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( χ 2＝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。
ObjectiveTo compare the therapeutic effect between regular spherical corneal refractive therapy (CRT) and dual axis CRT on myopia with corneal astigmatism.
MethodsA 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.
ResultsThe 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 ( χ 2=4.180, P=0.049).
ConclusionsFor the treatment of myopia with astigmatism, dual axis CRT shows better centricity and safety than spherical CRT.
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(06)：538-542.
DOI:10.3760/cma.j.cn115989-20200217-00073版权归中华医学会所有。
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