CAJ | 학술논문

背景关于双光镜是否能够延缓学龄儿童近视的发展一直存在争议,应用循证医学的方法对双光镜的效果进行评估具有重要的临床意义.目的系统评价双光镜和单焦点眼镜在延缓近视学龄儿童近视进展中的效果.方法系统检索MEDLINE(1966-2010年10月)、EMBASE(1974-2010年10月)、Cochrane Library、中国生物医学文献数据库(1978-2010年10月)和中国临床试验注册中心中关于双光镜治疗近视的随机对照试验,辅以手工检索相关期刊书籍,对检索所得文献进行双人筛选、评估和数据提取,针对屈光度进展量和眼轴长度进展量对纳入的研究进行Meta分析.结果有3项符合标准的高质量随机对照试验被纳入.在最长随访期时,双光镜和单焦点眼镜延缓近视学龄儿童屈光度进展量的加权平均差为0.22D(95%CI:-0.24～0.67),差异无统计学意义(P=0.35),在6、12、18、24个月和>30个月时的差异量分别为0.15(95%CI:-0.09～0.38)、0.17(95%CI:-0.05～0.39)、0.42(95%CI:-0.14～0.98)、0.23(95%CI:-0.21～0.66)和0.03(95%CI:-0.40～0.46),差异均无统计学意义.二者延缓近视学龄儿童眼轴长度进展量的加权平均差为-0.17mm(95%CI:-0.26～0.08),差异有统计学意义(P=0.0003).结论基于现有研究,双光镜和单焦点眼镜相比在延缓近视学龄儿童的近视进展方面差异无统计学意义.由于目前的高质量研究数量较少,上述结果仍需更多大样本的研究进一步证实.
배경 관우쌍광경시부능구연완학령인동근시적발전일직존재쟁의,응용순증의학적방법대쌍광경적효과진행평고구유중요적림상의의.목적 계통평개쌍광경화단초점안경재연완근시학령인동근시진전중적효과.방법 계통검색MEDLINE(1966-2010년10월)、EMBASE(1974-2010년10월)、Cochrane Library、중국생물의학문헌수거고(1978-2010년10월)화중국림상시험주책중심중관우쌍광경치료근시적수궤대조시험,보이수공검색상관기간서적,대검색소득문헌진행쌍인사선、평고화수거제취,침대굴광도진전량화안축장도진전량대납입적연구진행Meta분석.결과 유3항부합표준적고질량수궤대조시험피납입.재최장수방기시,쌍광경화단초점안경연완근시학령인동굴광도진전량적가권평균차위0.22D(95%CI:-0.24～0.67),차이무통계학의의(P=0.35),재6、12、18、24개월화>30개월시적차이량분별위0.15(95%CI:-0.09～0.38)、0.17(95%CI:-0.05～0.39)、0.42(95%CI:-0.14～0.98)、0.23(95%CI:-0.21～0.66)화0.03(95%CI:-0.40～0.46),차이균무통계학의의.이자연완근시학령인동안축장도진전량적가권평균차위-0.17mm(95%CI:-0.26～0.08),차이유통계학의의(P=0.0003).결론 기우현유연구,쌍광경화단초점안경상비재연완근시학령인동적근시진전방면차이무통계학의의.유우목전적고질량연구수량교소,상술결과잉수경다대양본적연구진일보증실.
Background Whether the wearing of bifocal lenses can delay the development of myopia in school childhood is in controversy.To assess the effect of bifocal lenses using evidence-based medicine method is of important significance.Objective Present study was to compare the effect of bifocal lenses with single vision lenses in retarding myopia progression in school-aged myopic children.Methods This was a evidence-based medicine study.The systematical literature search was performed from MEDLINE(1966 to October 2010),EMBASE(1974 to October 2010),Cochrane Library,Chinese Biomedical Database(1978 to October 2010),and Chinese Clinical Trial Registry combined with hand searching of related bibliographies of journals and books were applied to collect the randomized-controlled clinical trial about bifocal lenses.Screening,evaluation and data extraction of the retrieved literature were performed by two investigators independently.Mata-analysis was used to assess the progression of refraction and axial length among included randomized clinical trials.Results Three high-quality randomized-controlled clinical trials meeting the inclusion criterion were included in this meta-analysis.The results showed that the weighted mean difference in progression of refraction was 0.22D between bifocal lenses and single vision lenses(95% CI:-0.24-0.67),and the difference was statistical insignificance(P=0.35).The weighted mean difference in progression of refraction during the follow-up durations of 6,12,18,24 and ＞30 months were 0.15(95% CI:-0.09-0.38),0.17(95% CI:-0.05-0.39),0.42(95% CI:-0.14-0.98),0.23(95% CI:-0.21-0.66) and 0.03(95% CI:-0.40-0.46),respectively without statistical significance.The weighted mean difference in elongation of axial length between two interventions was -0.17mm(95% CI:-0.26-0.08) with a statistically significance(P=0.000).Conclusion Based on currently available studies,bifocal lenses could not significantly slow the progression of myopia in myopic school-aged children in comparison with single vision lenses.Because only few high-quality studies are currently available,this conclusion need to be supported by more large-sample-size clinical trials.