配戴离焦设计框架镜与角膜塑形镜对儿童近视眼控制效果的比较

Comparison on the control effect of wearing peripheral myopic defocus design spectacle lenses and orthokeratology lenses for myopia in children

目的比较7~14岁低度及中度近视儿童配戴离焦设计框架镜(PMDSL)与角膜塑形镜(OK镜)对近视控制的临床效果。方法前瞻性非随机对照研究。纳入2021年6月至2022年6月在郑州市中医院验配PMDSL(39例)和OK镜(42例)的7~14岁儿童,近视度数为-6.00~-0.75 D。所有纳入者只取右眼数据进行统计分析。根据近视儿童的矫正方式及散瞳后屈光度[以等效球镜度(SE)表示]分为四组:低度近视PMDSL组21例(-3.00 D≤SE<-0.50 D)、低度近视OK镜组23例(-3.00 D≤SE<-0.50 D)、中度近视PMDSL组18例(-6.00 D≤SE<-3.00 D)以及中度近视OK镜组19例(-6.00 D≤SE<-3.00 D);观察比较四组儿童戴镜前及戴镜后半年及1年的屈光度及眼轴长度(AL)的数据。结果低中度近视PMDSL组及OK镜组戴镜后的AL和SE均呈上升趋势,戴镜前的AL及SE与戴镜后各时间段相比较差异均有统计学意义(均P<0.05)。低度近视PMDSL组和OK镜组两组1年的SE变化量分别为-0.25(-0.50,0.00)D和-0.25(-0.25,-0.25)D,AL的变化量分别为0.11(0.06,0.31)mm和0.26(0.12,0.41)mm,两者对比差异无统计学意义(SE:Z=-1.73,P=0.083;AL:Z=1.61,P=0.107);中度近视PMDSL组和OK镜组两组1年的SE变化量分别为-0.50(-0.56,-0.25)D和0.00(-0.25,0.00)D,AL的变化量分别为0.35(0.17,0.42)mm和0.13(0.08,0.31)mm;两组对比差异有统计学意义(SE:Z=-3.79,P<0.001;AL:Z=2.67,P=0.007)。结论配戴PMDSL与OK镜均能有效地矫正儿童近视眼,OK镜对中度近视的进展控制效果更好。

Objective To compare the clinical efficacy of wearing peripheral myopic defocus design spectacle lenses(PMDSL)and orthokeratology lenses(OK lenses)for myopia control in children aged 7 to 14 years with low and moderate myopia.Methods This was a prospecitve non-randomized controlled study.Data of children aged 7-14 years old who underwent PMDSL(39 cases)and OK lenses(42 cases)in Zhengzhou Hospital of Traditional Chinese Medicine from Jun.2021 to Jun.2022 were collected.The degree of(equivalent spherical,SE)myopia ranged from-6.00 D to-0.75 D.Only the right eye data were taken for statistical analysis from the participants.Based on the correction method of myopic children and the diopter after mydriasis,they were divided into 4 groups:the low myopia PMDSL group consisted of 21 cases with myopia(-3.00 D≤SE<-0.50 D),the low myopia OK lens group consisted of 23 cases with myopia(-3.00 D≤SE<-0.50 D),the moderate myopia PMDSL group consisted of 18 cases with myopia(-6.00 D≤SE<-3.00 D),and the moderate myopia OK lenses group consisted of 19 cases with myopia(-6.00 D≤SE<-3.00 D).The refractive error and axial length(AL)were observed and compared among the 4 groups of children before,at half a year and 1 year after lens wearing.Results AL and SE of low and moderate myopia in the PMDSL group and the OK lenses group showed an upward trend after wearing glasses.The AL and SE before wearing glasses were statistically significant compared with each time period after wearing glasses(all P<0.05).The 1-year changes of SE in the low myopia PMDSL group and the OK lenses group were-0.25(-0.50,0.00)D and-0.25(-0.25,-0.25)D,and the changes of AL were 0.11(0.06,0.31)mm and 0.26(0.12,0.41)mm,respectively.There was no significant difference between the two groups(SE:Z=-1.73,P=0.083;AL:Z=1.61,P=0.107).The 1-year changes of SE in the moderate myopia PMDSL group and the OK lenses group were-0.50(-0.56,-0.25)D and-0.00(-0.25,0.00)D,and the changes of AL were 0.35(0.17,0.42)mm and 0.13(0.08,0.31)mm,respectively.The difference between the two groups was statistically significant(SE:Z=-3.79,P<0.001;AL:Z=2.67,P=0.007).Conclusion Wearing PMDSL and OK lens can effectively correct myopia in children,and OK lens has better control effect on the progression of moderate myopia.