夜戴型角膜塑形镜对青少年眼表功能的影响

Night-wearing orthokeratology on adolescent ocular surface function

摘要:

目的：研究青少年配戴夜戴型角膜塑形镜前后眼表和睑板腺功能的变化，探究角膜塑形镜对青少年泪膜的影响。

方法：前瞻性临床研究。选取2017-01/11于我院就诊的55例满足入选标准的8～16岁青少年并要求配戴角膜塑形镜患者，于戴镜前及戴镜后1wk， 1、3、6、12mo随访进行眼表疾病指数(OSDI)问卷、裂隙灯和Keratograph 5M检查非侵入性第一次泪膜破裂时间[NIBUT(f)]、非侵入性平均泪膜破裂时间[NIBUT(av)]、泪河高度(TMH)、睑板腺功能。

结果：研究期间所有患者均未发生感染性角膜炎。戴镜后1wk，1、3、6、12mo OSDI评分分别为7.38±1.71、9.21±1.39、10.19±1.02、10.28±1.18、10.29±1.85分，较戴镜前(4.80±1.63分)均增加(P<0.05)。戴镜后1wk，1、3、6、12mo NIBUT(f)为12.39±4.76、9.95±5.23、11.30±4.58、11.21±4.34、11.63±5.32s，NIBUT(av)为11.26±6.77、11.16±6.48、13.09±5.79、13.13±5.41、13.19±5.21s，NIBUT(f)戴镜后1mo与戴镜前，NIBUT(av)戴镜后1wk，1mo与戴镜前比较均有差异(均P<0.05)。TMH戴镜前后无明显变化(P>0.05)。角膜荧光素染色评分戴镜后1wk，1、3、6、12mo为3.51±1.67、3.54±1.62、4.05±1.52、4.14±1.32、4.50±1.43分，较戴镜前均增加(P<0.05)。睑板腺脂质分泌得分及睑板腺缺失评分在戴镜前后不同时间无明显变化(P>0.05)。

结论：配戴角膜塑形镜早期泪膜的功能降低，但戴镜后6mo逐渐恢复至戴镜前水平，并趋于稳定增加，配戴角膜塑形镜后眼部不适症状增加，角膜荧光素染色在戴镜后增加，对睑板腺的功能没有影响。

Abstract:

AIM: To study the effect of ocular surface and meibomian gland dysfunction of adolescents before and after wearing overnight orthokeratology, and to explore its effects on adolescent tear film.

METHODS: A prospective clinical study was conducted. 55 cases of 8 to 16-year-old adolescents who met the selection criteria from January 2017 to November 2017 were selected for orthokeratology. Before lens wear and after lens wear 1wk, 1mo, 3mo, 6mo, and 12mo were followed up for Ocular Surface Disease Index(OSDI)questionnaire, slit-lamp examination, and Keratograph 5M.

RESULTS: During the study period, no patients developed infectious keratitis. The OSDI scores were 7.38±1.71 points, 9.21±1.39 points, 10.19±1.02 points, 10.28±1.18 points, 10.29±1.85 points after wearing at 1wk, 1, 3, 6, and 12mo respectively, which were higher than those before wearing(4.80±1.63 points)were increased, and the difference was statistically significant at different times before and after wearing(P<0.05). 1wk, 1, 3, 6, 12mo NIBUT(f)values were 12.39±4.76s, 9.95±5.23s, 11.30±4.58s, 11.21±4.34s, 11.63±5.32s, and NIBUT(av)values were respectively 11.26±6.77s, 11.16±6.48s, 13.09±5.79s, 13.13±5.41s, 13.19±5.21s, NIBUT(f)1mo after wearing compared with before wearing, the difference was statistically significant(P<0.05), NIBUT(av)at 1wk and 1mo after wearing was compared with before wearing, the difference was statistically significant(all P<0.05), and the difference was both at 3, 6, 12mo after wearing and before wearing No statistical significance(all P>0.05).There was no significant change in TMH at 1wk, 1, 3, 6, 12mo after wearing, and the difference was not statistically significant(F=2.168, P>0.05). Corneal fluorescein staining scores were 3.51±1.67 points, 3.54±1.62 points, 4.05±1.52 points, 4.14±1.32 points, 4.50±1.43 points, respectively, 1wk after wearing, 1, 3, 6, and 12mo, which were higher than those before wearing(P<0.05). The meibomian gland lipid secretion score and the meibomian gland loss score did not change significantly at different times before and after wearing(P>0.05).

CONCLUSION: The tear film function in the early period of wearing the orthokeratology is reduced, but it gradually returns to the level before wearing the lens after 6mo, and tends to increase steadily. After wearing the orthokerato-scope, the symptoms of eye discomfort increase and corneal fluorescein stain increased after wearing, no effect on meibomian gland function.