摘要
目的 观察重复低强度红光照射控制儿童近视进展的有效性和安全性.方法 回顾性队列研究.纳入2022年1至12月就诊于大连大学附属中山医院、年龄范围为6～12岁、确诊为近视者60例(120只眼).根据是否照射重复低强度红光选取试验组30例(60只眼)和对照组30例(60只眼).试验组患者接受650 nm红光照射每日2次,每次3 min,间隔时间大于4 h,余时间佩戴单焦点框架眼镜;对照组佩戴单焦点框架眼镜进行日常活动.观察并比较两组在干预1、3、6及12个月后的裸眼视力(logMAR)、等效球镜度(SE)、眼轴长度、裂隙灯显微镜下眼前节表现、黄斑区光学相干断层扫描(OCT)、眼底检查.结果 干预1、3、6及12个月后:试验组SE分别为-1.00(-1.62,-0.53)、-1.00(-1.50,-0.37)、-1.00(-1.50,-0.37)、-0.94(-1.50,-0.50)D,对照组 SE 分别为-1.25(-1.75,-0.75)、-1.50(-2.00,-0.87)、-1.50(-2.25,-1.00)、-1.81(-2.50,-1.15)D,两组在干预3、6及12个月比较差异具有统计学意义(P3个月=0.004,P6个月＜0.001,P12个月＜0.001);试验组眼轴长度分别为(23.67±0.45)、(23.64±0.44)、(23.61±0.43)、(23.62±0.44)mm,对照组眼轴长度分别为(23.95±0.88)、(24.01±0.88)、(24.08±0.88)、(24.14±0.89)mm,两组在随访 1、3、6 及 12 个月比较差异具有统计学意义(P1个月=0.028,P3个月=0.004,P6个月=0.001,P12个月＜0.001);试验组随访各时间点裸眼视力分别为 0.20(0.40,0.10)、0.10(0.30,0.00)、0.10(0.20,0.00)、0.10(0.20,0.00),对照组裸眼视力分别为 0.30(0.40,0.10)、0.30(0.50,0.20)、0.40(0.50,0.20)、0.40(0.50,0.30),两组随访1、3、6、12个月裸眼视力比较差异具有统计学意义(P1个月=0.017,P3个月＜0.001,P6个月＜0.001,P12个月＜0.001);红光干预1、3、6及12个月后,试验组眼前节、眼底检查及黄斑区OCT与红光照射前相比无改变.试验组未出现眼红、眼痛、畏光、流泪、眼底病变等眼部并发症,亦未发现认知障碍及行为异常.仅2例儿童出现眼干涩,未停止使用红光,给予对症干预后症状消失.结论 重复低强度红光照射可以安全有效控制儿童近视进展.
Abstract
Objective To evaluate the efficacy and safety of the repeated low-level red-light for controlling myopia progression in children.Methods This was a retrospective cohort study.A total of 60 school children(120 eyes)aged 6-12 years with myopia treated at the Affiliated Zhongshan Hospital of Dalian University from Jan.2022 to Dec.2022 were included.Depending on whether repeated low-level red-light was irradiated,they were devided into a trail group and a control group with 30 cases(60 eyes)in each group.Participants in the trial group was irradiated with 650 nm red-light twice a day(3 minutes each time,with an interval of more than 4 hours)and single-vision spectacles were worn during the rest of the time;the control group wore single-vision spectacles for daily activities.Uncorrected visual acuity(logMAR),spherical equivalent(SE),axial length,anterior segment presentation under slit lamp microscope,and macular optical coherence tomography(OCT)were observed and compared before and at 1,3,6 and 12 months after intervention.Results At 1,3,6 and 12 months after intervention,the spherical equivalent of the trial group were-1.00(-1.62,-0.53),-1.00(-1.50,-0.37),-1.00(-1.50,-0.37)and-0.94(-1.50,-0.50)D,and the spherical equivalent of the control group were-1.25(-1.75,-0.75),-1.50(-2.00,-0.87),-1.50(-2.25,-1.00)and-1.81(-2.50,-1.15)D.The difference between groups was statistically significant at 3,6 and 12 months(P3months=0.004,P6months＜0.001,P12 months＜0.001).The axial length of the trial group were(23.67±0.45),(23.64±0.44),(23.61±0.43)and(23.62±0.44)mm,and the axial length of the control group were(23.95±0.88),(24.01±0.88),(24.08±0.88)and(24.14±0.89)mm,respectively.The difference between groups was statistically significant at 1,3,6 and 12 months(P1 month=0.028,P3 mo、ths=0.004,P6months=0.001,P12months＜0.001).The uncorrected visual acuity of the trial group was 0.20(0.40,0.10),0.10(0.30,0.00),0.10(0.20,0.00),0.10(0.20,0.00);the uncorrected visual acuity of the control group was 0.30(0.40,0.10),0.30(0.50,0.20),0.40(0.50,0.20),0.40(0.50,0.30).The difference between groups was also statistically significant at 1,3,6 and 12 months(P1month＜0.017,P3 months＜0.001,P6 months＜0.001,P12 months＜0.001).After 1,3,6 and 12 months of red light intervention,there were no abnormal changes in anterior segment,fundus examination or macular OCT compared with those before red-light irradiation.No ocular complications were observed in the trial group after the intervention,such as red eyes,eye pain,photophobia,tears,fundus damage,cognitive impairment or behavioral abnormalities.Dry eye children occured in two children,which vanished after symptomatic intervention was given without calling off the use of red light.Conclusion The repeated low-level red-light can effectively delay the progression of children myopia without obvious adverse complications.
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