目的 探讨角膜塑形镜对青少年中低度近视患者中央角膜厚度(central corneal thickness, CCT)和角膜内皮细胞的影响.方法 收集2010年3月至2013年8月58例(共109只眼)青少年中低度近视患者(其中男性24例,女性34例)的临床资料.平均等效球镜屈光度(-2.58±1.12)D,屈光度为-0.25~-5.25D.采用夜戴型角膜塑形镜进行近视矫正,每晚配戴7h,戴镜后1d,1、2周,1、3、6个月,使用A超和角膜内皮细胞计数分析仪收集中央角膜厚度、角膜内皮细胞数、平均细胞面积、细胞密度、细胞变异系数、六角形细胞比率等数据;用角膜荧光素染色法对角结膜并发症发生率进行统计.以后每隔6个月随访,复查上述指标.比较戴镜前及戴镜后6、12、24个月各参数变化.结果 中低度近视青少年患者戴镜前和戴镜后6、12、24个月的平均CCT值分别为(560.97±32.57)、(559.68±31.18)、(557±32.27)、(557.24±30)μm,差异无统计学意义( F= 0.393 ,P= 0.758).戴镜前后,患者的角膜内皮细胞数、细胞密度、角膜内皮细胞平均面积、细胞变异系数和角膜内皮细胞六边形比率差异均无统计学意义( F 值分别为1.643、0.808、1.436、0.017、0.029, P 值均>0.05).角结膜并发症发生率为20.18%,不伴有严重并发症.结论 青少年中低度近视患者长期科学配戴高透氧性角膜塑形镜对中央角膜厚度和角膜内皮细胞无明显影响,是一种相对安全的治疗方法.
Objective To investigate the effects of orthokeratology (OK) lens on the central corneal thickness (CCT) and endothelial cells in moderate-low myopic adolescent patient.Methods Fifty eight moderate-low myopic adolescent patients (109 eyes) treated with OK lenses were enrolled from March 2010 to August 2013, including 24 males and 34 females.They were fitted with overnight OK lens for 7h.The average baseline spherical equivalent refraction error was (-2.58±1.12) diopters (D) (-0.25 D to-5.25 D) before the treatment.The thickness measurements in the central cornea were obtained by A scan pachymeter;the cornea endothelial cell density, average cell area, coefficient of variation and hexagonal cell ratio were analyzed by endothelial microscopy before and 1d, 1, 2 weeks and 1, 3, 6 months after wearing OK lens.Corneal conjunctival complications rate was evaluated by cornea fluorescent.The above parameters were measured every six months after treatment.Results The mean CCT values before and 6, 12, 24 months after OK lens wearing were (560.97±32.57), (559.68±31.18),(557±32.27) and (557.24±30)μm, respectively ( F=0.393, P=0.758 ).There were no significant differences in cornea endothelial cell density, average cell area, coefficient of variation and hexagonal cell ratio at the different time points of OK wearing ( P >0.05).Corneal conjunctival complications rate was 20.18%, and no severe complications were observed.Conclusion In generally, long-term wearing of rigid gas permeable contact lenses is safety for mild-moderate myopic adolescent patients.