目的 观察角膜塑形镜(orthokeratology,OK)矫正近视的临床效果,评价其减缓近视度数增长的疗效及长期配戴的安全性.方法 回顾性病例研究.对2010年4月至2010年8月在中国医科大学眼科医院就诊的73例(143只眼)低、中度近视患者观察,其中45例(87只眼)配戴OK镜的患者作为实验组,28例(56只眼)配戴框架眼镜的患者作为对照组.根据初诊时近视程度将实验组再分为两组:A组43只眼(近视≤-3.00 D),B组44只眼(-3.00 D＜近视≤-6.00 D).实验组于戴镜前、戴镜1天(8～10 h)、1周、1个月、3个月、半年、1年、1年半、2年,进行裸眼视力检查.于戴镜前、戴镜2年后验光,测眼轴长度、角膜厚度、角膜内皮细胞密度及眼压检查.对照组于戴镜前和戴镜2年行电脑验光、主觉验光.戴镜前后各值比较采用配对t检验,各组间比较采用单因素方差分析,以P ＜0.05为差异有统计学意义.结果 实验组戴镜1天后裸眼视力均明显提高:A组戴镜1周平均视力达1.0以上,戴镜1年半视力开始下降,需重新试配,更换镜片.B组戴镜l周平均视力达0.8以上,戴镜1年视力开始出现下降,需重新试配,更换镜片.实验组戴镜2年后角膜垂直曲率和水平曲率均比戴镜前变平,且差异有统计学意义(P＜0.05).实验组戴镜2年后近视度数比戴镜前增长(0.65±0.58)D,与对照组戴框架镜2年后近视度数增长(2.19±0.61)D比较,差异有统计学意义(F =228.64P＜0.05).A组戴镜2年眼轴增长(0.45±0.28) mm,与戴镜前比较差异有统计学意义(t=9.834,P=0.000,P＜0.05),B组戴镜2年眼轴增长(0.34±0.33) mm,与戴镜前比较差异有统计学意义(t=2.570,P =0.014,P＜0.05),两组眼轴变化比较差异有统计学意义(F =5.360,P＜0.05),OK镜对低、中度近视均有控制作用,对中度近视控制效果更明显.实验组戴镜2年后角膜厚度、角膜内皮细胞密度、眼压与戴镜前相比,差异均无统计学意义(P＞0.05).结论 低、中度近视患者长期配戴OK镜,大部分患者戴镜1周可获0.8以上裸眼视力,并可保持1年左右,其后视力稍有下降,需更换镜片.长期配戴可有效控制近视度数发展,中度近视比低度近视控制效果更明显,且均未引起角膜厚度、角膜内皮细胞密度和眼压的变化.
目的 觀察角膜塑形鏡(orthokeratology,OK)矯正近視的臨床效果,評價其減緩近視度數增長的療效及長期配戴的安全性.方法 迴顧性病例研究.對2010年4月至2010年8月在中國醫科大學眼科醫院就診的73例(143隻眼)低、中度近視患者觀察,其中45例(87隻眼)配戴OK鏡的患者作為實驗組,28例(56隻眼)配戴框架眼鏡的患者作為對照組.根據初診時近視程度將實驗組再分為兩組:A組43隻眼(近視≤-3.00 D),B組44隻眼(-3.00 D＜近視≤-6.00 D).實驗組于戴鏡前、戴鏡1天(8～10 h)、1週、1箇月、3箇月、半年、1年、1年半、2年,進行裸眼視力檢查.于戴鏡前、戴鏡2年後驗光,測眼軸長度、角膜厚度、角膜內皮細胞密度及眼壓檢查.對照組于戴鏡前和戴鏡2年行電腦驗光、主覺驗光.戴鏡前後各值比較採用配對t檢驗,各組間比較採用單因素方差分析,以P ＜0.05為差異有統計學意義.結果 實驗組戴鏡1天後裸眼視力均明顯提高:A組戴鏡1週平均視力達1.0以上,戴鏡1年半視力開始下降,需重新試配,更換鏡片.B組戴鏡l週平均視力達0.8以上,戴鏡1年視力開始齣現下降,需重新試配,更換鏡片.實驗組戴鏡2年後角膜垂直麯率和水平麯率均比戴鏡前變平,且差異有統計學意義(P＜0.05).實驗組戴鏡2年後近視度數比戴鏡前增長(0.65±0.58)D,與對照組戴框架鏡2年後近視度數增長(2.19±0.61)D比較,差異有統計學意義(F =228.64P＜0.05).A組戴鏡2年眼軸增長(0.45±0.28) mm,與戴鏡前比較差異有統計學意義(t=9.834,P=0.000,P＜0.05),B組戴鏡2年眼軸增長(0.34±0.33) mm,與戴鏡前比較差異有統計學意義(t=2.570,P =0.014,P＜0.05),兩組眼軸變化比較差異有統計學意義(F =5.360,P＜0.05),OK鏡對低、中度近視均有控製作用,對中度近視控製效果更明顯.實驗組戴鏡2年後角膜厚度、角膜內皮細胞密度、眼壓與戴鏡前相比,差異均無統計學意義(P＞0.05).結論 低、中度近視患者長期配戴OK鏡,大部分患者戴鏡1週可穫0.8以上裸眼視力,併可保持1年左右,其後視力稍有下降,需更換鏡片.長期配戴可有效控製近視度數髮展,中度近視比低度近視控製效果更明顯,且均未引起角膜厚度、角膜內皮細胞密度和眼壓的變化.
목적 관찰각막소형경(orthokeratology,OK)교정근시적림상효과,평개기감완근시도수증장적료효급장기배대적안전성.방법 회고성병례연구.대2010년4월지2010년8월재중국의과대학안과의원취진적73례(143지안)저、중도근시환자관찰,기중45례(87지안)배대OK경적환자작위실험조,28례(56지안)배대광가안경적환자작위대조조.근거초진시근시정도장실험조재분위량조:A조43지안(근시≤-3.00 D),B조44지안(-3.00 D＜근시≤-6.00 D).실험조우대경전、대경1천(8～10 h)、1주、1개월、3개월、반년、1년、1년반、2년,진행라안시력검사.우대경전、대경2년후험광,측안축장도、각막후도、각막내피세포밀도급안압검사.대조조우대경전화대경2년행전뇌험광、주각험광.대경전후각치비교채용배대t검험,각조간비교채용단인소방차분석,이P ＜0.05위차이유통계학의의.결과 실험조대경1천후라안시력균명현제고:A조대경1주평균시력체1.0이상,대경1년반시력개시하강,수중신시배,경환경편.B조대경l주평균시력체0.8이상,대경1년시력개시출현하강,수중신시배,경환경편.실험조대경2년후각막수직곡솔화수평곡솔균비대경전변평,차차이유통계학의의(P＜0.05).실험조대경2년후근시도수비대경전증장(0.65±0.58)D,여대조조대광가경2년후근시도수증장(2.19±0.61)D비교,차이유통계학의의(F =228.64P＜0.05).A조대경2년안축증장(0.45±0.28) mm,여대경전비교차이유통계학의의(t=9.834,P=0.000,P＜0.05),B조대경2년안축증장(0.34±0.33) mm,여대경전비교차이유통계학의의(t=2.570,P =0.014,P＜0.05),량조안축변화비교차이유통계학의의(F =5.360,P＜0.05),OK경대저、중도근시균유공제작용,대중도근시공제효과경명현.실험조대경2년후각막후도、각막내피세포밀도、안압여대경전상비,차이균무통계학의의(P＞0.05).결론 저、중도근시환자장기배대OK경,대부분환자대경1주가획0.8이상라안시력,병가보지1년좌우,기후시력초유하강,수경환경편.장기배대가유효공제근시도수발전,중도근시비저도근시공제효과경명현,차균미인기각막후도、각막내피세포밀도화안압적변화.
Objective To observe the clinical effects of orthokeratology lens (orthokeratology,OK) on the correction of myopia,to evaluate the effects and safety of long-term Ortho-K on the myopia control.Methods A retrospective case study.Seventy-three cases (143 eyes) with low,and moderate myopia patients were divided into 2 groups,45 cases (87 eyes) with the Ortho-K contact lens in the experimental group,and 28 cases (56 eyes) wearing spectacles in the control group.The experimental group was subdivided into 2 groups:43 eyes in group A (myopia≤-3.00D),44 eyes in group B (-3.00D＜ myopia ≤-6.00D),based on the diopters.The visual acuity (VA) of the experimental group were taken respectively at pre-wear,1 day (8-10 hours),1 week,1 month,3 months,6 months,1 year,1 and a half years,2 years.The changes of axial length,corneal thickness,corneal endothelial and intraocular pressure within 2 years with the Ortho-K contact lens in the experimental group were compared.Refraction was measured in the control group pre-wearing and after 2 years.Data were analyzed by a paired t test before and after wearing glasses,Data between groups were compared with single factor analysis of variance,A P value of 0.05 or less was considered statistically significant.Results In the experimental group,VA improved significantly after wearing glasses a day.In group A,VA was 1.0 after a week,which decreased after 1 and a half of years,and then needed to test again and replace lenses.In group B,the mean VA was 0.8 after a week,which decreased after 1 and a half of years,and then needed to test again and replace lenses.The vertical and horizontal curvature of cornea in the experimental group became flatter than before,and the difference was statistically significant (P ＜0.05) after 2 years.The myopic degree in the experimental group increased (0.65 ± 0.58) D 2 years later,and the control group with spectacles increased (2.19±0.61) D,which showed statistically significant difference (F=228.64,P ＜0.05).The axial length in group A growth increased 0.45±0.28 mm2 years later,and the difference was statistically significant compared with before (t=9.834,P =0.000,P ＜0.05).The axial length in group B growth increased 0.34±0.33 mm 2 years later,and the difference was statistically significant compared with before (t =2.570,P =0.014,P ＜0.05).The axial length variation of two groups had statistical significance difference after 2 years (F =5.360,P ＜0.05).Ortho-K could control the development of low and moderate myopia,the effect was significantly compared with the moderate myopia.In the experimental group,there were no statistically significance in corneal thickness,corneal endothelial cell density,intraocular pressure after 2 years,compared with which measured before (P ＞0.05).Conclusions Most of the low,moderate myopia patients wearing Ortho-K long-term later can get visible VA more than 0.8,and can keep for about a year,when the visual acuity decrease slightly,lens need to be changed.The control effect of moderate myopia is significantly better than low myopia after Long-term wear,and can not cause the changes of corneal thickness,corneal endothelial cell density and intraocular pressure.
