不同屈光度初发性近视患者配戴角膜塑形镜的疗效分析
Clinical Observation on Orthokeratology of Onset Myopia with Different Diopter

目的：观察夜戴型角膜塑形镜(OK镜)对不同屈光度数的初发性近视患者的临床控制效果。方法：前瞻性病例研究收集自2017年4月~2018年4月在东莞光明眼科医院就诊的初发性近视患者158例(均右眼，共158眼)，平均年龄(10.09 ± 1.53)岁，配戴框架眼镜组68眼，配戴OK镜组90眼；其中OK镜组患者根据初次验光的等效球镜度(SE)分为4个亚组：A组(0~？1.00 D)，B组(？1.25~？2.00 D)，C组(？2.25~？3.00 D)，D组(？3.25~？4.00 D)。比较戴镜1年前后框架镜组及OK镜组裸眼视力(LogMAR)、等效球镜度、眼轴变化的差异；比较OK镜组内不同屈光度数的初发性近视患者戴镜1年前后的等效球镜度与眼轴增长变化的差异。结果：框架镜组与OK镜组随访1年后的裸眼视力、等效球镜度及眼轴变化差异均有统计学意义(t = 4.22, t = ？14.44, t = 5.74，p均<0.01)；OK镜组分为4个亚组，SE分别为(？0.88 ± 0.13) D、(？1.56 ± 0.23) D、(？2.67 ± 0.29) D、(？3.66 ± 0.27) D。戴镜1年后，眼轴增长分别为(0.29 ± 0.07) mm、(0.20 ± 0.10) mm、(0.15 ± 0.06) mm、(0.17 ± 0.08) mm，差异有统计学意义(F = 87.83, p < 0.01)；戴镜1年前后等效球镜度差值为(？1.08 ± 0.22) D、(？0.40 ± 0.20) D、(？0.32 ± 0.16) D、(？0.34 ± 0.13) D，差异有统计学意义(F = 12.13, p < 0.01)。结论：OK镜在近视防控的临床效果明显优于框架镜。不同屈光度的初发性近视患者配戴夜戴型角膜塑形镜的近视控制效果不一，初发近视屈光度越高，近视控制效果可能越好。
Objective: To observe the clinical efficacy of orthokeratology for onset myopia with different diop-ter. Methods: Prospective study. 158 patients (158 eyes) with onset myopia at Dongguan Guang-ming Ophthalmic Hospital were conducted from April 2017 to April 2018. Sixty-eight patients who wore spectacles were enrolled in the spectacles group and 90 patients who wore orthokeratology lenses were enrolled in ortho-K group. According to the equivalent spherical degree (SE), ortho-k group was divided into 4 groups, group A with 0~？1.00 D, group B with ？1.25~？2.00 D, group C with ？2.25~？3.00 D, group D with ？3.25~？4.00 D. The changes in uncorrected visual acuity (UCVA), re-fraction, axial length before and 1 year after wearing were measured and analyzed. Results: There were significant differences in UCVA, refraction and axial length before and 1 year after wearing spectacles or OK lens between spectacles group and ortho-k group respectively (t = 4.22, t = ？14.44, t = 5.74, p < 0.01). The mean spherical equivalence was (？0.88 ± 0.13) D, (？1.56 ± 0.23) D, (？2.67 ± 0.29) D, (？3.66 ± 0.27) D for the eyes in Ortho-K group which was divided into 4 groups. After one year, the axial length increase was (0.29 ± 0.07) mm, (0.20 ± 0.10) mm, (0.15 ± 0.06) mm, (0.17 ± 0.08) mm respectively in four groups, there was statistical difference (F = 87.83, p < 0.01). The mean spherical equivalence increase was (？1.08 ± 0.22) D, (？0.40 ± 0.20) D, (？0.32 ± 0.16) D, (？0.34 ± 0.13) D respectively; there was statistical difference (F = 12.13, p < 0.01). Conclusion: Compared with spectacles, orthokeratology can significantly control the progression of myopia, and it shows better effect for onset myopia with higher refraction.