儿童夜戴角膜塑形镜角膜并发症分析  

Analysis of corneal complications in children wearing orthokeratology lenses at night

作　　者：苗春旭 徐昕涌[2] 张会 

机构地区：[1]大连市旅顺口区人民医院眼科,116041 [2]大连大学附属新华医院眼科 [3]大连圣明近视防控中心

出　　处：《中华眼科杂志》2017年第3期198-202,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨儿童夜戴角膜塑形镜角膜并发症的特点、原因及转归.方法 回顾性病例分析.收集夜戴角膜塑形镜治疗近视113例（219只眼）,其中7例患者为单眼戴镜,平均年龄（11.5±2.0）岁,近视度数-1.00-9.00 D,其中-2.00-4.00 D 157只眼,于配戴角膜塑形镜当日,戴镜后1h、次日早晨及戴镜后2d、3d、1周、2周进行检查,之后每月复查1次,随访6个月.裂隙灯检查法观察角膜是否有水肿、机械损伤、色素沉积、混浊浸润;对荧光素染色形态、位置、数量、范围、深度追踪6个月以上.结果 点状角膜上皮剥脱18例（29只眼,13.24％）,角膜浅基质层浸润混浊5例（6只眼,2.74％）,角膜上皮下铁沉积症9例（17只眼,7.76％）,以上均无明显症状,经停戴镜及相关治疗,前者完全治愈,但后两者经6个月随访,病灶渐退.上述并发症除6只眼在3个月内出现,其余46只眼均发生在戴镜6个月以上.结论 儿童夜戴角膜塑形镜出现并发症应立即停戴镜,及时治疗和随访,避免恶化或出现严重并发症.角膜塑形术应严格控制在医疗单位进行,并由有资质的眼科医师随诊.Objective To explore the characteristics,prognoses and corneal complications of children wearing orthokeratology lenses （Ortho-K） at night.Methods Retrospective case analysis.A total of 113 cases （219 eyes） wore Ortho-K for myopia at night,including 7 cases with unilateral glass wear.The average age was （11.5±2.0） years old.The myopia ranged from-1.00 D to-9.00 D in all eyes and from-2.00 D to-4.00 D in 157 of them.Examinations were performed before lens wearing,at 1 hour,the next morning,2 days,3 days,1 week and 2 weeks after lens wearing,and thereafter once a month.The follow-up was 6 months.Slit lamp examination was used to observe whether there was edema,mechanical damage,pigment deposition,turbidity or infiltration.The morphology,location,number,range and depth of fluorescein staining were tracked for more than 6 months.Results There were punctate corneal epithelial exfoliation in 18 cases （29 eyes,13.24%）,corneal stromal infiltration and opacity in 5 cases （6 eyes,2.74%）,and corneal iron deposition in 9 cases （17 eyes,7.76%）,with no obvious symptoms.After stopping wearing lenses and related treatment,the punctate epithelial exfoliation was completely cured,and the other complications gradually disappeared within 6 months.These complications occurred within 3 months after lens wearing in six eyes and after at least 6 months of lens wearing in 46 eyes.Conclusions Children who have complications after wearing Ortho-K at night should immediately stop wearing the lenses.Timely treatment and follow-up help to avoid deterioration and serious complications.Orthokeratology should be performed in medical institutions,with the follow-up by qualified ophthalmic doctors.

关 键 词：近视 接触镜 角膜疾病 角膜混浊 

分 类 号：R778.11[医药卫生—眼科]