【摘要】 目的 观察瞳孔直径对角膜塑形镜近视控制作用的影响。方法 前瞻性研究。7～14岁低中度青少年近视患者49例（49眼），分别进行综合验光、瞳孔直径以及眼轴等检查，并按照角膜塑形镜的验配程序予以配戴，并测量戴镜前和2年后患者的眼轴长度及瞳孔直径。将瞳孔直径的均值作为分割点将患者分为2组：瞳孔直径低于均值组（26例）和瞳孔直径高于均值组（23例）。采用配对t检验、独立样本t检验、重复测量方差分析以及Pearson相关分析对数据进行分析。结果 配戴角膜塑形镜2年内，眼轴显著增长（F=67.182，P＜0.01）。瞳孔直径低于均值组与瞳孔直径高于均值组的眼轴增长分别为（0.43±0.28）mm、（0.24±0.27）mm，差异有统计学意义（t=2.379，P＜0.05），瞳孔直径高于均值组的眼轴增长量仅为瞳孔直径低于均值组的55.81%。初始瞳孔直径与2年眼轴增长之间呈显著负相关（r=-0.361，P<0.05）。且得出瞳孔直径与眼轴增长之间的回归方程为：眼轴增长=-0.161×瞳孔直径+0.987（F=7.048，P＜0.05）。瞳孔直径高于均值组2年后的瞳孔直径为（3.72±0.53）mm，而瞳孔直径低于均值组的为（3.51±0.37）mm，2组之间差异无统计学意义（t=2.543，P＞0.05）。结论 配戴角膜塑形镜后，瞳孔直径大的青少年近视患者可以获得更好的近视控制效果。这可能是由于大的瞳孔可以增强近视周边屈光对眼轴控制的积极作用。
【关键词】 角膜塑形术； 眼轴； 屈光，眼，周边； 瞳孔直径
DOI：10.3760/cma.j.issn.1674-845X.2014.02.006
作者单位：200041上海市眼病防治中心
通信作者：冯浩雁
Email：fenghaoyan@hotmail.com
Impact of pupil diameter on controlling the development of myopia in orthokeratology
Zhu Mengjun， Feng Haoyan， Zhu Jianfeng. Shanghai Eye Disease Prevention and Treatment Center，Shanghai 200041， China
Corresponding author：Feng Haoyan，Email：fenghaoyan@hotmail.com
【Abstract】 Objective To evaluate the impact of pupil diameter on controlling the development of myopia in orthokeratology. Methods Forty-nine children aged 7 to 14 years were enrolled in this prospective clinical study. Orthokeratology was performed to correct the refractive errors of these children after measurements of refraction， pupil diameter and axial length. Axial length （AL） and pupil diameter were measured 24 months after lens wearing. The average pupil diameter was calculated and was used as the criterion for dividing the children into ″pupil size above average″ vs ″pupil size below average″. Data were analyzed by a paired t-test， an independent t-test， repeated measured ANOVAs and Pearson correlation analysis. Results AL increased significantly throughout the 24-month observation period （F=67.182， P＜0.01）. The axial growth of subjects with below average pupil sizes and those with above average pupil sizes was 0.43±0.28 mm and 0.24±0.27 mm， indicating a statistically significant difference （t=2.379， P＜0.05）. AL change in subjects with above average pupil diameters was 55.81% of that for subjects with below average pupil diameters. Baseline pupil diameter was negatively correlated with axial growth at the 24-month visit （r=-0.361， P＜0.05）. Linear regression analysis was used between baseline pupil diameter and 2-year axial growth： Axial growth=-0.161× baseline pupil diameter +0.987 （F=7.048， P＜0.05）. The average pupil diameter for subjects with above average pupil sizes and those with below average pupil sizes after 2 years was 3.72±0.53 mm and 3.51±0.37 mm， indicating no statistically significant difference （t=2.543， P＞0.05）. Conclusion The effect of orthokeratology to control myopia would be more beneficial for children with larger pupil diameters than for children with smaller pupil diameters. This may be due to the enhancement of the myopic shift in the peripheral retina.
【Key words】 Orthokeratology； Axial length； Refractive，ocular peripheral； Pupil diameter
来源: 朱梦钧 等 中华眼视光学与视觉科学