长期配戴角膜塑形镜对青少年视觉质量及细菌感染发生的影响

  目的  探讨青少年长期配戴角膜塑形镜后对视觉质量和细菌感染发生率的影响，为促进青少年用眼卫生提供参考。  方法  收集前往河南省直第三人民医院定期复查的280例配戴角膜塑形镜的青少年作为研究对象，分别在佩戴前、配戴6个月、配戴1年时间点对患者进行眼部专科检查、视觉质量分析系统(Optical Quality Analysis System Ⅱ, OQAS-Ⅱ)客观视觉质量测评和眼部菌群检查，比较青少年配戴角膜塑形镜前后视觉质量和眼部菌群的变化。  结果  与配戴角膜塑形镜之前青少年的斯特烈尔比，调制传递函数，9%OV、20%OV、100%OV分别为(0.18±0.04，33.21±4.23，0.72±0.12，0.99±0.19，1.32±0.21)，青少年配戴6个月和配戴1年后患者的斯特烈尔比(0.21±0.05，0.24±0.03)和调制传递函数(37.65±5.29，39.01±3.94)均升高，9%客观视力(0.61±0.10，0.53±0.26)、20%客观视力(0.82±0.21，0.78±0.15)和100%客观视力(1.10±0.13，1.00±0.07)均降低，差异均有统计学意义(F值分别为7.89，6.59，6.52，9.47，8.49，P值均＜0.05)，而客观散射指数配戴前后(0.99±0.21，1.01±0.07，1.23±0.31)差异无统计学意义(F=-1.56，P＞0.05)。与配戴角膜塑形镜前相比，佩戴后患者的细菌感染发生率显著提高(P值均＜0.05)，配戴角膜塑形镜1年的患者铜绿假单胞菌感染率升至0.36%，大肠埃希菌感染率高达0.71%，金黄色葡萄球菌感染率高至0.36%。  结论  青少年长期配戴角膜塑形镜可有效改善视觉质量，但也会提高细菌感染发生率，需要临床上做好针对青少年的用眼卫生教育。

Effects of orthokeratology lens on visual quality and bacterial infection in adolescents

  Objective  To investigate the effects of orthokeratology on visual quality and incidence of bacterial infection in adolescents.  Methods  A total of 280 orthokeratology teenage patients were selected. Visual examination, OQAS-Ⅱ optical assessment and ocular flora were assessed before, 6 months and 1-year after orthokeratology wearing. Changes in visual and optical performance and ocular flora infection were compared.  Results  Compared with before wearing orthokeratography lens (0.18±0.04, 33.21±4.23, 0.72±0.12, 0.99±0.19, 1.32±0.21), parameters of adolescent patients including strayers ratio (0.21±0.05, 0, 24±0.03) and modulation transfer cutoff (37.65±5.29, 39.01±3.94) increased after wearing for 6 months and 1 year, 9% objective visual acuity(0.61±0.10, 0.53±0.26), 20% objective visual acuity (0.82±0.21, 0.78±0.15) and 100% objective visual acuity (1.10±0.13, 1.00±0.07) decreased, the differences were statistically significant (F=7.89, 6.59, 6.52, 9.47, 8.49, P < 0.05), while the objective scattering index index (0.99±0.21, 1.01±0.07, 1.23±0.31) had no significant difference before and after wearing orthokeratography lens (F=-1.56, P>0.05). Compared with before wearing, the incidence of bacterial infection significantly increased after wearing (P < 0.05). The infection rate of pseudomonas aeruginosa in patients who wore orthokeratology lens for 1 year rose to 0.36%, e. coli infection rates as high as 0.71%, staphylococcus aureus infection rates as high as 0.36%.  Conclusion  Long-term orthokeratology lens wear can effectively improve the visual quality of adolescents, but also increase the risk of bacterial infection. Timely awareness on good eye hygiene practice should be emphasized to the users.