不同年龄近视患者长期配戴增加压迫系数的角膜塑形镜控制眼轴的疗效

Efficacy of orthokeratology lenses with increased compression factor in the control of axial length for myopic patients of different ages

摘要:

目的：比较不同年龄近视患者配戴增加压迫系数的角膜塑形镜(ICF)和常规压迫系数的角膜塑形镜(CCF)2 a后眼轴长度的变化。

方法：回顾性研究。连续性纳入2020-07/ 2021-07在佛山爱尔眼科医院总院验配角膜塑形镜的8-15岁近视患者141例141眼(均取右眼数据)，按照压迫系数不同分为两组：配戴常规压迫系数为0.75 D的角膜塑形镜(CCF)组患者70例70眼和配戴增加压迫系数为1.25 D的角膜塑形镜(ICF)组患者71眼71眼，各组以12岁作为年龄的分界线，分为8-11岁和12-15岁患者。随访观察戴镜1 d，1 wk，1、6 mo，1、2 a的裸眼视力(UCVA)、水平角膜曲率(K1)及角膜染色情况； 戴镜6 mo，1、2 a的眼轴(AL)数据。观察两组患者戴镜期间不良反应及角膜上皮点染情况。

结果：ICF组患者UCVA提升快于CCF组，在戴镜1 d，1 wk，1 mo均有差异(均P<0.001)； 在戴镜6 mo，1、2 a均无差异(均P>0.05)； ICF组K1较CCF组下降更快，在戴镜1 d，1 wk，1 mo均有差异(均P<0.05)； 在戴镜6 mo，1、2 a均无差异(均P>0.05)。戴镜2 a，8-11岁患者中ICF组和CCF组眼轴增长量分别为0.35±0.17和0.48±0.26 mm(P=0.010)，12-15岁患者中ICF组和CCF组眼轴增长量分别为0.16±0.15和0.31±0.29 mm(P=0.011)。随访期间，ICF组6眼(8.5%)、CCF组7眼(10%)出现角膜点染(P>0.05)，均为1级点染。

结论：配戴ICF角膜塑形镜比配戴CCF镜片更有效地控制近视儿童眼轴增长，且塑形更快，UCVA提升更明显，尤其对12岁以下的儿童避免发展成为高度近视的意义更大，因此低龄儿童可优先考虑配戴增加压迫系数的镜片，对于12岁以上的儿童可根据配戴者的用眼习惯、眼表的健康状况及视功能等选择性增加镜片的压迫系数。

Abstract:

AIM: To compare the changes in axial length of myopic patients of different ages after wearing orthokeratology lenses with increased compression factor(ICF)or conventional compression factor(CCF)for 2 a.

METHODS: Retrospective study. A total of 141 myopia patients(141 right eyes)aged 8 to 15 years who fitted with orthokeratology lenses in the General Hospital of Foshan Aier Eye Hospital from July 2020 to July 2021 were continuously included. They were divided into the CCF group(70 cases, 70 eyes)and the ICF group(71 cases, 71 eyes). The patients in the CCF group were fitted with orthokeratology lens of 0.75 DS CCF, while patients in the ICF group were fitted with orthokeratology lens of 1.25 D ICF. Taking 12 years old as a boundary, these two groups were divided into 8-11 years old and 12-15 years old group. The uncorrected visual acuity(UCVA), horizontal corneal curvature(K1)and corneal staining were recorded for all subjects after wearing lenses for 1 d, 1 wk, 1, 6 mo, 1 and 2 a. The axial length(AL)was recorded after wearing lenses for 6 mo, 1 and 2 a, and the complication and corneal epithelial staining were observed during lens wearing.

RESULTS:The improvement of UCVA in the ICF group was faster than that in the CCF group, which were statistical significant after wearing lenses for 1 d, 1 wk and 1 mo, respectively(all P<0.001); however, there was no statistical significance between the two groups after 6 mo, 1 and 2 a(all P>0.05); K1 of the ICF group decreased faster than that of the CCF group, and there were statistical significance at 1 d, 1 wk, and 1 mo after wearing lenses(all P<0.05); there was no statistical significance at 6 mo, 1 and 2 a(all P>0.05). The axial length growth of patients aged 8-11 years old in the ICF group and CCF group was 0.35±0.17 and 0.48±0.26 mm, respectively(P=0.010), after wearing lenses for 2 a, and the axial length growth of patients aged 12-15 years old in the ICF group and CCF group was 0.16±0.15 and 0.31±0.29 mm, respectively(P=0.011). During the follow-up period, corneal spotting occurred in 6 eyes(8.5%)in the ICF group, and 7 eyes(10%)in the CCF group(P>0.05), all of which were grade 1 spotting.

CONCLUSION:Wearing ICF orthokeratology lens is more effective than wearing CCF lenses in controlling the growth of axial length, with faster shaping and more obvious improvement in UCVA, especially for the prevention of high myopia in children under 12 years. Therefore, young children can give priority to wearing lenses that increase the compression factor, and for children over 12 years old, the compression factor of the lens can be selectively increased according to the wearer's eye habits, health status of ocular surface and visual function.