角膜塑形镜矫治青少年近视散光的疗效及对角膜内皮细胞的影响

目的：探讨角膜塑形镜矫正青少年近视的临床效果及对角膜内皮细胞的影响。方法：随机在我院选择400例800眼明确诊断为近视的青少年患者，平均年龄为11．5±2．3岁，其中男239例，女161例，根据治疗方法随机分为角膜塑形组和框架眼镜组，分别为167例334眼和233例466眼，本试验所研究的数据包括：（1）疗效：裸眼视力、角膜曲率、眼轴长度、屈光度等；（2）角膜内皮细胞：角膜内皮细胞计数、密度、角膜点染程度以及角膜中央厚度等。观察时间分别为配戴后1d，1、6、12、24mo，了解角膜塑形镜治疗青少年近视的临床效果及对角膜内皮细胞的影响，采用方差分析进行组间和组内的比较。结果：框架眼镜组可在配戴眼镜后视力达正常，角膜塑形组患者在1 mo后视力达到正常水平。经2 a的配戴后角膜塑形镜组患者的角膜曲率、屈光度明显降低，分别为40.09±0．31、0．23±0．06 D，而框架眼镜组则有显著上升，两组比较差异具有统计学意义（P＜0．05）；两组患者眼轴长度治疗后的第1 mo较治疗前均有轻度增加，但差异无统计学意义（P＞0．05）；治疗2a后，两组的眼轴长度分别为23．96±0．38、26．49±0．88 mm，眼轴长度差异有统计学意义（P＜0．05）。角膜中央厚度在治疗2a 后则分别为527．33±27．69、526．98±26．89μm，2a后的角膜中央厚度比较，两组差异无统计学意义（P＞0．05），有关两组患者治疗后1 mo的角膜内皮细胞计数和密度较治疗前均有减少，但差异无统计学意义（P＞0．05）。结论：角膜塑形矫正青少年近视的临床效果好，对角膜内皮细胞的影响较小，且能够有效控制近视发展。

Clinical effect of orthokeratology for juvenile with myopia astigmatism and its effects on corneal endothelial cells

Abstract?AIM:To investigate the clinical effect of orthokeratology for 400 juvenile with myopia astigmatism and its effects on corneal endothelial cells.?METHODS:Four hundred patients(800 eyes), of whom the average age was 11.5 ±2.3 years old, 239 male, 161 female, were divided into two groups: orthokeratology group and spectacles group. Parameters including efficacy data ( uncorrected visual acuity, corneal curvature, axial length and diopter ) and corneal endothelial cell data ( count of endothelial cell, endothelial cell density, fluorescein staining and central corneal thickness) were observed at 1d, 1, 6, 12 and 24mo after wearing.? RESULTS: The visual acuity of spectacles group recovered to normal after wearing, that of orthokeratology group recovered to normal at 1mo after wearing.At 2a after wearing, the corneal curvature, diopter of orthokeratology group decreased significantly (40.09 ±0.31D, 0.23 ±0.06D respectively); while those of spectacles group increased, the differences between the two groups were significant (P<0.05).The axial length of the two groups increased slightly at 1mo after wearing ( P>0.05 ) compared to those before wearing. At 2a after wearing, the axial length of the two groups were 23.96 ± 0.38mm, 26.49±0.88mm respectively (P<0.05).At 2a after wearing, central corneal thickness was 527.33 ± 27.69mm, 526.98±26.89μm(P>0.05).The count of endothelial cell and endothelial cell density both decreased after wearing without significant differences (P>0.05).?CONCLUSION: Orthokeratology has less effect on the corneal endothelial cells, no obvious adverse reactions and can control the prognosis of myopia.