角膜塑形镜控制儿童近视进展的一年综合效果

目的 观察儿童配戴角膜塑形镜1年矫正近视及控制近视发展的临床有效性和安全性。设计 前瞻性病例系列。研究对象 2010-2015年105例在绵阳市中心医院眼科就诊的近视儿童，年龄8~12岁，等效球镜度-0.50~-5.00 D。方法 观察组35例（70眼）近视儿童配戴角膜塑形镜，对照组配比70例近视儿童配戴框架眼镜。随访观察1年，测量裸眼视力（LogMAR视力表）及屈光度（等效球镜）；采用IOL-Master光学相干生物测量仪测量眼轴；Humphery角膜地形图分析系统进行角膜地形图检查；A超角膜测厚仪测量中心角膜厚度。主要指标 视力、屈光度、眼轴、角膜厚度、角膜曲率及变化量。结果 配戴角膜塑形镜组（观察组）戴镜前球镜度数为（-4.15±1.08）D，戴镜后1年为（-3.21±1.02）D，两者比较差异有统计学意义（t=4.3, P＜0.001）；对照组为（-4.71±1.36）D，与观察组比较差异有统计学意义（t=5.59，P＜0.001）；观察组前后变化量（0.9±1.6）D，对照组（0.06±1.9）D（t=2.35，P=0.02）。观察组戴镜前裸眼视力为0.69±0.14，戴镜后0.42±0.11（t=10.8, P＜0.001），对照组0.58±0.15（t=-5.43，P＜0.001）；观察组前后变化量-0.26±0.19，对照组-0.03±0.19（t=-5.7，P＜0.001）。观察组戴镜前眼轴长度为（27.42±0.91）mm，戴镜后（27.0±1.2）mm（t=1.8，P=0.07），对照组（28.2±1.1）mm（t=-16.97，P＜0.001）；观察组前后变化量（-0.35±0.6）mm，对照组（1.3±1.1）mm（t=8.02，P＜0.001）。观察组戴镜前角膜厚度为（550.2±30.5）μm，戴镜后（548.1±26.8）μm（t=0.31, P=0.71），对照组（554.2±23.6）μm（t=1.55，P=0.24）；观察组前后变化量（2.3±1.36）μm，对照组（1.8±1.31）μm（t=1.78，P=0.08）。观察组戴镜前角膜曲率为（43.52±1.07）D，戴镜后（38.02±2.20）D（t=17.2, P＜0.001），对照组（44.37±2.12）D（t=-13.87，P＜0.001）；观察组前后变化量（3.81±2.17）D，对照组（0.91±1.4）D（t=8.03，P＜0.001）。角膜健康状况良好，因戴镜所致不适症状经适当用药或镜片处理后均可消失。结论 角膜塑形镜对儿童轻、中度近视是一种有效地矫正视力和控制近视进展的方法。（眼科，2016, 25： 98-101）

Efficacy and safety of Orthokeratology for myopic progression in children

Objective To observe the efficacy and safety of Orthokeratology for controlling myopic progression in children. Design Prospective case series. Participants 105 children with myopia in the Department of Ophthalmology of Mianyang Central Hospital from 2010 to 2015, who were 8~12 years old, with the spherical equivalent (SE) degree -0.50~-5.00 D. Method 35 cases (70 eyes) were in experimental group using Orthokeratology, 70 cases were in control group wearing myopic single vision lenses. The participants were followed for 1 year, measuring the visual acuity (LogMAR) and SE, the axial length (AL) (measured with IOL Master); corneal topographic map (Humphery Atlas 8.0 corneal topography analysis system); central corneal thickness (CCT)(AL2000). Main Outcome Measures Uncorrected visual acuity, SE, AL, CCT. Results In the experimental group, before therapy the SE was -4.15±1.08 D, after Orthokeratology therapy it was -3.21±1.02 D, the difference has statistical significance (t=4.3, P<0.001). In the control group it was -4.71±1.36 D at the end of the follow up, which was significant different from experimental group (t=5.59, P<0.001). The difference of before and after Orthokeratology therapy was 0.9±1.6 D and 0.06±1.9 D in the experimental and control group respectively (t=2.35, P=0.02). In the experimental group, before therapy the visual acuity (LogMAR) before and after Orthokeratology was 0.69±0.14 and 0.42±0.11 respectively (t=10.8, P<0.001), and in the control group after treatment it was 0.58±0.15 (t=-5.43, P<0.001). The difference of before and after therapy was -0.26±0.19 and -0.03±0.19 in the experimental and control group respectively (t=-5.7, P<0.001). In the experimental group, the AL was 27.42± 0.91 mm, and 27.0±1.2 mm before and after therapy respectively (t=1.8, P=0.07), and in the control group was 28.2±1.1 mm (t=-16.97, P<0.001). The difference of AL before and after therapy was -0.35±0.6 mm and 1.3±1.1 mm in the experimental and control group respectively (t=8.02, P<0.001). In the experimental group, the CCT was 550.2±30.5 μm, and 548.1±26.8 μm before and after therapy respectively (t=0.31, P=0.71), and in the control group was 554.2±23.6 μm(t=1.55, P=0.24). The difference of CCT before and after Orthokeratology therapy was 2.3±1.36 μm and 1.8±1.31 μm in the study and control group respectively (t=1.78, P=0.08). In the experimental group, the cornea curvature was 43.52±1.07 D and  38.02±2.20 D before and after therapy respectively (t=17.2, P<0.001), and in the control group was 44.37±2.12 D (t=-13.87, P<0.001). The difference before and after Orthokeratology therapy was 3.81±2.17 D and 0.91±1.4 D in the study and control group respectively(t=8.03, P<0.001). The cornea was in good health condition, and the discomfort symptoms disappeared after treatment with appropriate medication. Conclusion Orthokeratology for children with moderate myopia was an effective and safe control method. (Ophthalmol CHN, 2016, 25: 98-101)