[1]申笛,周堃,孙西宇,等.角膜塑形镜联合0.1 g·L阿托品延缓儿童近视进展分析[J].眼科新进展,2023,43(11):882-886.[doi:10.13389/j.cnki.rao.2023.0177]
　SHEN Di,ZHOU Kun,SUN Xiyu,et al.Efficacy of orthokeratology combined with 0.1 g·L atropine in slowing the progression of myopia in children[J].Recent Advances in Ophthalmology,2023,43(11):882-886.[doi:10.13389/j.cnki.rao.2023.0177]
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
43卷
期数:
2023年11期
页码:
882-886
栏目:
应用研究
出版日期:
2023-11-05

文章信息/Info

Title:
Efficacy of orthokeratology combined with 0.1 g·L-1 atropine in slowing the progression of myopia in children
作者:
申笛; 周堃; 孙西宇; 马晓欢; 才俊; 吴娟娟; 韦伟
710002　陕西省西安市，西安市第一医院眼科 陕西省眼科研究所 陕西省眼科学重点实验室 西北大学附属第一医院眼科 陕西省眼科疾病临床医学研究中心
Author(s):
SHEN Di; ZHOU Kun; SUN Xiyu; MA Xiaohuan; CAI Jun; WU Juanjuan; WEI Wei
Xi’an No.1 Hospital，Shaanxi Institute of Ophthalmology，Shaanxi Key Laboratory of Ophthalmology，the First Affiliated Hospital of Northwestern University,Clinical Research Center for Ophthalmology Diseases of Shaanxi Province，Xi’an 710002,Shaanxi Province,China
关键词:
近视; 角膜塑形镜; 阿托品; 眼轴长度
Keywords:
myopia;  orthokeratology;  atropine;  axial length
分类号:
R778.1
DOI:
10.13389/j.cnki.rao.2023.0177
文献标志码:
A
摘要:
目的　探讨角膜塑形镜联合0.1 g·L-1阿托品（AOK）控制儿童近视进展效果，并分析影响控制近视进展疗效的因素。
方法　回顾性研究。选取2020年10月至2022年11月在西安市第一医院激光近视治疗中心就诊的近视儿童60例（112眼）作为研究对象，根据治疗方法不同分为仅接受OK镜治疗的OK镜组31例（55眼）和同时接受OK镜和0.1 g·L-1阿托品治疗的AOK组29例（57眼）。根据基线年龄［年龄较小组（8~<10岁）和年龄较大组（10~14岁）］和基线眼轴长度（AL）［AL较短组（22.00~24.50 mm）与AL较长组（>24.50~27.00 mm）］对患儿进行分层比较。分析治疗后3个月、6个月、12个月两组患儿AL变化，采用混合线性模型分析两组患儿治疗前后数据，采用多因素线性回归分析比较影响控制近视进展疗效的因素。
结果　AOK组患儿在治疗后12个月累积AL增长（0.14±0.20）mm，显著小于OK镜组的（0.20±0.20）mm（P=0.01），AOK组比OK镜组患儿AL增长减少约30%。根据基线年龄和基线AL分层比较结果显示，AOK组患儿在年龄较小组、AL较长组等亚分组时AL变化显著小于OK镜组（均为P<0.05）。多因素线性回归分析结果表明，AOK组患儿的年龄、初始AL缩短、放松时长与AL变化均呈负相关（β=-0.20，P=0.04；β=-0.59，P<0.01；β=-0.22，P=0.02）。
结论　AOK控制儿童近视疗效优于单纯使用OK镜，联合治疗在控制基线年龄较小、基线AL较长儿童的AL增长方面更有效，治疗效果受到患儿年龄、初始AL长度、放松功能等因素的影响。
Abstract:
Objective　To investigate the effect of orthokeratology (OK) combined with 0.1 g·L-1 atropine (AOK) on controlling the progression of myopia in children and analyze factors influencing the effectiveness of myopia control.
Methods　This retrospective study involved 60 patients (112 eyes) who were admitted to the Laser Vision Center of Xi’an No.1 Hospital from October 2020 to November 2022. These patients were categorized into two groups according to therapies: OK group (31 patients, 55 eyes, treated with OK alone) and AOK group (29 patients, 57 eyes, treated with OK and 0.1 g·L-1 atropine). A stratified comparison was carried out based on baseline age ［the younger group (8-<10 years old) vs. the elder group (10-14 years old)］ and baseline axial length (AL) ［the shorter AL group (22.00-24.50 mm) vs. the longer AL group (>24.50-27.00 mm)］. The changes in AL at three, six and twelve months after treatment were compared between the two groups. The preoperative and postoperative data in the two groups were analyzed using a linear mixed model. The variables influencing the effectiveness of myopia control were analyzed using a multiple linear regression model.
Results　Over 12 months after survey, AL increased (0.14±0.20) mm in the AOK group and (0.20±0.20) mm in the OK group, and AL increase in the AOK group was 30% lower than that in the OK group (P=0.01). The stratified comparison revealed that in the younger and longer AL sub-groups, the AL changes in the AOK group were less significant than those in the OK group (both P<0.05). The multiple linear regression analysis revealed that in the AOK group, age, initial shortening of AL, and relaxation duration were negatively correlated with the AL changes (β=-0.20, P=0.04; β=-0.59, P<0.01; β=-0.22, P=0.02).
Conclusion　Compared to the OK therapy, the AOK therapy is more effective in reducing the progression of myopia in children and controlling the AL increase in younger children with longer baseline AL. The treatment effect is influenced by the baseline age, initial AL, and relaxation function.

参考文献/References:

［1］　LI F F,ZHANG Y,ZHANG X,YIP B H K,TANG S M,KAM K W,et al.Age effect on treatment responses to 0.05%,0.025%,and 0.01% atropine:low-concentration atropine for myopia progression study［J］.Ophthalmology,2021,128(8):1180-1187.
［2］　MORGAN I G,OHNO-MATSUI K,SAW S M.Myopia［J］.Lancet,2012,379(9827):1739-1748.
［3］　HOLDEN B A,FRICKE T R,WILSON D A,JONG M,NAIDOO K S,SANKARIDURG P,et al.Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050［J］.Ophthalmology,2016,123(5):1036-1042.
［4］　TAN Q,NG A L,CHOY B N,CHENG G P,WOO V C,CHO P.One-year results of 0.01% atropine with orthokeratology (AOK) study:a randomised clinical trial［J］.Ophthalmic Physiol Opt,2020,40(5):557-566.
［5］　CHEN Z,HUANG S,ZHOU J,QU X M,ZHOU X,XUE F.Adjunctive effect of orthokeratology and low dose atropine on axial elongation in fast-progressing myopic children:a preliminary retrospective study［J］.Contact Lens Anterior Eye,2019,42(4):439-442.
［6］　KINOSHITA N,KONNO Y,HAMADA N,KANDA Y,SHIMMURA-TOMITA M,KABURAKI T,et al.Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia:a 2-year randomised trial［J］.Sci Rep,2020,10(1):12750.
［7］　CHEN Z,ZHOU J,XUE F,QU X,ZHOU X.Two-year add-on effect of using low concentration atropine in poor responders of orthokeratology in myopic children［J］.Br J Ophthalmol,2022,106(8):1069-1072.
［8］　XU S,LI Z,ZHAO W,ZHENG B,JIANG J,YE G,et al.Effect of atropine,orthokeratology and combined treatments for myopia control:a 2-year stratified randomised clinical trial［J］.Br J Ophthalmol,2022.［Online ahead of print］.
［9］　WANG S,WANG J,WANG N.Combined orthokeratology with atropine for children with myopia:a meta-analysis［J］.Ophthalmic Res,2021,64(5):723-731.
［10］　KINOSHITA N,KONNO Y,HAMADA N,KANDA Y,SHIMMURA-TOMITA M,KAKEHASHI A.Additive effects of orthokeratology and atropine 0.01% ophthalmic solution in slowing axial elongation in children with myopia:first year results［J］.Jpn J Ophthalmol,2018,62(5):544-553.
［11］　TAN Q,NG A L,CHENG G P,WOO V C,CHO P.Combined 0.01% atropine with orthokeratology in childhood myopia control (AOK) study:a 2-year randomized clinical trial［J］.Contact Lens Anterior Eye,2023,46(1):101723.
［12］　ZHAO Q,HAO Q.Clinical efficacy of 0.01% atropine in retarding the progression of myopia in children［J］.Int Ophthalmol,2021,41(3):1011-1017.
［13］　ZHOU H,ZHAO G,LI Y.Adjunctive effects of orthokeratology and atropine 0.01% eye drops on slowing the progression of myopia［J］.Clin Exp Optom,2022,105(5):520-526.
［14］　XU S,LI Z,HU Y,ZHAO W,JIANG J,FENG Z,et al.Development and validation of a prediction model for axial length elongation in myopic children treated with overnight orthokeratology［J］.Acta Ophthalmol,2021,99(5):e686-e693.
［15］　WAN K,CHEUNG S W,WOLFFSOHN J S,ORR J B,CHO P.Role of corneal biomechanical properties in predicting of speed of myopic progression in children wearing orthokeratology lenses or single-vision spectacles［J］.BMJ Open Ophthalmol,2018,3(1):e000204.
［16］　WEI S,LI S M,AN W,DU J,LIANG X,SUN Y,et al.Safety and efficacy of low-dose atropine eyedrops for the treatment of myopia progression in Chinese children:a randomized clinical trial［J］.JAMA Ophthalmol,2020,138(11):1178-1184.
［17］　HUANG Y,LI X,FANG W,LUO W,YE H,DU X,et al.Development and validation of a simple nomogram for predicting rapid myopia progression in children with orthokeratology management［J］.Curr Eye Res,2023,48(5):465-473.
［18］　CHEN Y,XIONG R,CHEN X,ZHANG J,BULLOCH G,LIN X,et al.Efficacy comparison of repeated low-level red light and low-dose atropine for myopia control:a randomized controlled trial［J］.Transl Vis Sci Technol,2022,11(10):33.
［19］　TANG T,LI X,CHEN S,XU Q,ZHAO H,WANG K,et al.Long-term follow-up of changes in ocular biometric parameters in orthokeratology lens wearers with relatively large-scale axial length reduction［J］.Eye Vis,2023,10(1):6.
［20］　ZHAO Y,HU P,CHEN D,NI H.Is it possible to predict progression of childhood myopia using short-term axial change after orthokeratology?［J］.Eye Contact Lens,2020,46(3):136-140.
［21］　CHO H,SEO Y,HAN S H,HAN J.Factors related to axial length elongation in myopic children who received 0.05% atropine treatment［J］.J Ocul Pharmacol Ther,2022,38(10):703-708.
［22］　LAU J K,WAN K,CHEUNG S W,VINCENT S J,CHO P.Weekly changes in axial length and choroidal thickness in children during and following orthokeratology treatment with different compression factors［J］.Trans Vis Sci Tech,2019,8(4):9.
［23］　WANG A,YANG C,SHEN L,WANG J,ZHANG Z,YANG W.Axial length shortening after orthokeratology and its relationship with myopic control［J］.BMC Ophthalmol,2022,22(1):243.
［24］　朱梦钧,冯浩雁,朱剑锋,瞿小妹.调节幅度对角膜塑形术近视控制作用的影响［J］.中华眼科杂志,2014,50(1):14-19.
ZHU M J,FENG H Y,ZHU J F,QU X M.The impact of amplitude of accommodation on controlling the development of myopia in orthokeratology［J］.Chin J Ophthalmol,2014,50(1):14-19.

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备注/Memo

备注/Memo:
陕西省重点研发计划项目（编号：2022SF-404）
更新日期/Last Update: 2023-11-05