小角度间歇性外斜视伴近视患者使用不同类型镜片控制近视及斜视的作用

Effect of different types of lenses on controlling myopia and strabismus in patients with small-angle intermittent exotropia

摘要:

目的：比较小角度间歇性外斜视伴近视患者使用多点近视离焦镜片、角膜塑形镜、单光镜片的临床有效性。

方法：回顾性研究。选取2021-06/2022-09在我院就诊的小角度间歇性外斜视伴近视患者150例(均取主导眼数据进行分析，其中三棱镜检查为双眼所测数据)，年龄8-15岁，斜视度-10^△--20^△(块镜)，等效球镜度(SE)为-1.00--5.50 D，按照自愿原则分为三组：HAL组50例配戴多点近视离焦镜片； OK镜组50例夜间配戴角膜塑形镜； SVL组50例配戴普通单光镜片。比较三组患者戴镜前及戴镜1 a的眼轴、裸眼及戴镜棱镜度(取33 cm处三棱镜)、近水平正融像性集合(模糊点)、近立体视变化，采用纽卡斯尔(NCS)评分标准评估三组患者的眼位控制能力。

结果：HAL组、OK镜组、SVL组戴镜前眼轴分别为24.83±0.91、24.93±0.97、24.98±0.68 mm(P>0.05)，戴镜1 a为25.02±0.90、25.18±0.97、25.45±0.65(P<0.05)，与SVL组戴镜1 a眼轴增加0.47±0.30 mm相比，HAL组和OK镜组眼轴分别增加0.19±0.06、0.25±0.21 mm(均P<0.05)； 戴镜前33 cm处HAL组、OK镜组、SVL组三棱镜检查斜视度分别为-15.00^△±3.12^△、 -14.34^△±3.00^△、-14.06^△±3.22^△，戴镜1 a戴镜测三组棱镜度分别为：-9.34^△±3.84^△、-18.42^△±4.41^△、-19.58^△±5.21^△，与戴镜前相比分别增加了5.66^△±2.13^△、-4.08^△±3.34^△、-5.52^△±3.70^△(P<0.05)； 戴镜前HAL组、OK镜组、SVL组近立体视分别为89.20″±54.65″、93.00″±52.54″、88.40″±55.31″(P>0.05)，戴镜1 a分别为76.00″±20.40″、81.20″±18.91″、100.60″±51.41″(P<0.05)； 戴镜前三组近水平正融像性集合(模糊点)分别为：15.04±1.97、15.14±1.67、14.62±1.47(P>0.05)，戴镜1 a为17.10±2.02、13.12±1.41、13.26±2.45(P<0.05)； 戴镜1 a HAL组眼位控制能力较OK镜组和SVL组明显增强(P<0.05 )。

结论： 小角度间歇性外斜视伴近视患者配戴HAL组与OK镜组、SVL组相比，可有效控制斜视度及眼轴的变化，尤其对戴镜后斜视度有较好的控制效果，而戴OK镜与SVL均出现外斜视漂移，且HAL组戴镜后立体视觉及正融性集合得到明显改善。

Abstract:

AIM: To compare the clinical effectiveness of using multifocal defocus spectacle lenses, orthokeratology lenses, and single-vision spectacle lenses in patients with myopia and small-angle intermittent exotropia.

METHODS: This retrospective study included 150 patients aged 8-15 years with basic intermittent exotropia, strabismus of -10^△ to -20^△ prism diopters(D)(block lenses), and spherical equivalents of -1.00 to -5.50 D, who visited our hospital from June 2021 to September 2022. They were selected and divided into three groups on a voluntary basis: the HAL group(50 patients with multifocal myopia defocus spectacle lenses), the OK lens group(50 patients with nighttime orthokeratology lenses), and the SVL group(50 patients with regular single-vision spectacle lenses). After wearing the lenses consistently, changes in axial length, prism diopters with the naked eye and lenses(prism at 33 cm), positive fusional vergence of blurred points, and near stereopsis were observed and compared among groups before intervention and after 1 a. The Newcastle control score(NCS)was used to evaluate the eye position control ability of the patients in the three groups.

RESULTS: Before the intervention, the axial lengths of the HAL, OK lens, and SVL groups were 24.83±0.91, 24.93±0.97, and 24.98±0.68 mm, respectively(P>0.05). After 1 a, the axial lengths of the three groups were 25.02±0.90, 25.18±0.97, and 25.45±0.65, respectively(P<0.05). Compared with an increase of 0.47±0.30 mm in the SVL group after 1 a, the axial length of the HAL and OK lens groups increased by 0.19±0.06 and 0.25±0.21 mm, respectively(both P<0.05). Before intervention, the prism diopters of the HAL, OK lens, and SVL groups measured using the prism were -15.00^△±3.12^△, -14.34^△±3.00^△ and -14.06^△±3.22^△, respectively. After 1 a, the prism diopters of the three groups with lenses were -9.34^△±3.84^△, -18.42^△±4.41^△, and -19.58^△±5.21^△, respectively, which increased by 5.66^△±2.13^△, -4.08^△±3.34^△, and -5.52^△±3.70^△, respectively, compared with the preintervention values(P<0.05). Before intervention, the near stereopsis in the HAL, OK lens, and SVL groups were 89.20″±54.65″, 93.00″±52.54″, and 88.40″±55.31″, respectively(P>0.05). After 1 year, near stereopsis in the groups were 76.00″±20.40″, 81.20″±18.91″, and 100.60″±51.41″, respectively(P<0.05). The positive fusional vergence(fuzzy point)of the three groups was 15.04±1.97, 15.14±1.67, and 14.62±1.47, respectively, before intervention(P>0.05), and it was 17.10±2.02, 13.12±1.41, and 13.26±2.45, respectively, after 1 a(P<0.05). In addition, the eye position control in the HAL group was significantly better than that in the OK lens and SVL groups after wearing lenses for 1 a(P<0.05).

CONCLUSION: For patients with myopia and small-angle intermittent exotropia, wearing HAL can effectively control changes in strabismus and axial length compared with OK lenses and SVL, particularly for better control of strabismus, whereas wearing OK lenses or SVL would result in exotropic drifts. Stereopsis and positive fusional vergence were significantly improved in the HAL group.