青少年近视性屈光参差配戴角膜塑形镜的临床效果
吴志毅 赵莹莹 胡培克 陈彬彬 沙晓通 褚梦琪 倪海龙
浙江大学医学院附属第二医院，浙江杭州 310010
Clinical Observation on the Effect of Orthokeratology in Myopic Anisometropic Children
Zhiyi Wu, Yingying Zhao, Peike Hu, Binbin Chen, Xiaotong Sha, Mengqi Chu, Hailong Ni
The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, Hangzhou Zhejiang
310010, China
摘要 目的：观察青少年近视性屈光参差配戴角膜塑形镜的临床效果。方法：回顾性队列研究。收集浙江大学医学院附属第二医院眼科中心从2015年12月至2017年6月之间开始配戴角膜塑形镜的患者32例，年龄8～16（11.2±2.2）岁，随访时间2年。双眼等效球镜屈光度差值≥1.00 D，滴用睫状肌麻痹剂后的等效球镜度范围为-0.75～-6.00 D。患者分为高屈光度眼组（两眼中屈光度较高眼）和低屈光度眼组（两眼中屈光度较低眼），每组32眼，均配戴角膜塑形镜。观察双眼戴镜前以及戴镜后半年、1年、1.5年，2年的眼轴变化。数据采用配对t检验进行比较。结果：双眼眼轴差值由戴镜前（0.46±0.24 mm）
下降到戴镜2年后（0.33±0.28 mm），差异有统计学意义（t=5.038，P<0.001），高屈光度眼组戴镜2年后眼轴变化量（0.38±0.21）mm小于低屈光度眼组眼轴变化量（0.51±0.26 mm），差异有统计学意义（t=6.52，P<0.001）。结论：青少年长期配戴角膜塑形镜可以减小近视性屈光参差双眼之间的眼轴差值，减少屈光参差量，可以更有效减缓近视屈光度较高眼的眼轴增长，配戴角膜塑形镜是改善屈光参差的一种有效方式。
关键词 ：
近视 ,
屈光参差 ,
角膜塑形镜 ,
眼轴
Abstract ：Objective: To investigate the clinical effect of orthokeratology (ortho-k) lens wear on axial length
(AL) growth in juvenile myopic anisometropes. Methods: In this retrospective cohort study, 32 myopic
anisometropic participants,16 males and 16 females with an average age of 11.2±2.2 years, were fitted with ortho-k lenses from December 2015 to June 2017, and followed for about 2 years. Cycloplegic spherical equivalent error (SER) was -0.75 D to -6.00 D, and anisometropia ≥1.00 D. The eyes with greater myopia were assigned to the High refraction (H) group and the fellow eyes with less myopia to the Low refraction (L) group. Each group involved 32 eyes. All eyes were fitted with ortho-k lenses. Axial length (AL) was measured at the beginning of the study and at 6-, 12-, 18-, and 24-month follow-up visits. Results:A significant reduction in the AL difference was found, from the baseline (0.46±0.24 mm) to 24 months (0.33±0.28 mm) (t=5.038, P<0.001). Besides, after wearing Ortho-K lens for two years, the H group showed less AL growth than the L group in myopic anisometropic children (0.38±0.21 mm vs. 0.51±0.26 mm) (t=6.52, P<0.001). Conclusions: In myopic anisometropic children who wore OK lenses, the ALdifference would present a significant reduction. Ortho-k treatment slows AL growth in the more myopic eye of anisometropic patients. Wearing Ortho-K lens is an effective clinical method to treat anisometropia.
Key words ：
myopia
anisometropic
orthokeratology
axial elongation
收稿日期: 2019-10-01
通讯作者:
倪海龙（ORCID：0000-0002-2259-9873），Email：2101092@zju.edu.cn
引用本文:
吴志毅 赵莹莹 胡培克 陈彬彬 沙晓通 褚梦琪 倪海龙. 青少年近视性屈光参差配戴角膜塑形镜的临床效果[J]. 中华眼视光学与视觉科学杂志, 2020, 22(3): 219-223.
Zhiyi Wu, Yingying Zhao, Peike Hu, Binbin Chen, Xiaotong Sha, Mengqi Chu, Hailong Ni. Clinical Observation on the Effect of Orthokeratology in Myopic Anisometropic Children. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(3): 219-223. DOI: 10.3760/cma.j.cn115909-20191002-00268
链接本文:
https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191002-00268 或 https://www.cjoovs.com/CN/Y2020/V22/I3/219
[1]
Vincent SJ, Collins MJ, Read SA, et al. Myopic anisometropia:
Ocular characteristics and aetiological considerations. Clin Exp
Optom, 2014, 97(4): 291-307. DOI: 10.1111/cxo.12171.
[2]
O'Donoghue L, McClelland JF, Logan NS, et al. Profile of
anisometrepia and aniso-astignmtism in children: prevalence
and association with age,ocularbiometfic measures, and
refractivestatus. Invest Ophthalmol Vis Sci, 2013, 54(1): 602-
60
8. DOI: 10.1167/iovs.12-11066.
[3]
Deng L, Gwiazda JE. Anisometropia in children from infancy
to 15 years. Invest Ophthalmol Vis Sci, 2012, 53(7): 3782-3787.
DOI: 10.1167/iovs.11-8727.
[4]
Hu YY, wu JF, Lu TL, et al. Prevalence and associations of
anisometropia in children. Invest Ophthalmol Vis Sci, 2016,
57
(3): 979-988. DOI: 10.1167/iovs.15-18647.
[5]
Lovasik JV, Szymkiw M. Effects of aniseikonia, anisometropia,
accommodation, retinal illuminance, and pupil size on
stereopsis. Invest Ophthalmol Vis Sci, 1985, 26(5): 741-750.
[6]
Johnston RL, Sparrow JM, Canning CR, et al. Pilot National
Electronic Cataract Surgery Survey: I. Method, descriptive,
andprocessfeatures. Eye (Lond), 2005, 19(7): 788-794．DOI:
10
1038/sj.eye.6701644.
[7]
Karimian F, Ownagh V, Amiri MA, et al. Stereoacuity after
wavefront-guided photorefractive keratectomy in anisometropia.
J Ophthalmic Vis Res, 2017, 12(3): 265-269. DOI: 10.4103/jovr.jovr_138_16.
[8]
Zedan RH, El-Fayoumi D, Awadein A. Progression of high
anisometropia in children. J Pediatr Ophthalmol Strabismus,
20
17, 54(5): 282-286. DOI: 10.3928/01913913-20170320-06.
Epub 2017 May 17.
[9]
Smith MJ, Walline JJ. Controlling myopia progression in
children and adolescents. Adolesc Health Med Ther, 2015, 6:
13
3-140. DOI: 10.2147/AHMT.S55834.eCollection 2015.
[10]
Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16
interventions for myopia control in children: a network metaanalysis. Ophthalmology, 2016, 123(4): 697-708. DOI: 10.1097/
OPX.0000000000001315.
[11]
Fu AC, Chen XL, Lv Y, et al. Higher spherical equivalent
refractive errors is associated with slower axial elongation
wearing orthokeratology. Contact Lens Anterior Eye, 2016,
39
(1): 62-66. DOI: 10.1016/j.clae.2015.07.006.
[12]
金婉卿, 卢为为, 连燕, 等. 屈光参差儿童单眼配戴角膜塑形
镜的临床效果. 中华眼视光学与视觉科学杂志, 2018, 20(3):
13
9-144. DOI: 10.3760/cma.j.issn.1674-845X.2018.03.003.
[13]
Tsai WS, Wang JH, Lee YC, et al. Assessing the change of
anisometropia in unilateral myopic children receiving monocular
orthokeratology treatment. J Formos Medl Assoc, 2019, 118(7):
11
22-1128. DOI: 10.1016/j.jfma.2019.02.001.
[14]
Deng L, Gwiazda JE. Anisometropia in children from infancy
to 15 years. Invest Ophthalmol Vis Sci, 2012, 53(7): 3782-3787.
DOI: 10.1167/iovs.11-8727.
[15]
Wong TY, Ferreira A, Hughes R, et al. Epidemiology and
diseaseburden of pathologic myopia and myopic choroidal
neovascularization: An evidence-based systematic review.
Am J Ophthalmol, 2014, 157(1): 9-25. e12. DOI: 10.1016/
j.ajo.2013.08.010.
[16]
Zheng YF, Pan CW, Chay J, et al. The economiccost of myopia
in adults aged over 40 years in Singapore. Invest Ophthalmol Vis
Sci, 2013, 13; 54(12): 7532-7537. DOI: 10.1167/iovs.13-12795.
[17]
Cheung SW, Cho P, Fan D. Asymmetrical increase in axial
length in the two eyes of a monocular orthokeratology patient.
Optom Vis Sci, 2004, 81(9): 653-656.
[18]
Long, W, Li Z, Hu Y, et al. Pattern of axial length growth in
children myopic anisometropes with orthokeratology treatment.
Curr Eye Res, 2019. DOI: 10.1080/02713683.2019.1701685.
[19]
Chen Z, Zhou JQ, Qu XM, et al. Effects of orthokeratology
on axial length growth in myopic anisometropes. Cont Lens
and Anterior Eye, 2018, 41(3): p. 263-266. DOI: 10.1016/j.
clae.2017.10.014.
[20]
Zhang Y, Chen Y. Effect of Orthokeratology on Axial Length
Elongation in Anisomyopic Children. Optom Vis Sci, 2019,
96
(1): 43-47. DOI: 10.1097/OPX.0000000000001315.
[21]
Zhong, Y, Li K,Wu Q, et al. Orthokeratology lens for
management of myopia in anisometropic children: A
contralateral study. Cont Lens Anterior Eye, 2020, 43(1): 40-43.
DOI: 10.1016/j.clae.2019.03.003.
[22]
Hedeker D, Gibbons RD, Waternaux C. Sample size estimation
for longitudinal designs with attrition: Comparing time-related
contrasts between two groups. J Educ Behav Stat, 1999, 24(1):
70
-93.
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