角膜塑形镜的临床疗效及安全性

目的观察角膜塑形镜矫正青少年儿童近视的疗效，探讨角膜塑形镜对近视进展控制的临床效果，并观察其安全性。方法回顾性病例分析。选取2011-2012年间在上海瑞视维景眼科门诊部验配角膜塑形镜的近视青少年儿童58例，均以左眼作为研究对象，年龄（11.1±2.0）岁，平均等效球镜度（SE）（-3.68±1.36）D。选用Boston EqualensⅡ和Boston XO 2种不同材料角膜塑形镜，按照所验配的角膜塑形镜材料为A组（38例）和B组（20例），再以-3.00 D为界分为低度近视组（19例）和中度近视组（39例），患者连续配戴角膜塑形镜2年后停戴4周复诊，分别比较戴镜2年前后的SE、眼轴长度、角膜内皮细胞计数、中央角膜厚度、角膜平坦曲率值、角膜陡峭曲率值和角膜散光。采用独立样本t检验，符号秩和检验，Pearson相关分析等进行数据分析。结果配戴角膜塑形镜的患者在戴镜2年后均有近视度数加深[（-0.35±0.64）D，t=4.132，P<0.01]，眼轴长度增加[（0.33±0.33）mm，t=4.411，P<0.01]，角膜平坦曲率值减少[（-0.33±0.25）D，t=10.001，P<0.01]和角膜散光增加[（-0.34±0.38）D，t=6.873，P<0.01]；但A组与B组之间的差异无统计学意义。低度近视组的SE、眼轴长度和角膜散光改变量分别为（-0.70±0.68）D，（0.47±0.36）mm，（-0.54±0.37）D，均高于中度近视组的改变量[（-0.17±0.54）D，（0.26±0.29）mm，-0.25（-1.00，0.25）D]，差异均有统计学意义（t=3.193、-2.384，Z=-2.598，P＜0.01）。结论青少年儿童配戴角膜塑形镜2年后仍有少量近视进展和眼轴增长，并且中度近视的近视增加量可能低于低度近视者。

Analysis of the effects and safety of wearing orthokeratology lenses

Objective To investigate the effects and safety of wearing orthokeratology lenses for 2 years.Methods This was a retrospective analysis.The left eyes of 58 subjects (11.1±2.0 years old with a spherical equivalent of-3.68±1.36 D) were examined by measuring refraction,axial length,corneal endothelial cells,central corneal thickness,corneal horizontal curvature,corneal vertical curvature and corneal astigmatism.The same data were also collected four weeks after removal of the orthokeratology lenses that had been worn every night for two years.Patients were divided into group A (38 eyes) and B (20 eyes) based on the type of materials used for the orthokeratology lenses (Boston Equalens Ⅱ for group A and Boston XO for group B) and data were analyzed for the two groups.A value of -3.00 D was used to further divide the patients in a low myopia group (19 eyes) and a moderate myopia group (39 eyes).All the data were analyzed by an independent t test,rank sum test and correlation analysis.Results After 2 years of wearing orthokeratology lenses,four values were significantly different from baseline four weeks after removing the orthokeratology lenses:spherical equivalent (-0.35±0.64 D,t=4.132,P＜0.01),axial length (0.33±0.33 mm,t=4.411,P＜0.01),corneal flat curvature (-0.33±0.25 D,t=10.001,P＜0.01),and corneal astigmatism (-0.34±0.38 D,t=6.873,P＜ 0.01).Significant differences were found between the two groups when SE,AL and corneal astigmatism were compared.For the low myopia group,the variations in spherical equivalent (-0.70±0.68 D),axial length (0.47±0.36 mm) and corneal astigmatism (-0.54±0.37 D) differed from the moderate myopia group,which were-0.17±0.54 D,0.26±0.29 mm,and-0.25 (-1.00,0.25)D,respectively.The differences were significant (t=3.193,-2.384,Z=-2.598,P＜0.05).Conclusion The results suggest that there is slightly greater myopia and a longer axial length after 2 years of wearing orthokeratology lenses.And the lens seems to control myopia better in moderate myopes than in low myopes.