角膜塑形镜联合0.01%阿托品滴眼液治疗青少年近视

Effect of orthokeratology combined with 0.01% atropine solution on adolescents with myopia

摘要:

目的：探讨分析角膜塑形镜联合0.01%阿托品滴眼液在控制青少年近视过程中的疗效和安全性。

方法：收集2019-01/2022-01在衡水市人民医院眼科诊治的100例100眼(均取右眼数据)青少年近视患者，根据患者意愿采用随机对照原则将患者分为试验组和对照组，每组各50例50眼。对照组患者采用单一角膜塑形镜治疗，试验组患者采用角膜塑形镜联合0.01%阿托品滴眼液治疗。记录两组患者持续治疗1、3、6、9、12mo后的治疗数据，对比两组患者在治疗前后的屈光度、角膜曲率、眼轴长度(AL)、中央角膜厚度(CCT)、瞳孔直径(PD)、泪膜脂质层厚度(LLT)和泪膜破裂时间(BUT)、角膜总高阶像差(RMSh)、黄斑中心凹下脉络膜厚度(SFCT)、角膜内皮细胞密度(CD)和六边形细胞比例(HEX)等参数。随访期间观察患者不良反应发生情况。

结果：治疗后12mo，试验组患者屈光度、角膜曲率、AL分别为-2.42±0.17D、38.89±1.18D、25.44±0.23mm，均显著优于对照组(-2.56±0.19D、40.12±1.65D、25.54±0.19mm，均P<0.05)； 试验组患者CCT(538±33μm)低于对照组(545±41μm)，而试验组患者PD高于对照组(6.38±0.38mm vs 6.12±0.37mm，P<0.05)； 试验组患者LLT和BUT分别为61.14±8.41nm、9.24±2.05s，均显著高于对照组(56.14±7.22nm、7.27±1.99s，均P<0.05)； 试验组患者RMSh低于对照组(0.73±0.21μm vs 0.85±0.12μm，P<0.05)，而试验组患者SFCT显著高于对照组(289±55μm vs 282±59μm，P<0.05)。此外，治疗后12mo，试验组患者CD和HEX相比较对照组均无差异(均P>0.05)。治疗期间两组患者的主要不良反应为畏光、过敏反应、结膜炎和角膜炎，但两组比较无差异(均P>0.05)。

结论：角膜塑形镜联合0.01%阿托品滴眼液相比较单用角膜塑形镜能更有效控制青少年近视发展，且不增加不良反应。

Abstract:

AIM: To investigate the efficacy and safety of orthokeratology combined with 0.01% atropine solution in adolescents with myopia.

METHODS: A total of 100 adolescent myopic patients(100 right eyes)who received treatment at the Department of Ophthalmology, People's Hospital of Hengshui from January 2019 to January 2022 were enrolled. All patients were divided into two groups based on the patient's preferences and randomized controlled principles: control group(n=50)and experimental group(n=50). Patients in the control group received orthokeratology alone, while those in the experimental group received orthokeratology in combination with 0.01% atropine solution. Treatment data for both groups were collected at 1, 3, 6, 9 and 12mo after treatment. The observed indicators included refraction, corneal curvature, axial length(AL), central corneal thickness(CCT), pupil diameter(PD), lipid layer thickness(LLT), break-up Time(BUT), root-mean-square of higher-order aberration(RMSh), subfoveal choroidal thickness(SFCT), corneal endothelial cell density(CD), and hexagonal cell ratio(HEX). The adverse reactions experienced during follow-up period were also observed and recorded.

RESULTS: After 12mo of treatment, the refraction, corneal curvature, and AL in the experimental group were -2.42±0.17D, 38.89±1.18D and 25.44±0.23mm, respectively, which were significantly better than the control group(-2.56±0.19D, 40.12±1.65D and 25.54±0.19 mm, all P<0.05). The CCT of the experimental group(538±33 μm)was lower than that of the control group(545±41 μm), while the PD of the experimental group was higher than that of the control group(6.38±0.38 mm vs. 6.12±0.37 mm, P<0.05). LLT and BUT in the experimental group was 61.14±8.41 nm and 9.24±2.05s, respectively, which were significantly higher than those in the control group(56.14±7.22 nm and 7.27±1.99s, all P<0.05). RMSh in the experimental group was lower than that of the control group(0.73±0.21 μm vs. 0.85±0.12 μm, P<0.05), and SFCT in the experimental group was significantly higher than that of the control group(289±55 μm vs. 282±59 μm, P<0.05). Additionally, after 12mo of treatment, there was no significant difference in CD and HEX between the experimental group and the control group(all P>0.05). The main adverse reactions of both groups during treatment period were photophobia, anaphylaxis, conjunctivitis and keratitis, but there was no significant difference between the two groups(all P>0.05).

CONCLUSION: Compared to orthokeratology alone, the combination of orthokeratology and 0.01% atropine solution effectively prevents and improves the development of adolescent myopia without increasing the incidence of adverse reactions.