配戴角膜塑形鏡對(duì)青少年近視患者淚膜及視覺質(zhì)量的影響

朱　江，黃振平

?

配戴角膜塑形鏡對(duì)青少年近視患者淚膜及視覺質(zhì)量的影響

朱江，黃振平

Department of Ophthalmology,Suqian People’s Hospital Subordinate to Nanjing Drum Tower Hospital Group, Suqian 223800, Jiangsu Province, China

?METHODS:This was a prospective study comprised 23 myopia patients (39 eyes) wearing rigid gas permeable contact lens (RGP) between Jun.2015 and Aug.2015 in the Department of Ophthalmology of Jinling Hospital. Uncorrected visual acuity (UCVA), sphere refractive, cylinder refractive, Schirmer I test, tear film break-up time (BUT), the visual quality and the tear film quality with OQAS II were obtained before and 1wk, 1, 3, 6mo after wearing. The data was analyzed usingt-test and One-way.

?RESULTS:The UCVA in before and after 1wk, 1, 3, 6mo were 0.23±0.10, 0.81±0.23, 0.99±0.11, 1.01±0.09, 0.95±0.14, the difference was statistically significant (F=723.36,P<0.01). The sphere in before and after 1wk, 1, 3, 6mo were (-2.83±1.34)D, (-0.63±0.82)D, (-0.12±0.20)D, (-0.03±0.10)D, (-0.10±0.30)D respectively, the difference was statistically significant (F=107.01,P<0.01). The refractive cylinder in before and after 1wk, 1, 3, 6mo were (-0.12±0.21)D, (-0.13±0.22)D, (-0.12±0.21)D, (-0.14±0.26)D, (-0.21±0.27)D respectively, there was no significant difference before and after wearing RGP (F=2.58,P>0.05). Schirmer I test showed no statistically significant difference before and after wearing RGP (F=4.88,P>0.05). The stability of tear film was reduced after wearing RGP, and the difference was statistically significant (F=135.11,P<0.01). The modulate transfer function (MTF) cut-off frequency was reduced after wearing RGP, the object scatter index (OSI) was increased after wearing RGP, and the difference was statistically significant, the tear film quality OSI was increased after wearing RGP, and the difference was statistically significant (F=6.16, 19.23, 10.62,P<0.01).

?CONCLUSION:The UCVA is significantly increased after wearing RGP. However, there was no significant change in the base-line of tear secretion, but BUT is significantly reduced after wearing RGP. The stability of the tear film is reduced, which can lead to a decline in visual quality.

目的：運(yùn)用雙通道客觀視覺質(zhì)量分析系統(tǒng)(OQASⅡ)評(píng)價(jià)兒童配戴角膜塑形鏡對(duì)淚膜及視覺質(zhì)量的影響。

方法：采用前瞻性研究，選取2015-06/08在南京軍區(qū)南京總醫(yī)院眼科驗(yàn)配角膜塑形鏡的近視兒童23例39眼。觀察戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的裸眼視力(uncorrected visual acuity，UCVA)、球鏡度數(shù)、柱鏡度數(shù)、SchirmerⅠ試驗(yàn)、淚膜破裂時(shí)間(tear break-up time，BUT)、客觀散射指數(shù)(object scatter index，OSI)、調(diào)制傳遞函數(shù)截止頻率(modulate transter function cut off，MTF cut off)及客觀淚膜質(zhì)量的變化。

結(jié)果：戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的UCVA分別為0.23±0.10、0.81±0.23、0.99±0.11、1.01±0.09、0.95±0.14，戴鏡后較戴鏡前明顯提高，差異有統(tǒng)計(jì)學(xué)意義(F=723.36，P<0.01)；戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的球鏡度數(shù)分別為-2.83±1.34、-0.63±0.82、-0.12±0.20、 -0.03±0.10、-0.10±0.30D，戴鏡前后差異有統(tǒng)計(jì)學(xué)意義(F=107.01，P<0.01)；戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的柱鏡度數(shù)分別為-0.12±0.21、-0.13±0.22、-0.12±0.21、-0.14±0.26、-0.21±0.27D，差異無統(tǒng)計(jì)學(xué)意義(F=2.58，P>0.05)。戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的Schirmer Ⅰ試驗(yàn)結(jié)果分別為19.05±3.67、19.13±4.60、17.60±3.39、17.51±2.86、17.56±4.40mm，組間比較差異無統(tǒng)計(jì)學(xué)意義(F=4.88，P>0.05)；戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的BUT試驗(yàn)結(jié)果分別為11.15±1.81、8.90±1.93、8.31±1.84、7.00±1.78、5.95±1.49s，組間比較差異有統(tǒng)計(jì)學(xué)意義(F=135.11，P<0.01)。戴鏡前及戴鏡后1wk，1、3、6mo時(shí)的MTF cut off分別為40.89±7.04、33.47±8.61、33.48±7.38、33.08±8.88、33.24±10.31c/deg，OSI值分別為0.40±0.15、0.76±0.38、0.76±0.32、0.86±0.32、0.83±0.51，客觀淚膜質(zhì)量分別為0.80±0.23、1.25±0.51、1.28±0.47、1.29±0.53、1.40±0.65，差異有統(tǒng)計(jì)學(xué)差意義(F=6.16、19.23、10.62，P<0.01)。

結(jié)論：角膜塑形鏡可快速降低球鏡度數(shù)，提高UCVA，對(duì)淚液基礎(chǔ)分泌無影響，但可以縮短淚膜破裂時(shí)間，降低淚膜的穩(wěn)定性，影響視覺質(zhì)量。

角膜塑形鏡；淚膜；OQASⅡ；視覺質(zhì)量

引用：朱江，黃振平.配戴角膜塑形鏡對(duì)青少年近視患者淚膜及視覺質(zhì)量的影響.國(guó)際眼科雜志2016;16(11):2099-2102

0　引言

角膜塑形鏡是一種采用反轉(zhuǎn)幾何設(shè)計(jì)的硬性角膜接觸鏡，具有更高透氧性、安全性[1]。夜間配戴角膜塑形鏡可以壓平角膜中央部表面，特異性地降低角膜中央曲率，增加周邊曲率，快速降低患者的屈光度，通過一段時(shí)間的配戴后可以讓患者白天脫鏡并能獲得良好的視力，堅(jiān)持配戴能防控近視眼的發(fā)展，停戴后具有可逆等特點(diǎn)，很快會(huì)恢復(fù)到戴鏡前水平，角膜塑形鏡正日益廣泛用于控制青少年近視發(fā)展[2]。有研……