目的探讨长期持续配戴软性角膜接触镜对角膜透明度的影响。
方法采用横断面研究方法，对2018年1月至2020年12月在济南明水眼科医院拟行角膜屈光手术的女性近视患者行角膜光密度检查，按照患者持续配戴角膜接触镜的时间将患者分为配戴≥2年~<5年组、配戴≥5年~<10年组和配戴≥10年组，同期纳入年龄、性别匹配和未配戴角膜接触镜者作为对照组，每组50例50眼。以角膜中心为圆心将受检眼角膜划分为直径范围0~2、2~6、6~10、10~12 mm 4个环区，并按照角膜层次将角膜分为浅层(距角膜前表面≤120 μm)、深层(距角膜后表面≤60 μm)和中间层(角膜浅、深层之间)，均取右眼测量结果纳入研究，比较各组受检眼不同角膜环区各层的角膜光密度值。
结果随着角膜接触镜配戴时间的延长，角膜光密度值呈下降趋势。对照组、配戴≥2年~<5年组、配戴≥5年~<10年组和配戴≥10年组受检眼角膜光密度值分别为18.51±1.79、18.25±2.10、18.16±1.89和17.83±1.65，总体比较差异无统计学意义( F＝1.152， P＝0.329)。各组角膜0~2、2~6和6~10 mm环区浅层光密度值总体比较，差异均无统计学意义( F＝2.077、2.080、2.229，均 P>0.05)。10~12 mm环区浅层角膜光密度值总体比较，差异有统计学意义( F＝5.016， P＝0.002)，其中配戴≥5年~<10年组浅层角膜光密度值高于对照组和配戴≥2年~<5年组，配戴≥10年组角膜光密度值高于对照组，差异均有统计学意义(均 P<0.05)。各组角膜0~2 mm和6~10 mm环区中间层光密度值总体比较，差异均有统计学意义( F＝3.808、2.813，均 P<0.05)，其中配戴≥10年组角膜光密度值低于对照组，差异有统计学意义( P<0.05)。各组角膜0~2、2~6、6~10和10~12 mm环区深层光密度值总体比较，差异均有统计学意义( F＝5.485、5.625、3.398、2.775，均 P<0.05)，其中配戴≥5年~<10年组角膜0~2、2~6和10~12 mm深层角膜光密度值明显低于对照组和配戴≥2年~<5年组，配戴≥5年~<10年组6~10 mm和配戴≥10年组0~2、2~6、6~10 mm深层角膜光密度值明显低于对照组，差异均有统计学意义(均 P<0.05)。
结论女性持续配戴软性角膜接触镜5年内不影响角膜透明度，持续配戴5年以上会导致周边角膜浅层透明度下降。
ObjectiveTo investigate the influence of long-term wear of soft contact lenses on corneal transparency.
MethodsA cross-sectional study was conducted.The corneal optical density of female myopic patients who planned to undergo corneal refractive surgery in Jinan Mingshui Eye Hospital from January 2018 to December 2020 was examined.The patients were divided into ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group according to the duration of wearing contact lenses.Age- and sex-matched patients without wearing soft contact lenses were enrolled as a control group.There were 50 eyes from 50 cases in each group.The cornea was divided into 0-2, 2-6, 6-10, and 10-12 mm corneal vertex-centered annuli.The cornea over each annulus was divided into a superficial layer (≤120 μm from the outer surface of the cornea), a deep layer (≤60 μm from the inner surface of the cornea) and a central layer (between the superficial and deep layers). Measurements of the right eye were taken for analysis.The corneal optical density of different layers over different corneal ring regions was compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Jinan Mingshui Eye Hospital (No.2018-005). Written informed consent was obtained from each subject before any medical examination.
ResultsThe corneal optical density tended to decrease as the wearing duration of corneal contact lens extended.The corneal optical density values of control group, ≥2-<5 years group, ≥5-<10 years group, and ≥10 years group were 18.51±1.79, 18.25±2.10, 18.16±1.89 and 17.83±1.65, respectively, showing no significant difference ( F=1.152, P=0.329). There was no significant difference in the corneal optical density of the superficial layer over 0-2, 2-6, and 6-10 mm annuli among the four groups ( F=2.077, 2.080, 2.229; all at P>0.05). There was a significant difference in the corneal optical density of the superficial layer over 10-12 mm annulus among the four groups ( F=5.016, P=0.002), and the corneal optical density of the superficial layer was greater in ≥5-<10 years group than in ≥2-<5 years, and greater in ≥10 years group than in control group, showing statistically significant differences (both at P<0.05). There were significant differences in the corneal optical density of the central layer over 0-2 and 6-10 mm annuli ( F=3.808, 2.813; both at P<0.05), and the corneal optical density of the central layer was lower in ≥10 years group than in control group, showing a statistically significant difference ( P<0.05). There were significant differences in the corneal optical density of the deep layer over 0-2, 2-6, 6-10 and 10-12 mm annuli ( F=5.485, 5.625, 3.398, 2.775; all at P<0.05). The optical density of the deep layer was lower in ≥5-<10 years than in control and ≥2-<5 years groups over 0-2, 2-6, and 10-12 mm annuli, lower in ≥5-<10 years group than in control group over the 6-10 annulus, and lower in ≥10 years group than in control group over 0-2, 2-6, and 6-10 mm annuli, and the differences were statistically significant (all at P<0.05).
ConclusionsFor women, the long-term wear of soft contact lenses for 5 years does not affect corneal transparency, and long-term wear for more than 5 years can cause a decrease in the transparency of the superficial peripheral cornea.
董亚慧,侯杰,张静,等. 长期持续配戴软性角膜接触镜对近视患者角膜透明度的影响[J]. 中华实验眼科杂志,2023,41(04)：344-350.
DOI:10.3760/cma.j.cn115989-20210303-00144版权归中华医学会所有。
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董亚慧：直接参与设计试验、实施研究、采集/分析及解释数据、起草文章、修改文章；侯杰：实施研究、分析及解释数据、文章审阅；张静：实施研究、采集/分析及解释数据；许亚菲：采集/分析及解释数据；雷玉琳：直接参与选题、设计试验、采集/分析及解释数据、文章审阅及定稿
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