多区正向设计离焦框架眼镜联合低浓度阿托品与角膜塑形镜对儿童近视的延缓效果比较  

Comparison of the effect of delaying pediatric myopia progression between defocus incorporated multiple segments spectacle lenses combined with low-dose atropine and orthokeratology lenses

作　　者：宋德胜 张玉鑫 龙广凤 陈志钧[1] SONG Desheng;ZHANG Yuxin;LONG Guangfeng;CHEN Zhijun(Department of Ophthalmology,Children’s Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京医科大学附属儿童医院眼科,江苏省南京市210008

出　　处：《眼科新进展》2025年第4期291-297,共7页Recent Advances in Ophthalmology

基　　金：国家自然科学基金(编号:82100778)。

摘　　要：目的比较多区正向离焦镜片(DIMS)联合低浓度阿托品(0.1 g·L^(-1))(DIMSA)和角膜塑形镜(OK镜)对儿童近视的控制效果。方法前瞻性队列研究,纳入2022年1月至2023年2月在南京市儿童医院治疗的近视儿童。患儿分为DIMSA组(88例)或OK镜组(73例),仅右眼数据用于统计分析,随访1年。DIMSA组患儿在试验前和每次随访时测量眼轴长度(AL)和等效球镜度(SER),OK镜组患儿在试验前和每次随访时测量AL。计算两组患儿的AL回退率[(AL回退率=AL回退例数/该组总例数)×100%]以及眼轴增长(AE),比较两组患儿的近视控制效果。结果OK镜组患儿基线年龄大于DIMSA组,差异有统计学意义(P=0.001)。随访6个月、1年以及调整基线年龄后,DIMSA组患儿AE均小于OK镜组患儿,差异均有统计学意义(均为P<0.05)。多元线性回归分析显示,基线年龄是AE的唯一影响因素[OK镜组:非标准β=-0.024,标准β=-0.266(P=0.022);DIMSA组:非标准β=-0.052,标准β=-0.487(P<0.001)],AE与基线年龄呈负相关(OK镜组:r=-0.30,P<0.001;DIMSA组:r=-0.42,P<0.001);DIMSA组患儿基线年龄与SER增长呈正相关(r=0.28,P=0.0015)。随访1年时,两组间不同AE速度患儿比例比较,差异均有统计学意义(χ^(2)=11.09,P=0.004),DIMSA组患儿眼轴增长控制效果优于OK镜组。随访6个月及1年时,DIMS组患儿AL回退率均高于OK镜组,差异均有统计学意义(均为P<0.05)。两组患儿眼部均未发生严重的不良反应事件。结论DIMSA对轻中度近视儿童的近视控制效果优于OK镜。眼科医师应根据患儿的具体需求和特点选择合适的近视控制方式。Objective To compare the efficacy of controlling pediatric myopia progression between defocus incorporated multiple segments(DIMS)spectacle lenses combined with low-concentration atropine(0.1 g·L^(-1))(DIMSA)and orthokeratology(OK)lenses.Methods A prospective cohort study was conducted on myopic children treated at the Department of Ophthalmology,Children’s Hospital of Nanjing Medical University between January 2022 and February 2023.Participants were divided into a DIMSA group(88 cases)and an OK lens group(73 cases).Only right eye data were included for statistical analysis,and the children were followed up for 1 year.The axial length(AL)and spherical equivalent refraction(SER)were measured for the DIMSA group while only AL was measured for the OK lens group at baseline and each follow-up visit.The AL regression rate[(AL regression rate=the number of AL regression cases/total cases in the group)×100%]and axial elongation(AE)were calculated to compare the myopia control efficacy between the two groups.Results The baseline age of the OK lens group was significantly larger than that of the DIMSA group(P=0.001).The AE value in the DIMSA group was significantly smaller than that in the OK lens group after following up for 6 months,following up for 1 year,and adjusting for baseline age(all P<0.05).Multiple linear regression analysis revealed that baseline age was the only factor influencing the AE value[OK lens group:unstandardizedβ=-0.024,standardizedβ=-0.266(P=0.022);DIMSA group:unstandardizedβ=-0.052,standardizedβ=-0.487(P<0.001)].There was a negative correlation between AE and baseline age(OK lens group:r=-0.30,P<0.001;DIMSA group:r=-0.42,P<0.001).In the DIMSA group,baseline age was positively correlated with SER progression(r=0.28,P=0.0015).After following up for 1 year,the proportions of children with different AE velocities differed significantly between the two groups(χ^(2)=11.09,P=0.004).AE was controlled better in the DIMSA group than that in the OK lens group.AL regression rates in the DIMSA group

关 键 词：近视 多区正向离焦镜片 角膜塑形镜 阿托品 儿童 

分 类 号：R778.1[医药卫生—眼科]