among the three groups(χ^(2)=9.17,P=0.010;χ^(2)=7.11,P=0.029),and the≥18 years old group exhibiting a slower change than the≤13 years old group(P=0.003 and 0.009,respectively).In the 12th month,the percentage change of subjective optometric SE change among the three groups was statistically significant(χ^(2)=7.93,P=0.019),and the≥18 years old group showing a greater change than the≤13 years old group(P=0.005).Regarding UCVA,there were no significant difference until wearing the lens for 9 and 12 months,the UCVA of three groups were statistically different(χ^(2)=6.40,P=0.041;χ^(2)=8.78,P=0.012),and the≥18 years old group demonstrated better and more stable visual acuity than the≤13 years old group(P=0.017 and 0.003,respectively).However,there were significant differences in FK changes among the three groups at 3 and 9 months(χ^(2)=6.25,P=0.044;χ^(2)=7.57,P=0.023),and the FK changes in the≥18 years old group were smaller than those in the≤13 years old group(P=0.013 and 0.006,respectively).There were statistically significant differences in SK changes among three groups from 1 week to 9 months(χ^(2)=9.71-15.23,P<0.05),with further analysis revealing that the SK changes in the≥18 years old group were smalle r than≤13 years old group after l week,3 months(P=0.001,0.004),and were smaller than>13-<18 years old group and≤13 years old group after 2 weeks,1 month,6 months and 9 months(P<0.05).Throughout the treatment,complications,change in ocular pressure,and corneal thickness did not differ significantly among the three groups(P>0.05).Conclusions:Orthokeratology proves to be a safe and effective method for flattening the cornea,reducing diopter and improving UCVA in patients of different ages.Adult patients exhibit fewer changes in corneal curvature,resulting in more stable changes in diopter and UCVA compared to children.