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角膜塑形镜联合视觉训练对无调节紊乱症状的近视儿童调节功能的影响

杨扬  李军  王莉  李鹏  刘文兰  闫瑾   

  1. 710021 西安医学院眼视光教研室(杨扬、王莉、刘文兰、闫瑾);710004 西安, 陕西省眼科研究所青少年近视眼防治中心(李军);710054西安, 解放军第451医院眼科(李鹏)
  • 收稿日期:2018-02-07 出版日期:2019-11-25 发布日期:2019-12-06
  • 通讯作者: 杨扬,Email:yangyang-my@163.com E-mail:yangyang-my@163. com
  • 基金资助:

    陕西省教育厅2017年专项科学研究项目(17JK0662)

Influence of orthokeratology combined with visual training on accommodation of myopic children without symptomatic dysfunction

YANG Yang1, LI Jun2, WANG Li1, LI Peng3, LIU Wen-lan1, YAN Jin1   

  1. 1. Department of Medicine Technology Optometry,Xi’an Medical College,Xi’an 710021, China; 2. Youth Myopia Prevention and Treatment Center of Shaanxi Institute of Ophthalmology, Xi’an 710004, China; 3. Department of Ophthalmology, No.451 Hospitial of Chinese PLA, Xi’an 710054, China
  • Received:2018-02-07 Online:2019-11-25 Published:2019-12-06
  • Contact: YANG Yang, Email: yangyang-my@163. com E-mail:yangyang-my@163. com

摘要:

目的 观察角膜塑形镜联合视觉训练(orthokeratology combined with visual training, OCVT)对无调节紊乱症状的近视儿童调节功能的影响。设计 前瞻性病例系列。研究对象 120例无调节紊乱症状的近视儿童,平均年龄(11.18±1.89)岁,平均等效球镜度(-3.17±1.13)D。方法 120例儿童根据临床上选择的治疗方式不同被分为OCVT组(37例)、角膜塑形镜组(orthokeratology, Ortho-k,43例)和单光框架眼镜组(single vision spectacle lense, SVL,40例)。观察并比较三组儿童干预前和干预后1年的调节功能变化,并对OCVT组按照年龄中位数进行进一步的分层比较。主要指标 调节幅度(accommodative amplitude,AA)、调节灵敏度(accommodative sensitivity,AS)、调节滞后量(accommodative lag,Lag)、负相对调节(negative relative accommodation,NRA)和正相对调节(positive relative accommodation,PRA)。结果 共103例儿童完成试验(OCVT组31例,Ortho-k组37例,SVL组35例)。OCVT组干预前的AA、AS、Lag、NRA、PRA分别为(14.21±2.05)D,(8.87±1.80)cpm,(0.71±0.38)D,(1.80±0.38)D,(-1.85±0.42)D,干预后1年分别改善为(15.34±2.16)D、(11.16±2.18)cpm、(0.31±0.27)D、(2.15±0.35)D、(-2.08±0.45)D,其对调节功能的改善显著优于Ortho-k组和SVL组(P均<0.05)。分层比较显示,OCVT组低于年龄中位数者的AA、AS、Lag、NRA、PRA改变量与高于年龄中位数者比较差异均无统计学意义(P均>0.05)。结论  对于无调节紊乱症状的近视儿童,OCVT是一种较好的改善其调节功能的方法,但最佳的视觉训练类型和时间还需要进一步研究。

关键词: 角膜塑形镜, 视觉训练, 调节, 儿童

Abstract:

Objective To investigate the effect of orthokeratology combined with visual training(OCVT) on accommodation in myopic children without symptomatic dysfunction. Design Prospective case series.  Participants 120 children without symptomatic dysfunction, average ages 11.18±1.89 years, average spherical equivalent refraction-3.17±1.13 diopters(D). Methods All subjects were divided into three groups according to their selected therapy in clinic, including OCVT group (37 cases), orthokeratology group (Ortho-k, 43 cases) and single vision spectacle lense group (SVL, 40 cases). These subjects were followed up at least for 12 months. The changes of accommodation from baseline visit to 12-month visit were compared between the three groups. A more detailed analysis by median age were made in the OCVT group. Main Outcome Measures Accommodative amplitude (AA), accommodative sensitivity (AS), accommodative lag (Lag), negative relative accommodation (NRA) and positive relative accommodation (PRA). Results A total of 103 participants completed the study, which including 31 cases in OCVT group, 37 cases in Ortho-k group and 35 cases in SVL group. The baseline of AA, AS, Lag, NRA, PRA were(14.21±2.05)D,(8.87±1.80)cpm,(0.71±0.38)D,(1.80±0.38)D,(-1.85±0.42)D in the OCVT group respectively.  After 1 year intervention, AA, AS, Lag, NRA, PRA improved to(15.34±2.16)D,(11.16±2.18)cpm,(0.31±0.27)D,(2.15±0.35)D,(-2.08±0.45)D respectively, the improvement effect was better than that of the Ortho-k group and the SVL group(all P<0.05). When split by median age group, the changes in AA, AS, Lag, NRA, PRA of younger subjects and older subjects were not significantly different(all P>0.05). Conclusion  OCVT is a good way to improve the accommodation of myopic children without symptomatic dysfunction, but the best type and time of the visual training need further research.

Key words: orthokeratology, visual training, accommodation, children