引用:
原帖由 原子里的小草 于 2012-8-5 21:29 发表 
吴医生,您好,我们论坛上欢欢小朋友戴ok4年了,效果还可以,但是这次检查说内皮细胞减少明显,内皮细胞减少要紧吗,是所有小朋友戴镜时间长了都有这个问题吗
您好！
一般戴角膜接触镜会造成角膜内皮细胞的减少。根据目前的文献应该是这种角膜内皮细胞的减少对角膜的影响并不会很明显，并且变化是微小的，不会引起角膜的功能性改变，或者带来其它的问题。当然，这种变化还和镜片的处方是否正确，镜片是否清洁干净，以及是否定期更换新镜片等很多因素都有关系。我认为，角膜塑形镜对角膜的影响应该是存在的，这种影响是否会很明显，或者是否会给角膜带来其它的问题是需要我们长时间观察的。就目前的文献和观察来看，还没有发现角膜很明显的改变，但是我想，应该做到以下几点来保证角膜的健康：高品质的镜片，正确的处方，细致的护理，按时的复查，定期勤换镜。
有一篇北医谢培英教授的文章比较新，可以网上查一下看看：长期配戴角膜塑形镜对角膜厚度和角膜内皮细胞的影响 谢培英 等
另外一篇是国外的文章，也可参考。
Long-term efficacy and safety of overnight orthokeratology in myopic children
Poster Details
First Author: S.Hoshi JAPAN
Co Author(s): T. Hiraoka Y. Sato T. Oshika
Abstract Details
Purpose:
This 3-year prospective study was conducted to assess efficacy and safety of long-term application of overnight orthokeratology for young myopes.
Setting:
Fifty-seven eyes of 57 patients (38 males, 19 females; age 7 to 19; mean ± SD, 11.3 ± 3.1) who visited Sato Yuya Eye Clinic from March 2002 to November 2009 were enrolled in the study. Orthokeratology lenses with four-zone reverse-geometry design were used in the study. The patients were instructed to wear their orthokeratology lenses every night for at least 7 consecutive hours for 3 years.
Methods:
Uncorrected visual acuity and refraction were measured before and 1, 6, 12, 24, 36 months after orthokeratology lens wear started. Corneal endothelial cell density and axial length were evaluated before and 12, 24, 36 months after orthokeratology lens wear started. Unpaired t test and x2 test were used to compare the baseline data between the subjects who completed the study and the subjects who dropped out of the study. Time course of changes in uncorrected visual acuity, spherical equivalent refractive error (SER), astigmatism, corneal endothelial cell density, and axial length were assessed by repeated-measures analysis of variance (ANOVA). Where appropriate, Dunnett corrections were used to take account of post-hoc comparisons. Differences were considered statistically significant at p < 0.05.
Results:
Among the 57 patients, 51 patients successfully completed the 3-year follow-up examination (33 males, 18 females; age 7 to 18; 10.9 ± 2.7). Six patients uncompleted the study (5 males, 1 female; age 7 to 19; 14.3 ± 4.5), giving a dropout rate of 10.5%. There were significant differences in baseline age (p = 0.009) and SER (p = 0.025) between the subjects who completed and who dropped out of the study. No severe complications were noted throughout the observation period. There were significant improvements in uncorrected visual acuity (p < 0.001) and in SER (p < 0.001), the post-hoc test showed that compared to the baseline values both factors were significantly improved at all subsequent visits (p < 0.001). There was no significant change in astigmatism (p = 0.382) and corneal endothelial cell density (p = 0.131) throughout the observation period. In 3 years, axial length increased from 24.52 ± 0.80 to 25.03 ± 0.83 mm. The increases in axial length for 3 years was 0.51 ± 0.39 mm. Axial length significantly increased with time (p < 0.001), the post-hoc test showed that compared to the baseline value axial length elongated at all subsequent visits (p < 0.001).
Conclusions:
The dropout rate of this study (10.5%) was similar to that of other overnight orthokeratology studies in children. Myopic refractive error in dropouts was significantly larger than that in subjects who completed the 3-year study, indicating that subjects with higher myopia are more vulnerable to dropout from overnight orthokeratogy treatment. Uncorrected visual acuity and SER sufficiently improved at 1-month visit, and thereafter maintained that level over the study period. Besides, we did not observe any severe adverse events or statistically significant corneal endothelial cell loss during the 3-year observation period. The present study demonstrated clinically acceptable efficacy and safety of long-term application of overnight orthokeratology for mild to moderate myopia in Japanese children..
