摘要
目的探讨角膜塑形(OK)镜对儿童青少年低度近视眼进展控制的长期效果及其影响因素。方法选择2016年1月至2021年12月于上海交通大学医学院附属仁济医院眼科就诊的儿童青少年169例(294只眼)低度近视眼患者作为研究对象。其中,男性75例(134只眼),女性94例(160只眼);年龄8~14岁,平均年龄(9.5±1.6)岁。按照配戴OK镜时间分为2年、3年及4~5年组。对比患者配戴OK镜前后球镜屈光度、眼轴长度(AL)及角膜曲率的变化。近视眼控制进展以球镜屈光度改变(△SD)和眼轴长度改变(△AL)来衡量。患者的年龄、球镜屈光度、柱镜屈光度、AL及平均角膜曲率以(±s)表示,采用配对t检验进行比较。将不同性别、年龄、基线球镜屈光度及AL患者的△SD及△AL分别进行单因素方差分析,对差异具有统计意义的变量采用多元线性回归分析判断其相关性。结果配戴OK镜前,2年、3年及4~5年组患者的角膜曲率分别为(43.39±1.36)D、(43.21±1.32)D及(43.32±1.40)D;配戴后分别为(42.91±2.09)D、(42.85±1.30)D及(42.98±1.37)D,配戴前后的差异均有统计学意义(t=3.319,5.348,6.613;P<0.05);上述3组患者的△SD分别为(-0.71±0.56)D、(-0.74±0.59)D及(-1.15±0.88)D。经单因素方差分析,配戴2年组不同年龄、角膜曲率及AL患者△SD的差异均具有统计学意义(F=6.578,3.279,7.815;P<0.05);不同年龄、基线球镜屈光度、角膜散光及AL患者△AL的差异均具有统计学意义(F=17.389,6.994,3.566,5.708;P<0.05)。配戴3年组不同年龄、基线球镜屈光度及AL患者△SD的差异均具有统计学意义(F=6.639,13.785,5.443;P<0.05);不同年龄和基线AL患者△AL的差异均具有统计学意义(F=17.280,3.170;P<0.05)。配戴4~5年组不同年龄和基线球镜屈光度患者△SD的差异均有统计学意义(F=19.328,4.175;P<0.05);不同年龄和基线球镜屈光度患者△AL的差异均具有统计学意义(F=50.146,4.813;P<0.05)。将单因素分析中具有统计学意义的变量进行多元线性回归分析,结果显示患者年龄与各随访时间点△SD的相关性均具有统计学意义(β=0.183,0.231,0.508;P<0.05)。基线球镜屈光度及AL与配戴3年后的△SD的相关性均具有统计学意义(β=0.400,0.181;P<0.05)。患者年龄与各随访时间点△AL的相关性均具有统计学意义(β=-0.326,-0.488,-0.697;P<0.05);基线球镜屈光度及基线AL与配戴2年及3年后△AL的相关性均具有统计学意义(β=-0.172,-0.184;P<0.05)。结论随访低度近视眼患者配戴OK镜5年,患者的角膜中央曲率趋于平坦,且维持稳定。OK镜控制低度近视眼进展效果显著,且患者的年龄、球镜屈光度及AL是影响其近视眼进展控制效果的主要因素。
Objective To investigate the long-term clinical control effects of orthokeratology(Ortho-K)lenses in low myopia children and its factors.Methods One hunderd and sixty nine low myopia patients(294 eyes)with an average age of(9.5±1.6)years old(ranged from 8 to 14 years old)who were checked in at Department of Ophthalmology,Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2021.All patients were divided into 2 years,3 years and 4 to 5 years groups according to the period of their wearing Ortho-K lenses.The spherical diopters(SD),corneal curvature and axial length(AL)of patients were prospectively analyzed and compared before and after wearing.The changes of spherical diopters(△SD)and AL(△AL)were used to evaluate the controlling myopia progression.The age,SD,cylinder diopters,AL and corneal curvature were expressed by(±s),and compared by pairedttest.The different gender,age,the based SD,AL and other indices of patients were compared△SD and△AL after wearing Ortho-K lenses using univariate,respectively.The multiplelinear regression analysis was performed if variables with statistical significance for differences and its relevance determined.Results The average corneal curvature of patients before and after wearing in 3 groups was(43.39±1.36)D,(43.21±1.32)D,(43.32±1.40)D,(42.91±2.09)D,(42.85±1.30)D,(42.98±1.37)D,with a significant difference between groups(F=3.319,5.348,6.613;P<0.05).The△SD of patients in 3 groups was(-0.71±0.56)D,(-0.74±0.59)D,(-1.15±0.88)D.One-way ANOVA showed that there was a significant difference between the age,the average corneal curvature,AL,respectively and the△SD after wearing Ortho-K lenses for 2 years(F=6.578,3.279,7.815;P<0.05),and between the age,the based SD,corneal astigmatism,AL,respectively and△AL(F=17.389,6.994,3.566,5.708;P<0.05).After wearing Ortho-K lenses for 3 years,there was a significant difference between the age,the based SD,AL,respectively and△SD(F=6.639,13.785,5.443;P<0.05),and between the age,the based AL,respectively and△AL(F=17.280,3.170;P<0.05).After wearing Ortho-K lenses for 4 to 5 years,there was a significant difference between the age,the based SD,respectively and△SD(F=19.328,4.175;P<0.05),and between the age,the based SD and△AL(F=50.146,4.813;P<0.05).The variables with a significant difference after one-way ANOVA were performed by multiplelinear regression analysis.The age was correlated with△SD in 3 groups with a significant difference(β=0.183,0.231,0.508;P<0.05);the age correlated with△SD in 3 groups with a significant difference(β=-0.326,-0.488,-0.697;P<0.05).The based SD,increase of AL was correlated with△SD after wearing Ortho-K lenses for 3 years with a significant difference(β=0.400,0.181;P<0.05);the based SD and the based AL correlated with△AL after wearing Ortho-K lenses for 2 or 3 years with a significant difference,respectively(β=-0.172,-0.184;P<0.05).Conclusions During observation periods for 5 years,corneal curvature tended to flatter and remained stable.Ortho-K lenses has a capacity of effectively controlling progression of low myopia,especially axial myopia.Age,spherical diopters and AL were factors that affect its progression.
作者
付玥川
陶晨
Fu Yuechuan;Tao Chen(Department of Ophthalmology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200120,China)
出处
《中华眼科医学杂志（电子版）》
2022年第5期287-292,共6页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
上海市科学技术委员会科研计划项目(17411950205)
关键词
近视眼
角膜塑形镜
角膜曲率
眼轴
屈光度
Myopia
Orthokeratology
Corneal curvature
Axial length
Refraction
作者简介
通信作者:陶晨,Email:taochen1373@163.com。
