配戴角膜塑形镜对青少年近视患者眼表的影响

The effect of wearing orthokeratology on the ocular surface in adolescent myopia patients

目的:探讨配戴角膜塑形镜对青少年近视患者眼表的影响以及不同设计类型的角膜塑形镜对眼表影响的差别。方法:前瞻性队列研究。选取2021年6月—2022年3月在汕头国际眼科中心就诊选择配戴角膜塑形镜的41例青少年近视患者,选其右眼为受试眼。根据患者试戴角膜塑形镜类型分为VST组(21只眼)和CRT组(20只眼)。VST组男性8例,女性13例,年龄(10.7±1.7)岁,CRT组男性8例,女性12例,年龄(10.4±1.8)岁。分别于戴镜前和戴镜后1、3个月对研究对象的眼表疾病指数(Ocular Surface Disease Index,OSDI)量表评分、泪河高度、泪膜破裂时间、泪液基础分泌量、眼红指数、角膜上皮荧光素染色进行随访检查。结果:青少年近视患者在配戴角膜塑形镜后1个月、3个月与戴镜前相比,OSDI评分、眼红指数升高,泪膜破裂时间降低(均P<0.05),泪河高度与泪液基础分泌量无差异(均P>0.05)。戴镜后角膜上皮点染增加(主要以Ⅰ、Ⅱ级点染为主),且戴镜后1个月与3个月相比无差异(Z=-0.124,P>0.05)。两组患者戴镜前后的OSDI评分、泪河高度、泪膜破裂时间、泪液基础分泌量、眼红指数以及角膜上皮荧光素染色差异无统计学意义(均P>0.05)。结论:短期配戴角膜塑形镜不会对青少年近视患者的泪液分泌量造成影响,但会引起轻度的不适感,同时也会降低泪膜的稳定性以及增加角膜上皮损伤。VST型和CRT型角膜塑形镜对眼表的影响无差异。

Objective:To investigate the effects of orthokeratology on the ocular surface in adolescent myopia patients and the differences in the effects of different design types of orthokeratology on the ocular surface.Methods:Prospective cohort study.Forty-one adolescent myopia patients who attended Joint Shantou International Eye Center and chose to wear orthokeratology lenses from June 2021 to March 2022 were selected,and their right eyes were chosen as the subject eyes.The patients were divided into VST group(21 eyes)and CRT group(20 eyes)according to the type of orthokeratology they tried on.There were 8 males and 13 females in the VST group with the age of(10.7±1.7)years,and 8 males and 12 females in the CRT group with the age of(10.4±1.8)years.Ocular surface disease index(OSDI)scores,tear meniscus height(TMH),noninvasive tear break-up time(NIBUT),basal tear secretion,ocular redness index(ORI),and corneal epithelial fluorescein staining of the study subjects were examined at follow-up before and 1 and 3 months after lens wear,respectively.Results:In adolescent myopia patients,OSDI and ORI were increased and NIBUT was decreased at 1 and 3 months after orthokeratology lenses fitting compared with before lenses(both P<0.05),and there was no difference in the TMH and the basal tear secretion(both P>0.05).The increase in corneal epithelial pitting after lens wear was mainly dominated by grade Ⅰ and Ⅱ pitting,and there was no difference between 1 month and 3 months after lens wear(Z=-0.124,P>0.05).There were no statistically significant differences in OSDI,TMH,NIBUT,basal tear secretion,ORI,and corneal epithelial fluorescein staining between the two groups before and after lens wear(all P>0.05).Conclusion:Short-term wear of orthokeratology does not affect tear production in adolescent myopia patients,but causes mild discomfort,as well as decreasing tear film stability and increasing corneal epithelial damage.There is no difference in the effects of VST-and CRT-type orthokeratology on the ocular surface.