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高非球微透镜框架眼镜联合0.01%阿托品滴眼液的近视控制效果分析

Efficacy of Combining Highly Aspherical Lenslets Spectacles With 0.01% Atropine Eye Drops in Myopia Control

    摘要
  • 摘要:
    目的 探究高非球微透镜（highly aspherical lenslets, HAL）框架眼镜联合0.01%阿托品 (atropine, AT）滴眼液与单独使用HAL框架眼镜或普通单焦（single vision lenses, SVL）框架眼镜在儿童青少年中的近视控制效果差异。
    方法 回顾性队列研究，共纳入105例6～15岁近视患儿，根据近视矫正和控制的方式分为HAL+0.01%阿托品组（HAL+AT)、HAL组和SVL组，每组各35人。收集患者基线和戴镜1年的睫状肌麻痹验光、眼轴长度（axial length, AL）等相关数据。采用单因素方差分析或秩和检验比较3组患者基线和戴镜1年后AL和等效球镜度（spherical equivalent refraction, SER）的变化量。
    结果 各组间基线资料和戴镜时长均无明显差异（P>0.05）。戴镜1年后，HAL+AT组、HAL组和SVL组SER变化量分别为－0.13（－0.25, 0.00） D、－0.25（－0.63, －0.25） D和－0.63（－1.00, －0.25） D；AL变化量分别为（0.09±0.11） mm、（0.19±0.16） mm和（0.34±0.16） mm，HAL+AT组SER变化量（PHAL+AT vs. HAL=0.001, PHAL+AT vs. SVL=0.002）和AL变化量（PHAL+AT vs. HAL=0.009, PHAL+AT vs. SVL=0.001）均低于HAL组和SVL组。相比于SVL组，HAL+AT组近视进展延缓率和眼轴增长延缓率分别是79.4%和73.5%，HAL组的近视进展延缓率和眼轴增长延缓率分别是60.3%和44.1%。根据年龄和近视进展速度进行分层分析，结果显示，无论是低龄（6～8岁）儿童还是大龄（9～15岁）儿童，相较于SVL组，HAL+AT组既降低了近视进展较快（AL>0.36 mm/year）的人群比例，又增加了近视进展较慢（AL≤0.18 mm/year）人群比例（P<0.017)。
    结论 联合使用HAL框架眼镜和0.01%阿托品滴眼液能有效控制儿童青少年近视进展，在各年龄段的近视患儿中使用联合手段均能取得较好的近视控制效果。

     

    Abstract:
    Objective To explore the difference in myopia control efficacy between spectacle lenses with highly aspherical lenslets (HAL) combined with 0.01% atropine eye drops and spectacle lenses with HAL alone or single vision spectacle lenses (SVL) in children and adolescents.
    Methods A retrospective cohort study was conducted with a total of 105 myopic children aged 6-15 years. According to the specific myopia correction and control methods of each subject, they were evenly divided into the HAL+0.01% atropine (HAL+AT) group, the HAL group, and the SVL group, with 35 subjects in each group. Relevant data, such as cycloplegic refraction and axial length (AL) at baseline and 12 months after wearing spectacles, were retrieved. One-way analysis of variance, or the Kruskal-Wallis test, was used to analyze the changes in AL and spherical equivalent refraction (SER) after wearing spectacles for 12 months in comparison to those at baseline in the three groups.
    Results There was no statistically significant difference in the baseline parameters and duration of wearing spectacles among the three groups (P>0.05). After wearing spectacles for 12 months, the changes in SER were －0.13 (－0.25, 0.00) D, －0.25 (－0.63, －0.25) D, and －0.63 (－1.00, －0.25) D in the HAL+AT group, HAL group, and SVL group, respectively; AL elongation in the three groups was (0.09±0.11) mm, (0.19±0.16) mm, and (0.34±0.16) mm, respectively. The HAL+AT group exhibited slower SER changes (PHAL+AT vs. HAL=0.001, PHAL+AT vs. SVL=0.002) and AL elongation (PHAL+AT vs. HAL=0.009, PHAL+AT vs. SVL=0.001) than those of the HAL and the SVL groups. Compared with those of the SVL group, myopia progression was reduced by 79.4% and AL elongation was slowed down by 73.5% in the HAL+AT group, while in the HAL group, myopia progression and AL elongation were reduced by 60.3% and 44.1%, respectively. According to stratified analysis based on age and myopia progression rate, among younger children aged 6 to 8 years and older children aged 9 to 15 years, the HAL+AT group had a significantly lower proportion of subjects experiencing fast AL elongation (AL>0.36 mm/year) and a significantly higher proportion of subjects experiencing slow AL elongation (AL≤0.18 mm/year) compared to the SVL group (P<0.017).
    Conclusion The combination intervention of spectacle lenses with HAL and 0.01% atropine eye drops is effective in controlling myopia progression in children and adolescents, with better myopia control effect achieved using this combination intervention in myopic children of all ages.

     

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