儿童长期佩戴角膜塑形镜的角膜内皮状态评估

摘要

背景 配戴角膜塑形镜可通过非手术方式治疗和延缓近视儿童屈光度的进展,但长期佩戴对角膜组织的影响值得研究. 目的 观察儿童长期佩戴角膜塑形镜对角膜内皮的影响.方法 纳入2009年12月至2011年12月在同济大学附属第十人民医院眼科配戴角膜塑形镜的近视儿童76例150眼,近视儿童每日夜间佩戴角膜塑形镜8～10h,分别于配戴前,配戴后3、6、12、24个月用角膜内皮细胞显微镜测量戴镜者的角膜内皮细胞平均面积、角膜内皮细胞密度、角膜内皮细胞面积变异系数和角膜内皮六角形细胞密度,采用SPSS 13.0统计学软件对儿童配戴角膜塑形镜前后的上述各指标变化进行重复测量单因素方差分析. 结果 近视儿童配戴前与配戴后各时间点间角膜内皮细胞平均面积、角膜内皮细胞密度的变化差异均无统计学意义(F=11.34、7.16,均P＞0.05).配戴前与配戴后3、6、12、24个月近视儿童角膜内皮细胞面积变异系数的总体差异有统计学意义(F=12.70,P=0.02),其中配戴后24个月近视儿童的角膜内皮细胞面积变异系数值为0.36±0.02,明显高于配戴前的0.28±0.05,差异有统计学意义(P＜0.05).近视儿童配戴前及配戴后不同时间点间角膜内皮六角形细胞比例的总体差异有统计学意义(F=13.40,P=0.04),其中配戴后12个月、24个月的角膜内皮六角形细胞比例分别为(62±12)％和(60±14)％,明显低于配戴前的(69±12)％,差异均有统计学意义(P＜0.05).结论 角膜塑形镜长期佩戴可使角膜内皮六角形细胞的比例下降及角膜细胞面积变异系数增加.%Background Wearing of orthokeratology contact lens can slow down the development of myopia,especially in childhood.However,if wearing orthokeratology contact lens for long-term affect the corneal health is worthy of consideration.Objective This study was to evaluate the security of wearing orthokeratology contact lens in children.Methods A retrospective case-observational study was adopted.One hundred and fifty eyes of 76 myopic children aged 8-15 years were enrolled in Shanghai Tenth People's Hospital during December,2009 to December,2011.Orthokeratology contact lens were worn at night for 8-10 hours daily.Area of corneal endothelial cells,density of corneal endothelial cells,coefficient of variation of corneal endothelial cells and percentage of hexagonal cells were measured before wearing and 3,6,12,24 months after wearing.Repeated measurement of single factor analysis of variance was used to evaluate the changes of corneal endothelial cells after wearing of orthokeratology contact lens.Results No significant differences were found in the area of corneal endothelial cells and density of corneal endothelial cells among the different time points (F =11.34,P＞0.05 ; F =7.16,P＞0.05).A significant difference was seen in the coefficient of variation of corneal endothelial cells at various time points in the children(F=12.70,P=0.02),and the coefficient of variation of corneal endothelial cells was 0.36±0.02 24 months after wearing lens,which was higher than 0.28 ±0.05 before wearing lens (P＜0.05).In addition,the percentage of hexagonal cells in different time points was significantly different (F=13.40,P =0.04),and the percentages of hexagonal cells at 12 hours and 24 months after wearing lens were (62±12)％ and (60±14)％ respectively,which was significantly lower than (69±12)％ before wearing lens (P＜0.05).Conclusions Wearing of orthokeratology contact lens for over one year leads to the decrease of percentage of hexagonal cells and increase of coefficient of variation of corneal endothelial cells.