少年儿童近视的长期角膜塑形疗效和安全性观察  

The effects and safety of long-term Orthokeratology in young myopia patients

作　　者：谢培英[1] 王志昕[1] 迟蕙[1] 

机构地区：[1]北京大学医学部眼视光学研究中心,100083

出　　处：《中国斜视与小儿眼科杂志》2008年第4期145-152,共8页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探讨长期角膜塑形术降低近视度和控制近视的有效性和安全性。方法观察47例7～18岁少年儿童近视患者,连续配戴角膜塑形镜5年间的屈光度、视力、眼轴长度、角膜厚度、角膜内皮细胞以及裂隙灯下角结膜的改变,并与同时期配戴框架眼镜的中小学生近视患者2年的眼轴变化进行比较。其中33例66眼采用夜戴方式(夜戴组),近视度-1.00D～-5.25D,平均-3.54±0.82D,14例28眼采用日戴方法(日戴组),近视度-5.50D～-9.00D,平均-7.53±0.99D。结果5年期间近视降低度和角膜平均曲率半径增大值夜戴组分别为-2.69D～-2.82D和0.22mm～0.30mm,日戴组分别为-1.73D～-3.54D和0.13mm～0.24mm。与戴镜前比较,眼轴长度增加夜戴组自第3年起,日戴组自第4年起有统计学意义。同时期配戴框架眼镜组的2年的眼轴增长可达角膜塑形术的2倍以上。夜戴组裸眼视力提高至≥0.6的比例可达55.8～63.2%,≥0.8的比例可达43.8～49.3%。夜戴组与日戴组戴镜5年角膜厚度与角膜内皮细胞均未见明显改变(P>0.05)。观察期间未见严重角结膜并发症。结论科学规范的长期配戴角膜塑形镜,可持续有效降低近视度,显著提高裸眼视力,并有效控制眼轴的增长。长期戴镜对角结膜未产生明显影响,安全性亦较高。Objective To investigate the effects and safety of long-term Orthokeratology on the myopia reduction and myopia control in young myopia patients. Methods 47 young myopia patients （7～18 yeats） were fitted with Ortho-K contact lens over 5 years, 33 patients （66 eyes） with overnight wear （-1.00D^-5.25D, -3.54＋0.82D）, 14 patients （28 eyes） with day wear （-5.50D～-9.00D, -7.53±0.99D）. Refraction, visual acuity, corneal curvature and axial length were measured during 5 years. Ocular surface health was examined by slit--lamp microscope. Changes of corneal endothelia and corneal thickness were observed every year. We also compared the change of axial length with myopia students wearing spectacles within 2 years in primary and middle schools. Results Significant myopia reduction and central corneal curvature flattening were observed, which was -2.69D～-2.82D and 0.22mm-0.30mm respectively in overnight wear group, -1.73D--3.54D and 0.13mm-0.24mm in day wear group during 5 years. Compared with initial axial length increasing was significant statistically from 3rd years in overnight group, while from 4th years in day wear group. But the 2 years axial length increasing in primary and middle students who wearing spectacles （8-9 years,12～13 years） was over 2 times than that in overnight wear ortho-k lens group. The rate of UVA≥0.6 was up to 55.8-63.2%, ≥0.8 was up to 43.8--49.3% respectively. There were no remarkable complications in the ocular surface. There were no significant changes in corneal thickness and corneal endothelia after long-term Ortho-K CL wear, no matter overnight wear or day wear. Conclusions Scientific and standardized Orthokeratology for a long time can continuously and effectively decrease myopia, and improve the naked vision. In addition, it can control the increase of axial length efficiently. Long term Ortho-K CL wear would not influence the cornea and conjunctiva significantly, so it＇s safety for younger to wear.

关 键 词：少年儿童 近视 角膜塑形术 疗效 安全性 

分 类 号：R778.11[医药卫生—眼科] R512.5[医药卫生—临床医学]