长期配戴角膜塑形镜治疗近视的疗效及角膜并发症观察

Long-term observation of corneal complications and effectiveness by orthokeratology for myopia

摘要:

目的：观察配戴角膜塑形镜2a治疗近视的疗效及角膜并发症。

方法：观察2008-01/2012-09在本院接受规范验配并严格复查的角膜塑形镜治疗患者324例620眼，连续戴镜6mo； 1、2a后患者裸眼视力、屈光度数、角膜曲率变化及视觉质量、眼表并发症等情况。

结果：戴镜前裸眼视力0.15±0.14，戴镜后6mo 0.95±0.07，1a 0.93±0.10，2a 0.90±0.10，与戴镜前视力的差异均存在统计学意义(P<0.01)； 治疗前屈光度-3.34±1.43D，戴镜后6mo -0.73±0.67D，1a -0.93±0.57D，2a -0.97±0.66D，与戴镜前屈光度的差异均存在统计学意义(P<0.01)； 治疗前角膜曲率43.27±1.23D，戴镜后6mo 40.69±1.22D，1a 40.64±1.21D，2a 40.36±1.16D，与戴镜前角膜曲率的差异均存在统计学意义(P<0.01)。配戴角膜塑形镜期间共397眼发生轻度角膜上皮损伤(0～Ⅱ级)，发生率为64.0%，给予促角膜上皮修复药物后缓解； 仅5眼发生Ⅲ级角膜上皮损伤，发生率0.8%，仅1例患者出现丝状角膜炎，停戴后药物治疗痊愈； 106眼戴镜期间发生角膜镜片压痕，发生率17.1%； 144眼发生复视或重影，发生率为23.2%； 161眼出现眩光，发生率为26.0%，经早期观察或调整镜片后消失。

结论：在规范验配、严格复查的前提下，长期配戴角膜塑形镜是安全的，可显著提高裸眼视力，明显降低近视度数及角膜曲率。

Abstract:

AIM:To observe the long-term effectiveness and corneal complications by orthokeratology in myopia patients.

METHODS:A retrospective analysis was conducted for 324 patients(620 eyes)with myopia who weared orthokeratology lens with standardized examination and strict recheck. The change of uncorrected visual acuity, myopic diopter, corneal curvature, visual quality and the complications after continuous wearing orthokeratology for 6mo, 1 and 2a were observed.

RESULTS:The uncorrected visual acuity was 0.15±0.14 before orthokeratology, 0.95±0.07 at 6mo after wearing, 0.93±0.10 after 1a, 0.90±0.10 after 2a, which was increased significantly in every group compared with that before wearing(P<0.01). The myopic diopter was -3.34±1.43D before wearing orthokeratology, -0.73±0.67D at 6mo after wearing, -0.93±0.57D after 1a, -0.97±0.66D after 2a, which was decreased apparently in every group compared with that before wearing(P<0.01). The corneal curvature was 43.27±1.23D before wearing orthokeratology, 40.69±1.22D at 6mo after wearing, 40.64±1.21D after 1a, 40.36±1.16D after 2a, which was decreased significantly in every group compared with that before wearing(P<0.01). During the period of orthokeratology wearing, 397 eyes had mild corneal epithelial injury(0～Ⅱ), the incidence rate was 64.0%, which was relieved after promoting restoration drugs for corneal epithelium. The corneal epithelial injury at Ⅲ degree occurred in only 5 eyes, and the incidence rate was 0.8%. Only 1 patient had to stopped wearing orthoeratology for filamentary keratitis and cured with drugs. The pressure mark occurred in 106 eyes, and the incidence rate was 17.1%. Diplopia or double image happened in 144 eyes, and the incidence rate was 23.2%. Dazzle occurred in 161 eyes, and the incidence rate was 26.0%. These problems could disappeared with time or after adjusting lenses.

CONCLUSION:Long-term orthokeratology wearing can efficiently improve the uncorrected visual acuity, decrease the myopic diopter and corneal curvature. The standardized examination and strict recheck can ensure the safety of orthokeratology.