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[摘要] 目的 對比分析长期佩戴角膜塑形镜和单焦框架眼镜治疗近视的近远期疗效及角膜并发症情况，为临床近视保守治疗方案的选择提供参考。 方法 选择2013年7～12月在我院行近视治疗的近视患者100例200眼作为研究对象，按就诊顺序编号，将其采用数字随机表法分为对照组（采用单焦框架眼镜矫正治疗）和观察组（采用角膜塑形镜矫正治疗），每组50例100眼。观察组患者进行相关检查后，根据检查结果确定参数并配制镜片，指导患者及家长具体佩戴方法，每晚佩戴8～10 h；对照组患者据常规验光并配制相应的单焦镜片至于镜架后白天佩戴。两组患者均于佩戴后3 d、1个月、3个月、6个月、12个月、24个月、36个月回院随访，了解患者佩戴过程中的情况，指导患者正确佩戴。比较两组患者佩戴36个月过程中角膜并发症发生情况、36个月后两组患者均脱镜1个月，再检查裸眼视力、屈光度、角膜曲率及眼轴长度并行组间、治疗前后比较。 结果 佩戴36个月后，两组患者裸眼视力均较入组前明显提升（P<0.05），但观察组患者明显高于对照组（P<0.05）；两组患者屈光度、角膜曲率均较入组前明显下降（P<0.05），且观察组明显低于对照组（P<0.05），两组眼轴长度均较入组前增加（P<0.05），但观察组明显短于对照组（P<0.05）。观察组三年期间角膜并发症共发生56例56眼次，其它并发症21例21眼次，经暂停佩戴或药物对症处理或指导正确佩戴等措施后，1例因角膜并发症退出研究，对照组仅4眼次发生角膜并发症，其它并发症6眼次。观察组角膜并发症率显著高于对照组（P<0.05）。 结论 长期佩戴角膜塑形镜可延缓眼轴长度进展，有效的控制近视的屈光度，而单焦眼镜对青少年的近视没有明确的控制作用，虽戴角膜塑形镜在角膜相关并发症的发生率比单焦眼镜高，但在佩戴期间规范验配、严格复查、指导和随访，及时采取措施和改善并发症的前提下，长期佩戴角膜塑形镜是安全有效的。
[关键词] 角膜塑形镜；单焦框架静；近视；角膜并发症；对比分析
[中图分类号] R778.3 [文献标识码] B [文章编号] 1673-9701（2017）07-0065-03
[Abstract] Objective To compare and analyze the short-term and long-term curative effect of long-term wearing of MCT and single-focus glasses in the treatment of myopia and corneal complications， so as to provide references for the selection of conservative treatment of clinical myopia. Methods From July to December 2013， 100 patients （200 eyes） with myopia who were treated in our hospital were selected as the study subjects. The patients were divided into the control group （corrective treatment by single-focus glasses） and the observation group （corrective treatment by MCT） by the random number table according to the admission order， with 50 cases （100 eyes） in each group. After the relevant examinations in the observation group， the parameters were determined and the lenses were prepared according to the results of exam， and the patients and their parents were guided to learn the specific wearing method， with the wearing period of 8-10 h every night； the patients in the control group were asked to wear the glasses during daytime according to the routine optometry and the preparation of the corresponding single-focus lens. Two groups of patients were followed up for 3 d， 1， 3， 6， 12， 24， and 36 months after wearing， so that the situations during the wearing process could be understood in the patients， and they were guided to wear properly. The occurrence of corneal complications was compared between the two groups during the 36-month wearing. The two groups were off the glasses for 1 month after 36 months treatment， and the uncorrected visual acuity， diopter， corneal curvature and length of optic axis were re-examined. They were compared before and after the treatment and between two groups. Results After 36 months of wearing， the uncorrected visual acuity of the two groups was significantly higher than that before grouping （P<0.05）， but the observation group was significantly higher than the control group （P<0.05）； the diopter and corneal curvature of the two groups were significantly lower than those before grouping（P<0.05）， and the observation group was significantly lower than the control group （P<0.05）. The axial length of the two groups was higher than that before grouping （P<0.05）， but the observation group was significantly shorter than the control group（P<0.05）. The number of the incidence of corneal complications in the observation group was 56 cases 56 eye times in 3 years， and 21 cases 21 eye times in other complications. After the suspension of wearing or drug symptomatic treatment or guidance to properly wear and other measures， 1 case was withdrawn from the study due to corneal complications， the number of incidence of corneal complications was only 4 eye times in the control group， and 6 eye times in other complications. The incidence rate of corneal complications in the observation group was significantly higher than that in the control group（P<0.05）. Conclusion Long-term wearing corneal shape lens can delay the progress of ocular axial length， effective control of myopia diopter， and single focal glasses on juvenile myopia is no clear control function， although wearing corneal shape lens in corneal complication incidence is higher than single focal lens， but standard fitting， strict review during wear， guide and follow-up， take timely measures to the premise of complications and improve the long-term wearing corneal shape lens is safe and effective.
[关键词] 角膜塑形镜；单焦框架静；近视；角膜并发症；对比分析
[中图分类号] R778.3 [文献标识码] B [文章编号] 1673-9701（2017）07-0065-03
[Abstract] Objective To compare and analyze the short-term and long-term curative effect of long-term wearing of MCT and single-focus glasses in the treatment of myopia and corneal complications， so as to provide references for the selection of conservative treatment of clinical myopia. Methods From July to December 2013， 100 patients （200 eyes） with myopia who were treated in our hospital were selected as the study subjects. The patients were divided into the control group （corrective treatment by single-focus glasses） and the observation group （corrective treatment by MCT） by the random number table according to the admission order， with 50 cases （100 eyes） in each group. After the relevant examinations in the observation group， the parameters were determined and the lenses were prepared according to the results of exam， and the patients and their parents were guided to learn the specific wearing method， with the wearing period of 8-10 h every night； the patients in the control group were asked to wear the glasses during daytime according to the routine optometry and the preparation of the corresponding single-focus lens. Two groups of patients were followed up for 3 d， 1， 3， 6， 12， 24， and 36 months after wearing， so that the situations during the wearing process could be understood in the patients， and they were guided to wear properly. The occurrence of corneal complications was compared between the two groups during the 36-month wearing. The two groups were off the glasses for 1 month after 36 months treatment， and the uncorrected visual acuity， diopter， corneal curvature and length of optic axis were re-examined. They were compared before and after the treatment and between two groups. Results After 36 months of wearing， the uncorrected visual acuity of the two groups was significantly higher than that before grouping （P<0.05）， but the observation group was significantly higher than the control group （P<0.05）； the diopter and corneal curvature of the two groups were significantly lower than those before grouping（P<0.05）， and the observation group was significantly lower than the control group （P<0.05）. The axial length of the two groups was higher than that before grouping （P<0.05）， but the observation group was significantly shorter than the control group（P<0.05）. The number of the incidence of corneal complications in the observation group was 56 cases 56 eye times in 3 years， and 21 cases 21 eye times in other complications. After the suspension of wearing or drug symptomatic treatment or guidance to properly wear and other measures， 1 case was withdrawn from the study due to corneal complications， the number of incidence of corneal complications was only 4 eye times in the control group， and 6 eye times in other complications. The incidence rate of corneal complications in the observation group was significantly higher than that in the control group（P<0.05）. Conclusion Long-term wearing corneal shape lens can delay the progress of ocular axial length， effective control of myopia diopter， and single focal glasses on juvenile myopia is no clear control function， although wearing corneal shape lens in corneal complication incidence is higher than single focal lens， but standard fitting， strict review during wear， guide and follow-up， take timely measures to the premise of complications and improve the long-term wearing corneal shape lens is safe and effective.