中国斜视与小儿眼科杂志2008年第16卷第4期少年儿童近视的长期角膜塑形疗效和安全性观察谢培英王志昕迟蕙作者单位：100083北京大学医学部眼视光学研究中心摘要目的探讨长期角膜塑形术降低近视度和控制近视的有效性和安全性。方法观察47例7～18岁少年儿童近视患者，连续配戴角膜塑形镜5年间的屈光度、视力、眼轴长度、角膜厚度、角膜内皮细胞以及裂隙灯下角结膜的改变，并与同时期配戴框架眼镜的中小学生近视患者2年的眼轴变化进行比较。其中33例66眼采用夜戴方式（夜戴组），近视度-1.00D～-5.25D，平均-3.54±0.82D，14例28眼采用日戴方法（日戴组），近视度-5.50D～-9.00D,平均-7.53±0.99D。结果5年期间近视降低度和角膜平均曲率半径增大值夜戴组分别为-2.69D～-2.82D和0.22mm～0.30mm，日戴组分别为-1.73D～-3.54D和0.13mm～0.24mm。与戴镜前比较，眼轴长度增加夜戴组自第3年起，日戴组自第4年起有统计学意义。同时期配戴框架眼镜组的2年的眼轴增长可达角膜塑形术的2倍以上。夜戴组裸眼视力提高至≥0.6的比例可达55.8～63.2%，≥0.8的比例可达43.8～49.3%。夜戴组与日戴组戴镜5年角膜厚度与角膜内皮细胞均未见明显改变（P＞0.05）。观察期间未见严重角结膜并发症。结论科学规范的长期配戴角膜塑形镜，可持续有效降低近视度，显著提高裸眼视力，并有效控制眼轴的增长。长期戴镜对角结膜未产生明显影响，安全性亦较高。关键词近视矫正与控制角膜塑形术眼轴长度角膜厚度角膜内皮细胞Theeffectsandsafetyoflong-termOrthokeratologyinyoungmyopiapatients.XiePei-ying，WangZhi-xin，ChiHui.PekingUniversityOptometry&OphthalmologyCenter,Beijing100083ABSTRACTObjectiveToinvestigatetheeffectsandsafetyoflong-termOrthokeratologyonthemyopiare－ductionandmyopiacontrolinyoungmyopiapatients.Methods47youngmyopiapatients(7~18years)werefittedwithOrtho-Kcontactlensover5years,33patients(66eyes)withovernightwear(-1.00D~-5.25D,-3.54±0.82D),14patients(28eyes)withdaywear(-5.50D~-9.00D,-7.53±0.99D).Refraction,visualacuity,cornealcurvatureandaxiallengthweremeasuredduring5years.Ocularsurfacehealthwasexaminedbyslit—lampmicroscope.Changesofcornealendotheliaandcornealthicknesswereobservedeveryyear.Wealsocomparedthechangeofaxiallengthwithmyopiastudentswearingspectacleswithin2yearsinprimaryandmiddleschools.ResultsSignif－icantmyopiareductionandcentralcornealcurvatureflatteningwereobserved,whichwas-2.69D~-2.82Dand0.22mm~0.30mmrespectivelyinovernightweargroup,-1.73D~-3.54Dand0.13mm~0.24mmindayweargroupduring5years.Comparedwithinitialaxiallengthincreasingwassignificantstatisticallyfrom3rdyearsinovernightgroup,whilefrom4thyearsindayweargroup.Butthe2yearsaxiallengthincreasinginprimaryandmiddlestudentswhowearingspectacles(8~9years，12~13years）wasover2timesthanthatinovernightwearortho-klensgroup.TherateofUVA≥0.6wasupto55.8~63.2%，≥0.8wasupto43.8~49.3%respectively.Therewerenoremarkablecomplicationsintheocularsurface.Therewerenosignificantchangesincornealthicknessandcornealendotheliaafterlong-termOrtho-KCLwear,nomatterovernightwearordaywear.ConclusionsScientificandstandardizedOrthokeratologyforalongtimecancontinuouslyandeffectivelydecreasemyopia,andimprovethenakedvision.Inaddition,itcancontroltheincreaseofaxiallengthefficiently.LongtermOrtho-KCLwearwouldnotinfluencethecorneaandconjunctivasignificantly,soit’ssafetyforyoungertowear.Keywordsmyopiacorrectionandcontrolorthokeratologyaxiallengthcornealthicknesscornealen－dothelium·临床研究·145··中国斜视与小儿眼科杂志2008年第16卷第4期角膜塑形术已与近视治疗与控制紧密联系在一起。近几年随着这项技术水平的不断提高与完善，以及青少年近视逐年增加的趋势，使得更多的眼科、视光科医...
