| 方 薇,杨惠青,孙丽媛,赵立苹,赵丽燕,刘大川.青少年长期佩戴角膜塑形镜的疗效和安全性观察[J].现代生物医学进展英文版,2024,(15):2850-2857. |
| 青少年长期佩戴角膜塑形镜的疗效和安全性观察 |
| Observation on the Efficacy and Safety of Long-term Orthokeratology Lens Wear in Adolescents |
| Received:January 25, 2024 Revised:February 21, 2024 |
| DOI：10.13241/j.cnki.pmb.2024.15.008 |
| 中文关键词: 角膜塑形镜 近视 眼轴长度 角膜内皮细胞 |
| 英文关键词: Orthokeratology lens Myopia Eye axial length Corneal endothelial cell |
| 基金项目:首都临床特色应用研究项目（Z171100001017029） |
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| 中文摘要: |
| 摘要 目的：观察青少年近视患者长期佩戴角膜塑形镜的疗效，及其对眼部的安全性。方法：回顾分析2019.6～2023.4于我院眼科验配角膜塑形镜并长期佩戴（≥3年）的青少年近视患者30人（60眼），戴镜后1 d、7 d、1 mon、3 mon复诊，以后每3个月复查一次，比较戴镜前、戴镜后6 mon、1 a、2 a、3 a患者眼轴长度和角膜内皮镜检查各参数的变化。结果：本研究共观察病例30例（60眼），其中男13例，女17例，年龄7～14岁，平均年龄为9.77±1.89岁，等效球镜为 -5.00～-0.75 D，平均为 -1.98±0.97 D。其中5例（8眼，13.3%）发生1级角膜点染，未见2～3级染色，2例（4眼，6.7%）发生过敏性结膜炎，经停戴并给予相应治疗后痊愈。戴镜前和戴镜后6 mon、1 a、2 a、3 a眼轴长度分别为24.57±0.74 mm、24.67±0.85 mm、24.78±0.96 mm、24.91±0.97 mm和 25.06±0.85 mm，总体有增长趋势（F=21.904，P＜0.001），戴镜前与戴镜后各时间点眼轴长度间差异均有统计学意义，P值分别为0.027、0.001、0.000和0.000，戴镜后6 mon与戴镜后1 a、2 a、3 a差异有统计学意义，P值分别为0.005、0.000和0.008，戴镜后1 a与戴镜后2 a差异有统计学意义（P＜0.001），其他各时间点间差异无统计学意义（P＞0.05）。戴镜前和戴镜后6 mon、1 a、2 a、3 a细胞面积变异系数分别为25±2.9%、26±3.7%、27±4.1%、27±4.6%和 27±4.1%，总体F=5.490，P=0.001，两两比较发现戴镜前与戴镜后2 a、3 a间差异有统计学意义，P值分别为0.012和0.008（P＜0.05），戴镜后1 a与戴镜后2 a间差异有统计学意义（P=0.007），其他各时间点间差异无统计学意义(P＞0.05)。角膜厚度、内皮细胞在密度、平均面积、六边形细胞比例等在各时间点差异无统计学意义(P＞0.05)。结论：青少年近视患者通过长期佩戴角膜塑形镜，可比较有较地控制眼轴的快速增长，但必须经过全面的检查评估，佩戴合格且规格适当的镜片，规范操作，按时复诊，如出现过敏、角膜损伤等及时停戴并进行相应治疗，才能够保证长期佩戴的安全性。角膜细胞形态学检查发现：长期戴镜，角膜内皮细胞面积变异有增大的趋势。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effectiveness and safety of long-term wearing of orthokeratology lens in adolescent myopia patients. Methods: From June 2019 to April 2023, 30 myopic adolescents (60 eyes) who had been fitted with orthokeratology lens in the ophthalmology department of Xuanwu hospital and had worn them for a long time (≥ 3 years) were reviewed. They were reexamined 1 day, 7 days, 1 month and 3 month after wearing the glasses. The changes of the axial length and the parameters of corneal endothelioscopy were compared before and after wearing the glasses for 6 months, 1 year, 2 years and 3 years. Results: A total of 30 cases (60 eyes) were observed in this study, including 13 males and 17 females, aged 7-14 years old, with an average age of 9.77 ± 1.89 years old. The equivalent spherical scope was -5.00-0.75D, with an average of -1.98±0.97 D. Among them, 5 cases (8 eyes, 13.3%) developed grade 1 corneal staining, but no grade 2-3 staining was observed. 2 cases (4 eyes, 6.7%) developed allergic conjunctivitis, which was cured after stopping wearing and receiving corresponding treatment. The axial lengths of 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 24.57±0.74 mm, 24.67±0.85 mm, 24.78± 0.96 mm, 24.91±0.97 mm, and 25.06±0.85 mm, respectively, showing an overall increasing trend (F=21.904, P<0.001). There were statistically significant differences in axial lengths between pre and post wearing glasses at various time points, with P values of 0.027, 0.001, 0.000, and 0.000, respectively. There was a statistically significant difference between 6 mon after wearing glasses and 1 a, 2 a, and 3 a after wearing glasses. The P-values were 0.005, 0.000, and 0.008, respectively. There was a statistically significant difference (P<0.001) between 1 year after wearing the mirror and 2 years after wearing the mirror, while there was no statistically significant difference (P>0.05) between other time points. The coefficient of variation of cell area at 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 25± 2.9%, 26±3.7%, 27± 4.1%, 27±4.6%, and 27±4.1%, respectively. Overall, F=5.490, P=0.001. Comparing the two groups, it was found that there was a statistically significant difference between the two groups, with P values of 0.012 and 0.008, respectively (P<0.05). The difference between the two groups was statistically significant (P=0.007), There was no statistically significant difference between other time points (P>0.05). There was no statistically significant difference in corneal thickness, endothelial cell density, average area, and hexagonal cell ratio at each time point (P>0.05). Conclusion: Adolescent myopia patients can effectively control the rapid growth of their eye axis by wearing corneal reshaping lenses for a long time. However, comprehensive examination and evaluation must be conducted, qualified and appropriately sized lenses must be worn, standardized operations must be carried out, and follow-up visits must be made on time. If allergies or corneal injuries occur, timely cessation of wearing and corresponding treatment can ensure the safety of long-term wearing. Morphological examination of corneal cells revealed that long-term wearing of glasses showed an increasing trend in the variation of corneal endothelial cell area. |
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