Efficacy of atropine,orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis

Background/PurposeOrthokeratology (Ortho-K), atropine eye drops and combined atropine with Ortho-K are proven to be effective ways to prevent myopic progression in many studies, but there is scarce evidence regarding the comparative efficacy of different dosages of atropine,Ortho-K, and combined atropine with Ortho-K for childhood myopia.MethodsWe performed a network meta-analysis (NMA) to assess the relative efficacy of the aforementioned interventions for myopic progression; moreover, we calculated the surface under cumulative ranking area (SUCRA) to determine the relative ranking of treatments.ResultsWe identified 19 randomized controlled trials (3435 patients). NMA revealed that 0.01%–1% atropine, Ortho-K, and 0.01% atropine combined with Ortho-K inhibited axial elongation (AL) over one year. For refractive change, SUCRA analysis revealed that the hierarchy was high-dose (0.5%–1%), moderate-dose (0.1%–0.25%), and low-dose (0.01%–0.05%) atropine. Regarding AL, SUCRA analysis revealed the following hierarchy: Ortho-K combined with 0.01% atropine, high-dose atropine, moderate-dose atropine, Ortho-K, and low-dose atropine.ConclusionIn conclusion, we found that atropine (0.01%–1%), Ortho-K, and 0.01% atropine combined with Ortho-K could significantly slow down myopia progression. The atropine efficacy followed a dose-related pattern; moreover, Ortho-K and low-dose atropine showed similar efficacy. There was a synergistic effect of using 0.01% atropine combined with Ortho-K, and it showed comparable efficacy to that of high-dose atropine.     

角膜塑型术矫正近视二年后的临床观察

目的 :探讨角膜塑型术 (Orthokeratology ,简称Or tho K镜 )矫正近视的远期疗效 ,了解其对近视的矫正及控制近视进展的效果。并观察其安全程度。方法 :配戴Ortho K镜二年以上的青少年近视眼患者 ,共 86例 16 6眼 ,平均年龄(15 .5± 2 .6 )岁 ( 10～ 2 5岁 ) ,平均屈光度 ( - 4 .0 2± 1.78)D( -1.5～ - 7.0D)。对配戴前、后的角膜曲率、角膜地形图、角膜厚度、眼轴、眼压进行检测 ,平均观察期为 ( 2 8.2 5± 3.74 )个月。结果 :配戴前后平均裸眼视力分别为 0 .2 1± 0 .10和0 .99± 0 .2 3,差异有非常显著性 (P <0 .0 1) ;配戴前后角膜水平曲率均值分别为 ( 4 3.0 5± 1.10 )D和 ( 4 0 .84± 1.38)D ;配戴前后眼轴 (眼球前后径 )均值分别为 ( 2 4 .93± 0 .82 )mm和( 2 5 .16± 0 .82 )mm ,每年眼轴增长均值为 ( 0 .12± 0 .4 1)mm ;配戴前后角膜厚度均值分别为 ( 0 .5 6 5± 0 .0 30 )mm和 ( 0 .5 5 7±0 .0 34)mm ,配戴后角膜厚度平均变薄 0 .0 0 9mm ,差异有显著性 (P <0 .0 1) ;配戴前后眼压均值分别为 ( 15 .95± 2 .92 )mmHg和 ( 15 .35± 2 .6 0 )mmHg ,配戴后眼压平均下降 0 .6 0mmHg,差异有显著性 (P <0 .0 1)。配戴Ortho K镜期间有 79眼发生过角膜点状浸润 ,占配戴眼数的 4 7.31%。结论 :Or t     

角膜塑形镜对近视眼调节微波动幅度和调节滞后的影响

目的 研究近视眼配戴角膜塑形镜后调节微波动幅度和调节滞后的改变.方法 横断面研究.选取在视光门诊规范验配、随诊、配戴角膜塑形镜者15例作为观察组,框架眼镜者15例作为对照组;使用开放视野型红外验光仪(WAM-5500)测量两组在0～4 D的调节刺激下的调节反应,计算相应的调节微波动幅度、调节滞后值和调节误差指数.对两组相关数据进行独立样本t检验.结果 在0、1、2、3、4D调节刺激下,角膜塑形镜组的调节微波动幅度均大于框架眼镜组,且差异有统计学意义(t=3.704、3.277、2.365、2.179、2.591,P均＜0.05).角膜塑形镜组的调节滞后值均小于框架眼镜组,在2,3和4D调节刺激下,两组差异有统计学意义(t=-2.208,-2.244,-2.098,P均＜0.05);而在0和1 D调节刺激下,两组差异无统计学意义(t=-1.974、-1.758,P＞0.05).角膜塑形镜组的调节误差指数小于框架眼镜组,且差异有统计学意义(t=-2.098,P＜0.05).结论 近视眼配戴角膜塑形镜后,调节微波动幅度增大;在高调节需求时,调节滞后值减小,这为其延缓近视的进展提供了一定依据.     

Assessing the change of anisometropia in unilateral myopic children receiving monocular orthokeratology treatment

BackgroundThis study aimed at comparing the inter-eye axial elongation difference in order to evaluate the change of anisometropia in unilateral myopic children wearing monocular orthokeratology (Ortho-K) lens.MethodsIn this retrospective cohort study, we recruited monocular myopic subjects treated with monocular Ortho-K lens from May 2012 to January 2017. The axial length (AL) of both eyes was recorded, and we calculated the AL difference as our primary outcome, to evaluate myopia progression. High anisometropia was defined as anisometropia more than 2.50D. The generalized estimating equations (GEE) model was used to assess the related risk factors.ResultsA total number of 31 unilateral myopic patients were identified. The initial wearing age of the subjects was 12.32+/−3.07 years. In myopic eyes, the initial spherical equivalent was −2.73+/−0.95 diopter (D). The mean follow-up duration was 2.01+/−1.48 years. A significant reduction in the AL difference was found, from 0.83+/−0.45 millimeters at the baseline to 0.59+/−0.49 millimeters at 24 months (P = 0.039). Besides, after wearing Ortho-K lens for a long term, high anisometropic wearers showed more AL difference reduction than low anisometropic wearers in unilateral myopic children (P=0.002).ConclusionThis study demonstrated that the myopic eyes in unilateral myopic children had less AL growth than the companion emmetropic eyes when treated with monocular Ortho-K lenses. Wearing Ortho-K lens for a long time would present a more significant AL difference reduction in high anisometropic children.     

角膜塑形镜对近视青少年脉络膜厚度的影响研究

目的随访观察配戴角膜塑形镜及框架眼镜1年的青少年低、中度近视患者,探讨戴镜前后及2组间脉络膜厚度的差异。方法选取-1.00~-6.00 D的252例青少年近视患者,随机分为试验组及对照组,试验组配戴角膜塑形镜,对照组配戴框架眼镜。应用重复测量方差分析、独立样本t检验分析患者治疗1年期间的眼轴,黄斑中心凹及鼻侧、颞侧脉络膜厚度(应用EDI-SD OCT)。结果治疗1年后,试验组患者的眼轴增加明显缓于对照组(低度近视组t=19.071,P<0.001;中度近视组t=19.457,P<0.001);试验组戴镜后各时间点的脉络膜厚度与戴镜前相比均有增厚(P<0.001),低度近视组在戴镜1个月内脉络膜增厚最为明显(P<0.05),1个月后基本趋于稳定(P>0.05),而中度近视组在戴镜3个月内脉络膜增厚最为明显(P<0.05),3个月后基本趋于稳定(P>0.05)。颞侧脉络膜厚度厚于鼻侧。1年后试验组与对照组脉络膜厚度比较差异均有统计学意义(P<0.001)。结论青少年近视患者配戴角膜塑形镜后,眼轴增长变慢,早期脉络膜厚度有不同程度增加,1~3个月后基本保持稳定。     

环曲面和球形角膜塑形镜在散光患者中的疗效分析

目的 比较环曲面和球形角膜塑形镜在中高度散光患者治疗中的疗效。方法 回顾性分析2019年6月至2020年9月安徽省第二人民医院眼科佩戴角膜塑形镜片的77名近视合并中、高度散光(≥1.0 D)患者的临床资料。根据受试者选择透镜设计不同分为环曲面组(n=36)和球形组(n=41)。观察两组患者1年内佩镜的治疗效果,评价指标为裸眼视力(UCVA)、镜片偏心度及角膜散光J0、J45。结果 环曲面及球形组UCVA分别从佩戴前的0.80(0.60, 0.10)、0.80(0.55, 0.90)下降到佩戴12个月后的0(0.00, 0.08)、0(0.00, 0.10),两组佩戴前后各时间点比较,差异无统计学意义(P>0.05)。环曲面组及球形组镜片偏心度由戴镜1天的(0.46±0.25)mm、(0.53±0.21)mm增加至戴镜12个月的(0.73±0.41)mm、(1.32±0.12)mm,角膜散光J0分别由基线时的(-0.59±0.73)D、(-0.78±0.41)D下降到佩戴12个月的(-0.13±0.68)D、(-0.69±1.19)D,两组患者佩戴1个月后偏心度和角膜散光J0比较,...     

佩戴角膜塑形镜及框架眼镜对青少年调节反应的影响

目的探讨青少年佩戴角膜塑形镜和框架眼镜后调节反应的变化及两者的差异。方法青少年近视患者共76例,排除屈光参差、眼底疾患等因素后,根据患儿依从性及家长意愿,34例患者佩戴角膜塑形镜,42例患者佩戴单焦点框架眼镜。所有患者矫正残余屈光不正,用分光检影装置测定初次及戴镜1年后双眼的调节反应,并计算相应的调节滞后量。结果共74例完成该研究,初次测定两组调节反应、调节滞后无统计学差异（P〉0．05）。佩戴角膜塑形镜1年后调节反应、调节滞后与初次无显著差异（P〉0．05）,佩戴框架眼镜1年后调节反应、调节滞后与初次测定有统计学差异（P〈0。05）;1年后佩戴角膜塑形镜组调节反应大于框架眼镜组,调节滞后小于框架眼镜组,两者差异有统计学意义（P〈0．05）。结论青少年近视眼佩戴角膜塑形镜1年后调节反应明显大于佩戴框架眼镜者,调节滞后明显小于佩戴框架眼镜者,在延缓近视进展方面,角膜塑形镜有一定的作用。     

角膜塑型术矫正近视6年后的临床观察

目的探讨角膜塑型术（Orthokeratology,简称为Ortho-K镜）,矫正近视的长期疗效及其控制近视发展的效果。方法配戴Ortho-K镜6年后的青少年近视患者,8例16眼,男3例,女5例。平均年龄18岁±3.14岁（17～22）岁,配戴前裸眼视力0.28±0.272（0.06～0.5）,平均屈光度（-5.01±4.32）D,观察期（5～7）年,平均观察期（6.5±1.81）年。配戴前后进行视力、屈光度、眼轴、眼压等临床指标的系统检测。结果裸眼视力由配戴前的0.28±0.272上升到0.71±0.581,P〈0.001,有非常显著性差异。屈光度由配戴前的-5.01±4.32D降低到-2.13±3.62D,P〈0.001,有非常显著性差异。眼轴由配戴前的（25.83±2.81）mm到（26.28±1.65）mm,P〉0.1,差异无统计学意义。眼压由（15.74±4.92）mmHg降低到（10.45±3.10）mmHg,P〈0.001,有非常显著性差异。戴镜期间有7眼发生角膜浅层点状侵润,经治疗后痊愈。tBUT为9.44±13.24s,低于正常水平,但患者没有干眼症状。结论长期配戴Ortho-K镜具有一定的矫正近视及控制近视发展的效果。     

角膜塑型接触镜配戴的微生物研究

目的了解角膜塑型接触镜配戴者眼部、镜片及护理用品的微生物状况,了解角膜塑型接触镜配戴者眼部感染的可能原因,为临床治疗提供依据.方法从配戴角膜塑型镜者结膜囊、常规清洗消毒前后镜片、镜盒及护理液取材进行细菌、真菌及阿米巴培养,并按常规方法进行鉴定.结果细菌检查阳性率结膜囊为66.3%;清洗消毒前后镜片分别为72.4%和11.2%(P＜0.01);镜盒同清洗消毒前镜片;多功能护理液为8%(4/50).眼部感染者均检出有细菌生长.结论角膜塑型接触镜配戴者镜片及护理用品有微生物污染,常规的护理操作可明显减少镜片上污染的微生物.     

后巩膜加固术与角膜塑形术治疗中小学生近视的疗效比较

目的对后巩膜加固术与角膜塑形术治疗中小学生近视进行比较。方法 后巩膜加固术36例72眼,角膜塑形术75例150眼,对手术前后视力,屈光变化及不良反应进行分析,术后观察时间平均19.6个月。结果 后巩膜加固术有1例近视发展-0.75D,4例近视度减少-0.25D～0.50D,其余不变,有效率97％,无其他不良反应;角膜塑形术有效率56％,随着时间推移,近视回退率逐渐增多,不良反应有异物感、畏光、角膜上皮剥脱、散光增加。结论 后巩膜加固术治疗中小学生近视的疗效优于角膜塑形术。