青少年近视配戴角膜塑形镜后的疗效分析

Analysis of the effect of orthokeratology on controlling myopia in adolescents

摘要:

目的 分析青少年近视配戴角膜塑形镜后控制近视效果的影响因素，为临床验配工作提供依据。方法 回顾性研究2019年2月至8月在武汉大学附属爱尔眼科医院验配角膜塑形镜的青少年近视患者105例（206只眼），分析患者配戴角膜塑形镜前与18个月后眼轴变化量与年龄、性别、屈光度、眼轴、角膜散光、平k、陡k、e值、瞳孔直径、可见虹膜直径、镜片定位等参数的相关性。应用SPSS 23.0进行广义线性模型拟合和单因素方差分析。结果 向后选择法多因素分析表明，眼轴变化量跟年龄、原始屈光度相关（P<0.001、P<0.001），患者基线年龄越大，眼轴增长越缓慢。将基线屈光度进行分组单因素方差分析，发现-3.00 D以上的近视控制效果优于-3.00 D以下（P<0.01），2组组间控制效果无明显差异。结论 年龄和基线屈光度是配戴角膜塑形镜控制近视的影响因素。年龄大的患者比年龄小的眼轴增长缓慢，针对年龄小的患者角膜塑形镜各弧区应个性化设计；基线屈光度-3.00 D以上的近视控制效果优于-3.00 D以下，而3.00 D以上和3.00 D以下的近视控制效果却不受屈光度增减的影响，对屈光度-3.00 D以下患者密切随访，联合其余近视控制手段综合治疗。

Abstract:

Objective To analyze the factors influencing the effect of wearing orthokeratology on controlling myopia in adolescents， and provide basis for clinical work.Methods A retrospective study was conducted among 105 cases of juvenile myopia（206 eyes） who came to the Wuhan Aier Eye Expert Hospital affiliated to Wuhan University from February to August，2019. The correlation between the parameters（age，gender，diopter，axial length，corneal astigmatism，flat k，steep k，eccentricity value，pupil diameter， corneal diameter，position） and ocular axial length changes after wearing orthokeratology for 18 months was analyzed. SPSS 23.0 was used for generalized linear model fitting and one-way ANOVA.Results Backward selection multivariate analysis showed that the ocular axial length changes were correlated with the age and original diopter（P<0.001，P<0.001）. The older the patient’s baseline age，the slower the axial length growth. The one-way ANVOA showed that the effect of myopia above -3.00 D was better than that below -3.00 D（P<0.01），showing no significant difference between the two groups.Conclusion Age and diopter are influencing factors of wearing orthokeratology to control juvenile myopia. The axial growth of the older patients is slower than that of the younger patients，so each area of the orthokeratology should be designed individually for the younger patients. The effect is better on myopia above -3.00 D than that on myopia below -3.00 D. However，the control effect of myopia less than 3.00 D and greater than 3.00 D is not affected by the increase or decrease of diopter. Patients with myopia below -3.00 D should be closely followed up and treated combined with other myopia control methods.