- 學位論文
配戴角膜塑型鏡片合併使用極低濃度阿托平眼藥水對於高危險近視進展孩童的影響
The Effects of Combined Orthokeratology with Low Concentration Atropine Treatment in Myopic Children at Risk of Fast Progression
摘要
研究背景 近視是孩童區屈光異常中常見的一個疾病。其成因分爲軸性的近視以及非軸性的近視，前者因眼軸不斷增長導致影像無法清晰投射於視網膜之上，也是兒童近視的主要成因。近視是一種疾病，與許多嚴重的併發症相關，如視網膜剝離、近視性黃斑新生血管出血、近視性黃斑退化、青光眼等，防治及控制兒童近視乃是一重要議題。控制近視的治療方法有許多，本文主要探討極低濃度阿托平(0.01%)眼藥水以及角膜塑形鏡片合併使用對於兒童近視控制的效果。阿托平眼藥水已證實為有效控制近視的方法，而角膜塑形鏡片也是一有效控制近視的治療工具，其作用機轉的假說為鏡片造成的週邊近視性離焦，來延緩眼軸的增長。然而，合併使用阿托平眼藥水及角膜塑形鏡片的治療效果則未有共識，本文主要欲探討合併兩種治療方式於近視孩童的控制成效。 研究方法 此研究乃回溯性統計及分析近視孩童於2009年至2015年使用阿托平藥水(0.01%)合併角膜塑形鏡片或單純使用角膜塑形鏡片的治療效果。與家長討論孩童平時的活動之後，若患童被評估為高危險近視進展的族群，則提供極低濃度阿托平眼藥水(0.01%)合併角膜塑形鏡片的治療方法。主要評估治療成效的方法是測量患童的眼軸長度。 結果 總共收錄47位孩童，47顆眼睛，來自22位男孩及25位女孩。平均屈光異常的球面當量為−3.68 ± 1.41 D，追蹤平均時間為3.93 ± 1.18年，每位孩童的追蹤時間皆大於兩年。患童的平均年紀為10.60 ± 1.62歲。在47位患童中，32位(68%)接受了極低濃度阿托平眼藥水(0.01%)合併角膜塑形鏡片的治療，25位(32%)接受了角膜塑形鏡片的治療，兩組每年平均增長的眼軸長沒有顯著差別(p = 0.977, 統計方法：GEE)，兩組也均無報告治療副作用。 結論 針對高危險近視進展的孩童，使用合併極低濃度阿托平(0.01%)眼藥水合併角膜塑形鏡片治療方法其效果與一般近視孩童單獨使用角膜塑形鏡片並無差異。仍需其他研究來證實阿托平藥水與角膜塑形鏡片治療的相互影響關係。
並列摘要
Background and Objectives Myopia is among the most common refractive errors that affect children. It is related with severe complications such as retinal detachment, myopic macular degenerations, and glaucoma, which were sight-threatening. Slowing the progression of myopia has become a considerable concern for parents of myopic children. The purpose of this study is to evaluate the combined effects of low concentration (0.01%) atropine and orthokeratology (OK) in myopic children at risk of fast progression. Material and Methods The retrospective study included children aged 9-15 years with a spherical equivalent (SE) refraction of −3.68 ± 1.41 D and astigmatism of −2.50 D or less. They were assigned to two treatment protocols, OK or OK with low concentration atropine (0.01%), based on the patient’s assessment. After consulting with parents, myopic children at risk of fast progression generally were applied combination therapy. Their axial length (AXL) was measured and compared. Results Forty-seven eyes from 47 children (22 boys and 25 girls) with myopia (SE, −3.68 ± 1.41 D) undergoing treatment with OK or OK with low concentration atropine, from 2009–2015, with at least 2 years follow-up were enrolled. The average follow-up period and patient’s mean age were 3.93 ± 1.18 years and 10.60 ± 1.62 years, respectively. Thirty-two children (68.09%, the study group) received the combination therapy, whereas the other 15 (31.91%, the control group) received only OK. Annual AXL elongation showed no significant differences between the two groups (p = 0.977 by GEE). There were no significant adverse effects in either group. Conclusions Myopic children at risk of fast progression with combination therapy did not show significant difference from single therapy of OK treatment in myopic children, Further studies should be designed to clarify the additional effect of atropine toward OK.