儿童青少年夜戴角膜塑形镜引起角膜上皮损伤的原因分析

Causes of Corneal Epithelial Injury in Children and Adolescents with Overnight Orthokeratology

目的:角膜上皮损伤是配戴角膜塑形镜常见的并发症之一,本文通过观察连续过夜配戴角膜塑形镜6个月的儿童青少年患者,对其发生角膜上皮损伤的原因进行总结和分析,为今后更好地开展角膜塑形镜的临床验配工作提供相关参考。方法:回顾性分析从2020年11月至2021年12月在我院验配角膜塑形镜的儿童青少年患者162例(310眼),年龄8~17周岁,平均(12.45 ± 2.21)岁。近视度数为−1.00~−6.00D,其中A组(−1.00~−2.00D)67眼,B组(−2.25~−4.00D) 146眼,C组(−4.25~−6.00D) 97眼。观察患者戴镜后1晚、1周、1月、3个月和6个月的裸眼视力、前表面角膜地形图、角膜上皮荧光染色、镜片情况等。结果:戴镜6个月期间发生角膜上皮损伤65眼,其中A组6眼,B组26眼,C组33眼。期间发生I级角膜上皮损伤39眼,II级角膜上皮损伤22眼,III级角膜上皮损伤4眼,无IV级角膜上皮损伤。戴镜1晚发生角膜上皮损伤41眼,戴镜1周时13眼,戴镜1个月时3眼,戴镜3个月时3眼,戴镜6个月时5眼。角膜上皮损伤的原因分析:机械损伤26眼,镜片沉积物24眼,不良卫生习惯6眼,护理液过敏或毒性反应4眼,泪液分泌不足3眼,镜片配适不当2眼。结论:夜晚睡觉配戴角膜塑形镜可能会引起部分患者角膜上皮损伤,多数为不超过II级的轻度角膜上皮损伤;−4.00D以上角膜上皮损伤的发生率较高,戴镜1晚时更容易发生角膜上皮损伤,摘戴镜片操作不规范导致的机械损伤和镜片沉积物是引起角膜上皮损伤的主要原因。

Objective: Corneal epithelial injury is one of the common complications on orthokeratology. This article summarizes and analyzes the causes of corneal epithelial injury in children and adolescents who wear orthokeratology lenses overnightfor 6 months continuously, so as to provide relevant reference for better clinical fitting of corneal plastic lenses in the future. Methods: A retrospective analysis was made of 162 children and adolescents (310 eyes) who had been fitted with orthokeratology in our hospital from November 2020 to December 2021. The age ranged from 8 to 17 years old, with an average of 12.45 ± 2.21 years old. The degree of myopia was −1.00~−6.00D, including 67 eyes in Group A (−1.00~−2.00D), 146 eyes in Group B (−2.25~−4.00D) and 97 eyes in Group C (−4.25~−6.00D). The uncorrected visual acuity, anterior surface corneal topography, corneal epithelial fluorescence staining and lens condition of the patients were observed at 1 night, 1 week, 1 month, 3 months and 6 months after wearing orthokeratology lenses. Results: 65 eyes of corneal epithelial injury occurred during 6 months of wearing orthokeratology lenses, including 6 eyes in Group A, 26 eyes in Group B and 33 eyes in Group C. During this period, there were 39, 22, 4 eyes with grade I, II, III corneal epithelial injury, and no grade IV corneal epithelial injury. Corneal epithelial injury occurred in 41 eyes one night after wearing glasses, 13 eyes one week, 3 eyes one month, 3 eyes three months, and 5 eyes six months. Cause analysis of corneal epithelial injury: 26 eyes with mechanical injury, 24 eyes with lens deposits, 6 eyes with bad hygiene habits, 4 eyes with allergic or toxic reaction to nursing solution, 3 eyes with insufficient tear secretion, and 2 eyes with improper lens fitting. Conclusion: Wearing orthokeratology lenses at night may cause corneal epithelial injury in some patients, most of which are mild corneal epithelial injury not exceeding grade II The incidence of corneal epithelial injury above −4.00D is higher, and corneal epithelial injury is more likely to occur when wearing orthokeratology lenses for one night. Mechanical damage and lens deposit caused by non-standard lens removal and wearing operation are the main causes of corneal epithelial injury.