脉络膜厚度在角膜塑形镜和周边离焦型镜片框架镜控制近视患者中的差异  

Difference in choroidal thicknesses under myopia control using the orthokeratology lens and peripheral defocus spectacle lens

作　　者：陈颖[1] 刘晓庆 周瑜峰 程瑜[1] 沈玺[1] CHEN Ying;LIU Xiaoqing;ZHOU Yufeng;CHENG Yu;SHEN Xi(Department of Ophthalmology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200020,China)

机构地区：[1]上海交通大学医学院附属瑞金医院眼科,上海市200020

出　　处：《眼科新进展》2023年第2期131-136,共6页Recent Advances in Ophthalmology

摘　　要：目的评价脉络膜厚度(ChT)在角膜塑形镜(Ortho-K)和周边离焦型镜片框架镜(Multi-focus)近视控制上的差异。方法回顾性分析2019年11月至2021年12月期间在上海交通大学医学院附属瑞金医院眼科就诊后选择Ortho-K(Ortho-K组)或Multi-focus(Multi-focus组)控制近视的儿童资料,随访中观察近视进展和ChT变化。按标准ETDRS格将黄斑中心凹(标记为0区)和黄斑旁区的环形区分为内层(1区)和外层(2区),按上方(S)、鼻侧(T)、下方(I)、颞侧(N)四个方位,分别观察各个方位患者的ChT的算术平均值。基线数据和末次随访数据采用两独立样本t检验,组间随访数据的比较采用重复测量方差分析,组内末次随访数据与基线资料分别进行配对样本t检验。结果Ortho-K组纳入16例患者,Multi-focus组纳入26例患者,两组均以单眼计入研究,所有基线资料均衡可比(均为P>0.05)。两组组内各指标随时间变化趋势均有统计学意义(均为P<0.001),时间与组别交互后等效球镜度(P=0.003)、平均ChT(P=0.003)、ChT T1(P=0.003)、ChT T2区(P=0.001),ChT S1区(P=0.042)、ChT S2区(P=0.002)及ChT I2区(P=0.008)变化趋势均显著。两组各个方位的ChT在戴镜的3~6个月有上升趋势,其中Ortho-K组波动更大;两组在戴镜后6个月到12个月趋于稳定,而戴镜12个月后又出现下降的趋势。戴镜后15个月,Ortho-K组患者等效球镜度进展了(-0.36±0.23)D,Multi-focus组进展了(-0.84±0.16)D,但两组之间的等效球镜度和眼轴长度变化差异均无统计学意义(均为P>0.05),而两组间0区、I1区、S2区、N2区、I2区及平均ChT差异均有统计学意义(均为P<0.05)。结论Multi-focus能够作为不符合Ortho-K适应证的近视儿童的光学替代治疗方法,然而两者在长期的近视控制中可能存在差异。Objective To evaluate the difference in choroidal thicknesses(ChT)under myopia control via orthokeratology(Ortho-K)lens and peripheral defocus spectacle(multi-focus)lens.Methods The myopia progression and ChT changes during the follow-up of children who visited the Ophthalmology Department of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from November 2019 to December 2021 and used the Ortho-K lens(Ortho-K group)or multi-focus lens(multi-focus group)for myopia control were reviewed.Based on the standard Early Treatment of Diabetic Retinopathy Study grid,the subfoveal area was marked as zone 0,the inner layer of the perimacular annular area was marked as zone 1,and the outer layer was marked as zone 2.The arithmetic mean of ChT in the following four orientations was obtained:superior(S),nasal(N),inferior(I),and temporal(N).Baseline data and last follow-up data were analyzed by two independent sample t-tests,comparison of follow-up data between the two groups was carried out using the analysis of variance for repeated measures,and paired sample t-test was performed separately for the last follow-up data and baseline data within groups.Results A total of 16 individuals were included in the Ortho-K group and 26 individuals were included in the multi-focus group.One eye was chosen in the study for both groups,and all baseline data in the two groups were comparable(all P>0.05).Both groups(within-group factors)showed statistically significant trends over time(both P<0.001).After the time-group interaction,the equivalent spherical refraction(SER)(P=0.003),mean ChT(P=0.003),temporal ChT in the T1 zone(P=0.003)and T2 zone(P=0.001),superior ChT in the S1 zone(P=0.042)and S2 zone(P=0.002),and the inferior ChT in I2 zone(P=0.008)showed significant change trends.Meanwhile,an increasing trend was observed in the ChT in all directions from 3 to 6 months after wearing the lenses in both groups,with greater fluctuations in the Ortho-K group.The two groups tended to be stable from 6 to 12 months after wearing the

关 键 词：脉络膜厚度 角膜塑形镜 周边离焦型镜片 近视 光学相干断层扫描 

分 类 号：R778[医药卫生—眼科]