夜戴型角膜塑形镜对青少年泪膜的影响

摘要

Objective To observe the changes in tear quantity and tear break-up time(BUT) before and after wearing overnight orthokeratology (OK),and investigate the influence of OK on tear film in young adolescents.Methods Prospective clinic study was conducted in 60 adolescents,aged 8-16 years,who met the inclusion criteria during November 2016 and May 2017 in the Second Hospital of Dalian Medical University were chosen and fitted with OK (OK group).At the same time,60 adolescents who met the same requirement were fitted with spectacle (spectacle group).The two groups were both divided into three subgroups according to the age (subgroup of 8-10 years old,11-13 years old,and 14-16 years old).The BUT,Schirmer' s I test score,and corneal fluorescent (FL) were measured and recorded before wearing and 1 week,1 month,3 months,6 months and 12 months after wearing.Results Totally 57 patients in the OK group (114 eyes) and 59 patients in the spectacle group (118 eyes) completed the follow-up study.No significant difference in Schirmer' s Ⅰ test scores was observed between the OK group and spectacle group (all P＞0.05).The BUT in OK group was significantly lower than that in the spectacle group at all the time points (all P ＜ 0.05).Of all subgroups,the subgroup aged from 8-10 years exhibited the sharpest and most rapid reduction in BUT.Conclusion Based on our findings,long-term OK wearing has no effect on tear volume but reduces the stability of tear film.The results suggest that OK should be considered to be a good alternative for children and adolescents with spectacle;however,it may influence the quality of tear film.In addition,special attention should be paid to younger adolescents,and regular follow-up is needed.%目的 观察青少年配戴角膜塑形镜前后不同时间基础泪液分泌量与泪膜破裂时间的变化,探究其对青少年泪膜的影响.方法 采用前瞻性临床研究,选取2016年11月至2017年5月于大连医科大学附属第二医院就诊的60例满足入选标准的8 ～16岁青少年患者验配角膜塑形镜(角膜塑形镜组);同期对60例满足相同要求的青少年患者验配普通框架眼镜(框架镜组),并根据年龄将其分为三组(8 ～10岁组、11 ～13岁组、14 ～ 16岁组);于戴镜前及戴镜后1周、1个月、3个月、6个月、12个月随访泪膜破裂时间与基础泪波分泌量.结果 角膜塑形镜组57例(114眼)、框架镜组59例(118眼)完成随访.两组患者在配戴夜戴型角膜塑形镜前后基础泪液分泌量差异无统计学意义(P＞0.05),各时间点同期与框架镜组相比,角膜塑形镜组患者泪膜破裂时间明显降低(P＜0.05).与其他年龄组相比,8～10岁组泪膜破裂时间更早出现变化.结论 长期配戴角膜塑形镜对青少年基础泪液分泌量无明显影响,但会明显降低泪膜质量.配戴年龄是角膜塑形镜影响泪膜质量的重要因素,故应注意定期随访的必要性.