青少年近视性屈光参差患者长期配戴角膜塑形镜效果观察

目的 探讨青少年屈光参差患者配戴角膜塑形镜3年后眼轴、中央角膜厚度及角膜内皮细胞密度的变化。设计 回顾性病例系列。研究对象 2011－2013年在北京同仁验光配镜中心验配角膜塑形镜且连续戴镜3年以上、按时复诊的近视性屈光参差青少年患者21例（42眼）。方法 依近视度数将患眼分为高度数眼组（高于-3.00 D）及低度数眼组（低于等于-3.00 D），观察并比较戴镜前及戴镜6个月、1年、2年、3年后各组眼轴、中央角膜厚度及角膜内皮细胞密度等参数的变化。主要指标 眼轴、中央角膜厚度、角膜内皮细胞密度。结果 戴镜前及戴镜6个月、1年、2年、3年后高度数眼组眼轴分别为（25.16±0.78）mm、（25.27±0.81）mm、（25.43±0.91）mm、（25.50±0.85）mm和（25.64±0.87）mm，低度数眼组眼轴分别为（24.13±0.99）mm、（24.38±0.96）mm、（24.49±1.00）mm、（24.71±0.94）mm和（24.88±1.01）mm，双眼眼轴均随时间增长（F=48.2；P=0.000），高度数眼组眼轴更长（F=10.186；P=0.003）。各时间点眼轴差异量分别为（1.03±0.45）mm、（0.90±0.40）mm、（0.85±0.39）mm、（0.79±0.41）mm及（0.76±0.44）mm，戴镜后双眼眼轴差异量逐渐缩小（F=9.494；P=0.000）。戴镜前及戴镜6个月、1年、2年、3年后高度数眼组角膜内皮细胞密度分别为（3362.57±278.73）个/mm2、（3393.67±325.88）个/mm2、（3333.76± 288.72）个/mm2、（3276.90±240.49）个/mm2及（3259.71±357.41）个/mm2，低度数眼组角膜内皮细胞密度分别为（3365.62±352.75）个/mm2、（3387.62±363.57）个/mm2、（3314.05±270.12）个/mm2、（3290.71±327.64）个/mm2及（3307.05±357.12）个/mm2，随着戴镜时间延长，双眼角膜内皮细胞密度呈下降趋势（F=4.386；P=0.006），双眼间比较无统计学差异（F=0.007， P=0.932）。戴镜前及戴镜6个月、1年、2年、3年后高度数眼组中央角膜厚度分别为（548.81±28.34）μm、（531.43±33.30）μm、（526.05±30.84）μm、（523.38±27.54）μm和（525.29±27.92）μm，低度数组眼中央角膜厚度分别为（549.76±28.72）μm、（536.90±26.51）μm、（534.24±27.67）μm、（534.19±25.84）μm及（531.76±27.16）μm，戴镜后6个月中央角膜厚度下降，以后无变化（F=56.843；P=0.000）。结论 青少年近视性屈光参差患者长期配戴角膜塑形镜后双眼眼轴差距缩小。角膜塑形效果于戴镜6个月内稳定。（眼科， 2017, 26： 131-134）  

The long-term clinical effects of orthokeratology in adolescent with myopic anisometropia

Objective To investigate the changes of axial length (AL), central corneal thickness (CCT), and corneal endothelial cell density(CECD) after wearing orthokeratology (ortho-k) lens in adolescent with myopic anisometropia. Design Retrospective case series. Participants 21 myopic anisometropic adolescent (42 eyes) from  2011 to 2013, aged between 8 and 15 years old, wearing the ortho-k lens more than 3 years in Beijing Tongren Eye Care Center. Methods The eyes were divided into high myopia and low myopia group according to the myopic degrees. The changes in AL, CCT, and CECD were measured before and 6 months, 1 year, 2 years and 3 years after wearing ortho-k lens. Data were analyzed using repeated measured ANOVA. Main Outcome Measures AL, CCT, CECD. Results The AL of high myopia group before and after ortho-k lens wearing for 6 months, 1 year, 2 years, 3 years was (25.16±0.78) mm, (25.27±0.81)mm, (25.43±0.91)mm, (25.50±0.85)mm and (25.64±0.87)mm respectively, and the data of low myopia group was (24.13±0.99)mm, (24.38±0.96)mm, (24.49±1.00)mm, (24.71±0.94)mm and (24.88±1.01)mm respectively. During the 3 years of observation period, the AL of both eyes increased every year after ortho-k lens wearing (F=48.2; P=0.000). The gap of AL between low myopic eyes and highly myopic eyes had significantly decreased (F=9.494; P=0.000) from (1.03±0.45)mm to (0.90±0.40)mm, (0.85± 0.39)mm, (0.79±0.41) mm and (0.76±0.44) mm. The CECD of highly myopic eyes before and after ortho-k lens wearing for 6 months, 1 year, 2 years, 3 years was (3362.57±278.73)/mm2, (3393.67±325.88)/mm2, (3333.76± 288.72)/mm2, (3276.90±240.49)/mm2 and (3259.71±357.41)/mm2, and the data of low myopic eyes was (3365.62±352.75)/mm2, (3387.62±363.57)/mm2, (3314.05±270.12)/mm2, (3290.71±327.64)/mm2 and (3307.05±357.12)/mm2 respectively. With the time prolonged, the CECD decreased (F=4.386; P=0.000), but there was no significant difference between the two groups. Before and after wearing ortho-k lens for 6 months, 1 years, 2 years and 3 years, the CCT data of highly myopic eyes was (548.81±28.34) μm, (531.43±33.30) μm, (526.05±30.84) μm, (523.38±27.54) μm and (525.29±27.92) μm respectively, and data of low myopic eyes was (549.76±28.72) μm, (536.90± 26.51) μm, (534.24±27.67) μm, (534.19±25.84) μm and (531.76±27.16) μm respectively. The baseline CCT of both eyes was not significantly different, both group reduced by the 6-month visit (F=56.843; P=0.000), and remained unchanged thereafter. Conclusions Orthokeratology treatment can reduce the axial length gap in adolescent with myopic anisometropia. The corneal shape remains stable within 6 months. (Ophthalmol CHN, 2017, 26: 131-134)