Zhu Meng-Jun, Ding Li, Du Lin-Lin, Chen Jun, He Xian-Gui, Li Shan-Shan, Zou Hai-Dong
Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China.
Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China.
Int J Ophthalmol. 2022 Aug 18;15(8):1322-1330. doi: 10.18240/ijo.2022.08.15. eCollection 2022.
To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology (ortho-k) over 1-year period and its effects on the axial elongation.
A total of 202 Chinese myopic children were enrolled in this prospective clinical trial. Ninety-five subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study. Axial length (AL) was measured before enrollment and every 6mo after the start of ortho-k. The photopic pupil diameter (PPD) was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx. Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation.
Compared with spectacle group, the average 1-year axial elongation was significantly slower in the ortho-k group (0.25±0.27 0.44±0.23 mm, <0.0001). In ortho-k group, PPDs significantly decreased from 4.21±0.62 mm to 3.94±0.53 mm after 1mo of lens wear (=0.001, Bonferroni correction) and the change lasts for 3-month visit. No significantly change during the other follow-up visits was found (>0.05, Bonferroni correction). The 4.81 mm PPD may be a possible cutoff point in the ortho-k group. Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period (=-3.09, =0.003). In ortho-k group, univariate analyses indicated that those with older age, greater degree of myopia, longer AL, smaller baseline PPD (PPD) experienced a smaller change in AL. In multivariate analyses, older age, greater AL and smaller PPD were associated with smaller increases in AL. In spectacle group, PPD tended to be stable (>0.05, Bonferroni correction) and did not affect axial growth.
PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment. Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.
探讨近视儿童在为期1年的夜间角膜塑形术（ortho-k）治疗过程中的明视瞳孔大小行为及其对眼轴伸长的影响。
共有202名中国近视儿童纳入这项前瞻性临床试验。角膜塑形术组95名受试者和眼镜组88名受试者完成了1年的研究。在入组前以及角膜塑形术开始后每6个月测量眼轴长度（AL）。使用Pentacam AXL测定明视瞳孔直径（PPD），并在照明为300 - 310勒克斯的检查室中进行测量。采用逐步多元线性回归分析来确定对眼轴伸长有贡献的变量。
与眼镜组相比，角膜塑形术组1年的平均眼轴伸长明显较慢（0.25±0.27对0.44±0.23毫米，<0.0001）。在角膜塑形术组，戴镜1个月后PPD从4.21±0.62毫米显著降至3.94±0.53毫米（=0.001，Bonferroni校正），且这种变化持续到3个月随访时。在其他随访期间未发现显著变化（>0.05，Bonferroni校正）。4.81毫米的PPD可能是角膜塑形术组的一个可能切点。1年后，PPD低于或等于4.81毫米的受试者与PPD高于4.81毫米的受试者相比，眼轴伸长往往较小（=-3.09，=0.003）。在角膜塑形术组，单因素分析表明年龄较大、近视度数较高、眼轴较长、基线PPD（PPD）较小的受试者眼轴变化较小。在多因素分析中，年龄较大、眼轴较长和PPD较小与眼轴较小的增加相关。在眼镜组，PPD趋于稳定（>0.05，Bonferroni校正），且不影响眼轴生长。
在角膜塑形术治疗1个月和3个月时PPD显著降低。PPD较小的儿童眼轴伸长往往较慢，可能从角膜塑形术中获益更多。
