刘波; 霍姝佳; 陈利; 周素君; 熊洁

doi:10.3760/cma.j.cn115989-20200217-00073

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• 临床研究 •

单矢高和双矢高设计CRT角膜塑形镜矫正近视伴角膜散光疗效比较

中华实验眼科杂志, 2021,39(6) : 538-542. DOI: 10.3760/cma.j.cn115989-20200217-00073

摘要

目的

比较单矢高和双矢高设计的角膜屈光矫治(CRT)角膜塑形镜矫正近视伴角膜散光的疗效。

方法

采用非随机对照临床研究，收集2018年5—12月在陆军军医大学第一附属医院配戴CRT角膜塑形镜的8～14岁患儿48例48眼，根据患儿监护人意愿，将患儿分为双矢高组和单矢高组各24例24眼，分别配戴双矢高CRT角膜塑形镜和单矢高CRT角膜塑形镜。随访1年，比较2个组患儿配戴角膜塑形镜后的裸眼视力、偏心量、眼轴年增长量和角膜点染发生率。

结果

戴镜后1周和1个月双矢高组裸眼视力优于单矢高组，差异均有统计学意义(均P<0.05)，其他时间点2个组裸眼视力比较差异均无统计学意义(均P>0.05)。单矢高组各观察时间点光学中心偏离视轴量大于双矢高组，差异均有统计学意义(均P<0.05)。2个组整体上随时间变化偏心程度变化不大，总体比较差异无统计学意义(F_时间＝2.301，P＝0.074)。单矢高组偏心主要表现在水平方向。双矢高组和单矢高组眼轴年增长中位数分别为0.12(0.10，0.45)mm和0.14(0.10，0.46)mm，2个组比较差异无统计学意义(Z＝0.248，P＝0.804)。双矢高组角膜Ⅲ～Ⅳ级点染率为4.2%(1/24)，明显低于单矢高组的25.0%(6/24)，差异有统计学意义(χ²＝4.180，P＝0.049)。

结论

对于近视伴角膜散光患者，双矢高CRT角膜塑形镜较单矢高CRT角膜塑形镜表现出更优异的稳定性及安全性。

引用本文: 刘波, 霍姝佳, 陈利, 等. 单矢高和双矢高设计CRT角膜塑形镜矫正近视伴角膜散光疗效比较 [J] . 中华实验眼科杂志, 2021, 39(6) : 538-542. DOI: 10.3760/cma.j.cn115989-20200217-00073.

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据估计，2020年全球约有25亿近视患者，占总人口的1/3，严重影响着人类健康^[1]。角膜接触镜、框架眼镜和屈光手术是矫正近视的3种有效方法。角膜塑形镜是一种逆几何设计的硬性角膜接触镜，通过夜间配戴，使角膜前表面曲率变平以降低眼整体屈光力。既往的随机对照研究显示了角膜塑形镜在近视矫正和近视控制方面的安全性和有效性^[2]。目前国际上角膜塑形镜有视觉重塑治疗(vision shaping treatment，VST)和角膜屈光矫治(corneal refractive therapy，CRT)2种设计。对于中高度角膜散光患者，需要用环曲设计角膜塑形镜矫正，既往病例对照研究发现配戴VST设计的环曲角膜塑形镜后屈光力和散光显著降低，对延缓近视进展安全、有效^[3]。双矢高CRT角膜塑形镜对近视伴角膜散光的矫正效果鲜有报道，本研究拟对单矢高和双矢高设计的CRT角膜塑形镜矫正近视伴角膜散光的疗效进行比较。

贡献者信息

刘波

陆军军医大学第一附属医院眼科，重庆　400038

霍姝佳

陆军军医大学第一附属医院眼科，重庆　400038

陈利

陆军军医大学第一附属医院眼科，重庆　400038

周素君

陆军军医大学第一附属医院眼科，重庆　400038

熊洁

陆军军医大学第一附属医院眼科，重庆　400038

通信作者

熊洁

陆军军医大学第一附属医院眼科，重庆　400038

Email：352216115@qq.com

关键词

近视; 散光; 角膜塑形镜; 眼轴; 单矢高; 双矢高;

基金项目

重庆市科卫联合医学科研项目（2021MSXM068）

陆军军医大学临床科研项目（2018XLC3012）

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2021-06-10

收稿日期：2020-10-17

修回日期：2021-05-06

本文编辑

刘艳施晓萌

Clinical Science

Comparison of therapeutic effect between regular spherical CRT and dual axis CRT on myopia with corneal astigmatism

Bo Liu, Shujia Huo, Li Chen, Sujun Zhou, Jie Xiong

Published 2021-06-10

Cite as Chin J Exp Ophthalmol, 2021, 39(6): 538-542. DOI: 10.3760/cma.j.cn115989-20200217-00073

Abstract

Objective

To compare the therapeutic effect between regular spherical corneal refractive therapy (CRT) and dual axis CRT on myopia with corneal astigmatism.

Methods

A non-randomized controlled study was conducted.Aged 8 to 14 years old, forty-eight patients (48 eyes) wearing CRT orthokeratology enrolled from May, 2018 to December, 2018 in First Affiliated Hospital of Army Medical University were divided into dual axis CRT group (24 eyes) and spherical CRT group (24 eyes) according to their guardians' willingness.After 1-year follow-up, the visual acuity, eccentricity distance in treatment area, annual axial growth and the corneal punctate staining incidence of the two groups were compared.The study followed the Declaration of Helsinki, and was approved by an Ethics Committee of First Affiliated Hospital of Army Medical University (No.KY201975). Written informed consent was obtained from guardians prior to any examination.

Results

The uncorrected visual acuity of the dual axis CRT group was better than that of the spherical CRT group at one week and one month after correction, and the differences were statistically significant (both at P<0.05), and there was no significant difference in uncorrected visual acuity between the two groups at other time points (all at P>0.05). The deviations of optical center in the spherical CRT group at each observation time points were significantly larger than that in the dual axis group (all at P<0.05), and the deviation was not obviously changed with time in both groups and there was no significant difference in deviation change between the two groups (F_time=2.301, P=0.074). The eccentricity was mainly in horizontal direction in spherical CRT group.The median annual axial growth was 0.12 (0.10, 0.45)mm in the dual axis CRT group and 0.14 (0.10, 0.46)mm in the spherical CRT group, with no significant difference between the two groups (Z=0.248, P=0.804). There was 4.2%(1/24) of the patients having grade Ⅲ-Ⅳ corneal punctate staining in the dual axis CRT group, and 25.0%(6/24) in the regular spherical CRT group, showing significant difference between the two groups (χ²=4.180, P=0.049).

Conclusions

For the treatment of myopia with astigmatism, dual axis CRT shows better centricity and safety than spherical CRT.

Key words:

Myopia; Astigmatism; Orthokeratology; Axial length; Spherical; Dual axis

Contributor Information

Bo Liu