关于儿童和青少年高度近视干预措施的争议  

Controversies over interventions for high myopia in children and adolescents

作　　者：赵文辰(综述) 何鲜桂[1] 邓俊杰(审校) Zhao Wenchen;He Xiangui;Deng Junjie(Shanghai Eye Disease Prevention and Treatment Center,Shanghai Eye Hospital,Shanghai Vision Health Center,Shanghai 200040,China;Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai Key Laboratory of Ocular Fundus Diseases,National Eye Disease Clinical Medicine Research Center,Shanghai 200080,China)

机构地区：[1]上海市眼病防治中心上海市眼科医院上海市视觉健康中心,上海200040 [2]上海交通大学附属上海市第一人民医院,上海市眼底病重点实验室,国家眼部疾病临床医学研究中心,上海200080

出　　处：《中华实验眼科杂志》2022年第6期588-593,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家重点研发计划项目(2016YFC0904800、2019YFC0840607);国家科技重大专项项目(2017ZX09304010);国家卫生健康委医政医管局课题项目(YF20200630);上海市公共卫生优秀学科带头人培养计划项目(GWV-10.2-XD09)。

摘　　要：随着近视的高发和低龄化趋势,高度近视的防控措施持续受到关注。目前控制儿童和青少年高度近视进展的手段主要包括低浓度阿托品滴眼液点眼、配戴角膜塑形镜或多焦点软性角膜接触镜(MFSCLs)、后巩膜加固术等,这些干预措施也已在高度近视儿童群体中开展,并被证实可能可以有效控制近视进展,但在临床用法、安全性等方面仍存在一些争议。其中,低浓度阿托品滴眼液存在着使用浓度与安全性的矛盾,较高浓度的阿托品控制效果较好,但也伴随着更高的不良反应发生风险;同时部分儿童应用阿托品后近视控制效果不佳。角膜塑形镜长期配戴的控制效果不够明确,且角膜塑形镜的度数设置尚缺少定论。MFSCLs配戴对高度近视的控制效果仍需大样本的临床试验进一步证明。后巩膜加固术作为手术手段,其不良反应的发生风险及创伤较其他干预措施大,目前尚无高级别循证医学证据证明其有效性。各类高度近视干预措施的推广应用仍需高级别的循证医学证据支持。本文从药物、光学、手术及其他干预措施几个方面就近年来儿童和青少年高度近视干预措施存在的争议进行综述。With the high incidence and early onset age of myopia,continuous attention has been paid to the prevention and control of high myopia.Interventions to control the progression of high myopia in children and adolescents at present mainly include low-dose atropine eye drops,orthokeratology,multifocal soft contact lenses and posterior scleral reinforcement.The interventions have also been applied among children with high myopia and have been proved effective in controlling the progression of myopia.Controversies over their clinical usages and safety still exist.There is a contradiction between concentration and safety of low-dose atropine eye drops,namely,higher concentration showing better efficacy is accompanied by the higher risk of adverse reactions.Meanwhile,there exist some children having poor response to atropine treatment.The long-term effect of orthokeratology lens is unclear,and how to choose the power of orthokeratology lens has not come to an agreement.The effect of multifocal soft contact lens on high myopia needs to be further verified by clinical trials with large sample size.Posterior scleral reinforcement is a surgical procedure,having a higher risk of adverse reactions and trauma than other interventions,and there is a lack of high-level evidence-based medical evidence to prove its efficacy.The promotion and application of interventions for high myopia still require the support of high-level medical evidences.From the perspectives of medicine,optics,surgery and other strategies,the recent controversies about the intervention for high myopia in children and adolescents were reviewed in this article.

关 键 词：近视 防控 儿童 青少年 高度近视 

分 类 号：R778.11[医药卫生—眼科]