夜戴型角膜塑形镜治疗青少年近视的效果

目的观察夜戴型角膜塑形镜治疗青少年近视随访2 a的治疗效果。方法选取2014年7月至2016年6月在我院验配夜戴型角膜塑形镜且连续配戴2 a以上,并按时复查者110例(206眼)纳入研究,按照近视度数和角膜曲率高低分为低度近视组(等效球镜度数≤-3.00 D)和中度近视组(等效球镜度数>-3.00^-6.00 D)、低曲率组(角膜曲率平坦值≤43.0 D)和高曲率组(角膜曲率平坦值>43.0~46.0 D)。观察戴镜前和戴镜后1个月、3个月、6个月、1 a、2 a的裸眼视力、屈光度、角膜曲率、眼轴长度、中央角膜厚度及角膜内皮细胞变化情况并进行比较。结果戴镜后1个月、3个月、6个月、1 a、2 a的裸眼视力分别为(0.039±0.080)logMAR、(0.029±0.070)logMAR、(0.025±0.090)logMAR、(0.016±0.050)logMAR、(0.300±0.830)logMAR,与戴镜前(0.710±0.280)logMAR相比,差异均有统计学意义(均为P<0.05)。低度近视组、中度近视组裸眼视力、残余屈光度在戴镜后1 a、2 a与戴镜后1个月、3个月、6个月相比,差异均有统计学意义(均为P<0.05)。低曲率组角膜曲率平坦值在戴镜后1 a、2 a分别为(38.75±0.35)D、(39.96±1.96)D,与戴镜后1个月[(40.04±0.14)D]、3个月[(39.75±2.05)D]、6个月[(39.18±1.06)D]比较,差异均具有统计学意义(均为P<0.05);高曲率组角膜曲率平坦值在戴镜后1个月[(41.98±1.09)D]、2 a[(40.85±2.20)D]与戴镜后3个月[(41.47±1.09)D]、6个月[(41.02±1.12)D]、1 a[(40.63±1.13)D]比较,差异均具有统计学意义(均为P<0.05)。戴镜前后角膜内皮细胞计数、眼轴长度、中央角膜厚度比较,差异均无统计学意义(均为P>0.05)。结论在规范验配、严格复查下,角膜塑形镜是一种有效矫正视力和控制近视进展的方法。

Two-year follow-up outcomes of overnight orthokeratology for myopia correction and control in adolescents

Objective　To evaluate the 2-year efficacy of overnight orthokeratology for myopia correction and control in adolescents.Methods　This was a retrospective,uncontrolled study.From July 2014 to June 2016,110 patients (206 eyes) who had been wearing overnight orthokeratology in Eye Hospital of China Academy of Traditional Chinese Medicine were enrolled and followed up to 2 years.All patients were divided into 4 groups according to refraction and corneal curvature:low myopia group (spherical equivalent ≤-3.00 D) and moderate myopia group (spherical equivalent -3.00 D~-6.00 D),low corneal curvature group (corneal curvatureflatness ≤43.0 D) and high corneal curvature group(corneal curvatureflatness 43.0 D-46.0 D).The uncorrected visual acuity (UCVA),refraction,corneal curvature,axial length,central corneal thickness and corneal endothelial cells were measured before and 1 month,3 months,6 months,12 months,24 months after wearing orthokeratology.The UCVA was converted into a logarithm of the minimal angel of resolution (logMAR) for record and analysis.All results were analyzed by SPSS 22.0.Results　During 1 month,3 months,6 months,12 months and 24 months after wearing orthokeratology,the UCVA were (0.039±0.080)logMAR,(0.029±0.070)logMAR,(0.025±0.090)logMAR,(0.016±0.050)logMAR and (0.300±0.830)logMAR,respectively,the difference was statistically significant compared with before wearing orthokeratology ［(0.710±0.280)logMAR］ (all P＜0.05).At 12 months and 24 months after wearing orthokeratology,there were significant differences in UCVA and residual refraction compared with 1 month,3 months and 6 months after wearing orthokeratology between low myopia group and moderate myopia group (all P＜0.05).In low corneal curvature group,the corneal curvature flatness at 12 months and 24 months after wearing glasses were(38.75±0.35)D and (39.96±1.96)D,respectively,compared with (40.04±0.14)D at 1 month after wearing,(39.75±2.05)D at 3 months after wearing,(39.18±1.06)D at 6 months after wearing,and the difference was statistically significant (all P＜0.05).In high corneal curvature group,the corneal curvature flatness were (41.98±1.09)D after 1 month and (40.85±2.20)D after 24 months,compared with (41.47±1.09)D after 3 months,(41.02±1.12)D after 6 months,(40.63±1.13)D after 12 months,the difference was statistically significant (all P＜0.05).There was no significant difference in corneal endothelial cells,axial length and central corneal thickness before and after wearing glasses (all P＞0.05).Conclusion　In the standard fitting,strict review,orthokeratology is an effective method for correcting visual acuity and controlling the progress of myopia.