低中度近视青少年配戴角膜塑形镜5年的眼轴及角膜内皮变化

目的 探讨低中度青少年近视患者夜戴角膜塑形镜5年后眼轴（AL）及角膜内皮细胞密度（CD）、内皮六边形细胞比例（HEX）及内皮变异系数（CV）的变化。设计 回顾性病例系列。研究对象 选取配戴角膜塑形镜且连续戴镜5年以上、依从性好的低中度青少年近视患者68例（135眼）。方法 依近视等效球镜度数将患眼分为低度近视组（-0.75~-3.00 D）及中度近视组（-3.25~-5.75 D），观察并比较戴镜前及戴镜1、2、3、4、5年后两组患者AL、CD、HEX及CV等参数的变化。主要指标 AL、CD、HEX、CV。结果 戴镜前及戴镜后1~5年，两组AL均随时间增长（F=16.863，6.780；P=0.000，0.000）。低度近视组1~5年AL增长量分别为（0.28±0.15）mm、（0.21±0.16）mm、（0.17±0.15）mm、（0.12±0.08）mm及（0.11±0.06）mm，中度近视组1~5年AL增长量分别为（0.25±0.14）mm、（0.16±0.10）mm、（0.15±0.09）mm、（0.10±0.07）mm及（0.08±0.05）mm，两组年AL增长量均随时间降低（F=28.434，21.296；P=0.000，0.000），且5年后中度近视组AL增长较缓（t=6.577，P=0.011）。戴镜前及戴镜1~5年后，低度近视组和中度近视组双眼CD（F=1.239，1.421；P=0.290，0.216）、HEX（F=2.156，2.227；P=0.058，0.051）及CV（F=2.147，2.038；P=0.059，0.073）变化均无统计学意义，同期双眼间比较均无统计学差异（P均>0.05）。结论 5年的随访结果显示角膜塑形镜对中度近视控制效果优于低度近视。长期夜戴角膜塑形镜对角膜内皮细胞无明显影响。（眼科，2018,  27：141-145）

The changes of axial length and corneal endothelial cell of overnight orthokeratology in adolescent with low to moderate myopia

Objective To evaluate the effects and safety of long-term overnight orthokeratology (ortho-k) in adolescent with low to moderate myopia. Design Retrospective study. Participants 68 myopic juvenile (135 eyes) with ortho-k lens wearing more than 5 years. Methods Subjects were divided into low-myopia (SE -0.75~-3.00 D) and moderate-myopia (SE -3.25~-5.75 D) groups. Axial length (AL) was measured at baseline and every year after ortho-k lens wearing. The cell density (CD),  hexagonal cell ratio (HEX),  and coefficient of variation (CV) of the corneal endothelial cell layer were measured at each year. Data were analyzed using repeated one-way ANOVA and t-test analyses. Main Outcome Measures AL,  CD,  HEX,  CV. Results During the five years of observation periods,  the AL of both groups increased (F=16.863,  6.780; P=0.000,  0.000). The annual axial growth after ortho-k lens wearing for 1 to 5 years was (0.28±0.15)mm,  (0.21±0.16)mm,  (0.17±0.15)mm,  (0.12±0.08)mm and (0.11±0.06)mm in low-myopia group; and the data of moderate-myopia group was (0.25±0.14)mm,  (0.16±0.10)mm,  (0.15±0.09) mm,  (0.10±0.07)mm and (0.08±0.05)mm respectively. With time prolonged,  the annual axial elongation of both groups decreased (F=28.434,  21.296; both P<0.001),  and the moderate-myopia group represented less axial elongation after 5 years (t=6.577; P=0.01). After ortho-k lens wearing for 1 to 5 years,  the CD (F=1.239,  1.421; P =0.290,  0.216),  HEX(F=2.156,  2.227; P=0.058,  0.051) and CV(F =2.147,  2.038; P=0.059,  0.073) of the corneal endothelial cell layer remained stable,  and there was no significant difference of corneal endothelial cell layer changes between two groups (all P >0.05). Conclusions Five-year follow-up showed that ortho-k lens has a better effect on myopia control in moderate myopia than low myopia. Long term overnight wearing of ortho-k lens has no significant effect on corneal endothelial cells. （Ophthalmol CHN,  2018, 27：141-145）