青少年近视眼患者配戴角膜塑形镜后角膜透明度的变化分析  

The changes in corneal transparency after orthokeratology with juvenile myopia

作　　者：丁雯芝 荆丽丽 杜显丽 Ding Wenzhi;Jing Lili;Du Xianli(Qingdao Eye Hospital,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University Shandong Academy of Medical Sciences,Qingdao 266071,China)

机构地区：[1]山东省第一医科大学(山东省医学科学院)山东省眼科研究所山东省眼科学重点实验室-省部共建国家重点实验室培育基地青岛眼科医院,266071

出　　处：《中华眼科杂志》2019年第6期435-441,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨青少年近视眼患者配戴角膜塑形镜后角膜透明度的变化特点及其原因。方法前瞻性自身对照研究。选择2016年1至8月在青岛眼科医院配戴角膜塑形镜的青少年近视眼患者,取右眼纳入研究。于戴镜前、戴镜后1 d、1周及1、3、6、12个月时对角膜光密度值进行评估,应用Pentacam角膜地形图光学密度软件进行测量,角膜直径范围以角膜中心为圆点分为≤2 mm、>2 mm且≤6 mm、>6 mm且≤10 mm、>10 mm且≤12 mm 4个区域,角膜厚度分为前(前120μm)、中、后(后60μm)3层。采用重复测量单因素方差分析对戴镜前后各参数行总体比较,若有差异则进一步采用LSD检验两两比较。结果40例(40只眼)近视眼患者纳入研究,其中男性24例,女性16例,年龄(10.76±1.74)岁。戴镜前角膜光密度值为13.18±0.23,于戴镜早期有降低趋势,但差异无统计学意义(3个月内:t=-1.594,-1.472,0.064,1.971;P>0.05);戴镜6个月时显著增加并达峰值15.31±0.23(t=7.613,P<0.01),戴镜1年时仍维持较高值15.15±0.24(t=7.227,P<0.01)。角膜前、中、后层光密度值的变化趋势与整体基本一致,戴镜早期均有下降趋势,至戴镜后6和12个月明显增加(前层t=7.143,6.177,中层t=7.508,6.563,后层t=6.722,8.533;P<0.01),仅后层于1周时光密度值降低,差异有统计学意义(戴镜前10.21±0.14,戴镜后1周9.91±0.14,t=-2.348,P=0.024)。按角膜直径范围分析发现≤2 mm区角膜光密度值于戴镜1个月开始显著增加(戴镜前12.88±0.14,戴镜后1个月13.31±0.19,t=2.158,P=0.037),>2 mm且≤6 mm区于3个月开始显著增加(戴镜前11.71±0.13,戴镜后3个月12.50±0.19,t=3.213,P=0.003),>6 mm且≤10 mm区于6个月时开始显著增加(戴镜前11.40±0.30,戴镜后6个月13.70±0.33,t=7.635,P=0.000),各区高值均持续至1年。与其他直径范围不同的是>10 mm且≤12 mm区域,戴镜前后光密度值无明显改变(F=1.668,P>0.05)。另外,早期角膜光密度值的显著降低主要集中在角Objective To evaluate the changes of corneal transparency undergoing overnight orthokeratology treatment. Methods Prospective cohort study. Right eyes of juvenile myopic patients fitted with Ortho-K CL at Qingdao Eye Hospital were enrolled. Corneal optical density values were measured by the Pentacam Scheimpflug system before orthokeratology and at 1 day, 1 week, and 1, 3, 6, and 12 months after wearing. Four concentric radial zones centered on the apex of the cornea (≤2 mm,>2 mm and ≤6 mm,>6 mm and ≤10 mm, and>10 mm and ≤12 mm diameter) were applied. Anterior layer (anterior 120 μm), central layer, and posterior layer (posterior 60 μm) were defined according to corneal depth. The data analysis were used One-Way Repeated Measures ANOVA and LSD test. Results Forty patients (40 eyes) with myopia (24 male and 16 female, age 10.76±1.74 years) were in enrolled. Corneal optical density value was 13.18±0.23 before orthokeratology, then showed a decreasing trend at the early stage, but there was no statistical difference (within 3months: t=-1.594,-1.472, 0.064, 1.971;P>0.05). The value increased significantly and reached the peak (15.31±0.23, t=7.613, P<0.01) at 6-month, and was still maintained in a high value at 1-year (15.15±0.24, t=7.227, P<0.01). Anterior, central, and posterior layer of corneal optical density values had a downward trend at early stage, and increased significantly in 6-and 12-month (anterior layer t=7.143, 6.177, central layer t=7.508, 6.563, posterior layer t=6.722, 8.533;P<0.01). Only the values decreased significantly in posterior layer at 1-week (baseline 10.21±0.14 vs. 1-week 9.91±0.14, t=-2.348, P=0.024). The corneal optical density value of ≤2 mm diameter began to increase significantly at 1-month (baseline 12.88±0.14 vs. 1-month 13.31±0.19, t=2.158, P=0.037),>2 mm and ≤6 mm diameter at 3-month (baseline 11.71±0.13 vs. 3-month 12.50±0.19, t=3.213, P=0.003), and>6 mm and ≤10 mm diameter at 6-month (baseline 11.40±0.30 vs. 6-month 13.70±0.33, t=7.635, P=0.000). The

关 键 词：近视 接触镜 角膜基质 光密度测定法 

分 类 号：R778.11[医药卫生—眼科]