长期单眼配戴角膜塑形镜对眼表的影响

Effects of long-term monocular orthokeratology on the ocular surface

摘要:

目的：探讨持续单眼配戴角膜塑形镜对眼表的影响。

方法：回顾性研究2013-01/2015-12在无锡市101医院眼科门诊就诊的单眼近视眼(对侧眼为正视眼)持续配戴角膜塑形镜6mo以上的患者。观察戴镜眼和非戴镜眼在戴镜前和戴镜后各时间点(1wk，1、3、6mo)的泪膜破裂时间、泪液基础分泌量、角膜中央厚度、角膜内皮细胞密度、结膜充血、角膜上皮荧光素染色的情况。

结果：单眼持续配戴角膜塑形镜患者共53例，年龄10.43±1.70岁，等效球镜度-3.37±1.50D。戴镜眼戴镜1wk泪膜破裂时间缩短，戴镜后1wk与戴镜后1、3、6mo泪膜破裂时间相比，差异无统计学意义(P>0.05)； 非戴镜眼泪膜破裂时间各时间点无明显差异(P>0.05)。戴镜眼和非戴镜眼戴镜后各时间点泪液基础分泌量与戴镜前相比，差异均不明显(P>0.05)。戴镜后各时间点角膜中央厚度和角膜内皮细胞密度与戴镜前比较，差异均无统计学意义(P>0.05)。戴镜眼角膜上皮染色主要为Ⅰ级点染，Ⅰ级点染在戴镜后1wk，1、3、6mo分别为10眼(19%)、6眼(11%)、8眼(15%)、6眼(11%)，Ⅱ级点染分别为1眼(2%)、0眼、0眼、1眼(2%)。10例患者戴镜后会出现结膜充血(评分1分)。所有病例在及时停戴、使用抗生素及角膜修复剂后，角膜上皮点状染色均消失，结膜充血消退。非戴镜眼观察期内未见明显结膜充血，角膜上皮染色均为0级。

结论：持续配戴角膜塑形镜会引起泪膜稳定性的下降，结膜、角膜上皮会出现不同程度的影响，但对泪液分泌、角膜厚度和角膜内皮细胞无明显影响。非戴镜眼无明显眼表损害。

Abstract:

AIM:To study the effects of long-term wearing monocular orthokeratology on ocular surface.

METHODS: A retrospective study was conducted in patients with unilateral myopia(The contralateral eye of each patient was emmetropic.)who used orthokeratology lens for more than half a year. The patients were recruited from January 2013 to December 2015, in ophthalmological clinic, 101 Hospital of PLA, Wuxi. The tear break-up time(BUT), basal tear secretion, central corneal thickness, corneal endothelial cell density, conjunctival congestion and corneal epithelium fluorescein staining were observed before wearing orthokeratology and at different time points during wearing orthokeratology.

RESULTS: Fifty-three young patients(53 eyes)with long-term wearing a monocular orthokeratology lens were observed, whose ages were 10.43±1.70 years old and their spherical equivalents(SEs)were -3.37±1.50D. For the myopic eyes, after 1-week treatment of monocular orthokeratology, the BUT was shortened, but there was no significant difference compared with those after 1-month, 3-month, 6-month treatment of monocular orthokeratology(P>0.05). For the emmetropic eyes, there was no significant difference in changing the BUT at above different time points(P>0.05). There was no significant difference in the value of basal tear secretion at those time points between two different kinds of eyes(The myopic eyes with orthokeratology and the emmetropic eyes without orthokeratology)(P>0.05). Compared with before wearing orthokeratology lens, there was no significant difference in both corneal center thickness and corneal endothelial cell density at those time points after wearing orthokeratology lens(P>0.05). After wearing orthokeratology lens, the corneal epithelial stain was mostly Ⅰ dyed. After 1wk, 1, 3 and 6mo respectively, the Ⅰ dyed amounts were 10 eyes(19%), 6 eyes(11%), 8 eyes(15%), 6 eyes(11%),the Ⅱ dyed amounts were 1 eye(2%), 0, 0, 1 eye(2%). The conjunctival congestion(score 1)showed up on 10 patients after wearing the orthokeratology lens. After all the 10 cases stopping wearing orthokeratology lens, but taking some antibiotics and corneal repair agents, the corneal epithelium stain disappeared and the conjunctival congestion faded away. For the emmetropic eyes, no obvious conjunctival congestion was observed during the observation period, and the corneal epithelial stain was 0.

CONCLUSION: Continuous wearing orthokeratology can cause the decrease of the stability of tear film. And it also affects the conjunctiva and corneal epithelium by degrees. But it has no significant effect on tear secretion, corneal thickness and corneal endothelial cells. There will be no apparent ocular surface damage on non-wearing eyes.