摘要
目的 观察配戴角膜塑形镜后角膜不同点位知觉及厚度变化及两者间相互关系.并观察这些变化与轻、中度近视和不同设计镜片之间的关系.方法 临床病例回顾研究.对2015年1～4月在沈阳爱尔眼科医院就诊的76例（142只眼）8～18 （11.96±2.68）岁,轻、中度青少年近视眼患者验配角膜塑形镜,随访观察并记录配戴角膜塑形镜1晚次日晨起摘镜后及摘镜后lh和戴镜1周、3个月角膜5个点位（瞳孔中心、距离瞳孔中心3 mm处上方、下方、鼻侧、颞侧）知觉值,以及戴镜1周、3个月相应点位角膜厚度值.结果 （1）配戴角膜塑形镜1晚次日晨起摘镜后、摘镜lh及戴镜1周、3个月角膜5个点位知觉与戴镜前（58.91±4.69、57.81±7.19、58.13±7.40、57.22±8.54、58.31±7.19） mm比较均降低,且戴镜1晚次日晨起摘镜后角膜5个点位知觉（49.98±12.63、48.07±14.85、47.40±14.32、47.89±13.92、47.19±14.42）mm最低,与摘镜1 h（51.46±12.48、49.03±14.60、49.94±13.35、49.91±13.25、49.76±13.37） mm比较,差异均有统计学意义.（2）配戴角膜塑形镜1周、3个月后瞳孔中心角膜厚度（分别为539.79±27.87、540.70±23.60）μm较戴镜前（546.52±31.88）μm降低,其余4点位角膜厚度（分别为670.36±37.53、627.67±35.19、652.41±32.34、620.10±33.28和678.29±32.98、636.30±24.03、648.92±25.57、623.03±26.93）μm较戴镜前（661.77±42.38、618.82±39.36、643.10±39.93、614.99±36.68） μm增厚,差异有统计学意义.（3）配戴角膜塑形镜前、1周、3个月角膜（5个点位）知觉变化与相应时间相应点位厚度变化相关分析相关系数r分别为-0.032、-0.044和-0.002,P值分别为0.39、0.25和0.96,两者差异无统计学意义.（4）角膜（5个点位）知觉及厚度变化在轻度和中度近视患者间比较无统计学意义（P＞0.05）.（5）角膜知觉及厚度变化在配戴不同设计镜片患者间比较无统计学意义（P＞0.05）.（6）随访期间,有2.1％（3只眼）发生角膜上皮少量点状荧光素染色,均发生在戴镜1周内,滴人工泪液后好转.所有患者均未发现Ⅱ级及以上角膜着染及其他严重并发症.结论 （1）配戴角膜塑形镜3个月角膜知觉与戴镜前相比是降低的,而瞳孔中心角膜厚度较戴镜前降低,其余4点角膜厚度较戴镜前增厚.（2）配戴角膜塑形镜3个月角膜知觉变化与厚度变化无相关性.（3）配戴角膜塑形镜3个月角膜知觉及厚度变化与近视程度和镜片设计均无相关.
Objective To investigate the changes of the corneal sensitivity and thickness at 5 different points of the cornea and the relationship between them after wearing orthokeratology lens,and to observe the difference of the changes between the degree of myopia and different lens designs.Methods Seventy-six patients （142 eyes） with mild and moderate myopia aged 8-18 （11.96±2.68） years were fitted into orthokeratology.The corneal sensitivity values of the 5 points （the center of the pupil and the superior,the inferior,the nasal and the temporal with a distance of 3mm to the pupil center） after wearing orthokeratology for one night and one hour after taking off the lens,wearing orthokeratology for one week,three months and the corneal thickness of the corresponding points after wearing orthokeratology for one week,three months were observed.Results Compared to the initial values （58.91±4.69,57.81±7.19,58.13±7.40,57.22±8.54,58.31±7.19）mm,the corneal sensitivity values of the 5 points were decreased after wearing orthokeratology for one night and one hour after taking off the lens,wearing orthokeratology for one week,three months.Among which the values of the 5 points （49.98±12.63,48.07±14.85,47.40±14.32,47.89±13.92,47.19±14.42）mm were the lowest after wearing orthokeratology for one night,and had significant difference when compared to the values （51.46±12.48,49.03±14.60,49.94±13.35,49.91±13.25,49.76±13.37）mm at the time one hour after taking off the lens.Compared to the initial values （546.52±31.88,661.77±42.38,618.82±39.36,643.10±39.93,614.99±36.68）um,the corneal thickness of the pupil center was decreased after wearing orthokeratology for one week （539.79±27.87）um and three months （540.70±23.60）um,while the corneal thickness of the other four points were thickened （670.36±37.53,627.67±35.19,652.41±32.34,620.10±33.28 and 678.29±32.98,636.30±24.03,648.92±25.57,623.03±26.93）um.With the correlation coefficient r being-0.032,-0.044 and-0.002,P being 0.39,0.25 and 0.96,the corneal sensitivity and thickness at 5 different points of the cornea had no significant correlation before and after wearing orthokeratology for one week and three months.The changes of the corneal sensitivity and thickness at 5 different points of the cornea had no significant difference between mild myopia and moderate myopia （P 〉0.05）.The changes of the corneal sensitivity and thickness had no significant difference between different lens designs （P 〉0.05）.During following up time,the rate of corneal fluorescein staining was 2.1% （3 eyes）,and all occurred within one week after wearing the orthokeratology and were less than Ⅱ level and all improved after using artificial tear eyedrops.No other severe complications were observed.Conclusions Compared to the initial values,the corneal sensitivity values are decreased,the corneal thickness of the pupil center is decreased,while the corneal thickness of the other four points are thickened after wearing orthokeratology for three months.There is no relevance between the corneal sensitivity changes and the corneal thickness changes after wearing orthokeratology for three months.The changes of the corneal sensitivity and thickness have no relevance with the degree of myopia and different lens designs.
出处
《中国实用眼科杂志》
2016年第5期460-465,共6页
Chinese Journal of Practical Ophthalmology
关键词
角膜知觉
角膜厚度
角膜塑形镜
近视
Corneal sensitivity
Corneal thickness
Orthokeratology
Myopia
