Purpose

To determine the efficacy, predictability and safety of long-term orthokeratology in children and adults.

Methods

Case histories of 300 orthokeratology patients (596 eyes; 34.3% children; 65.7% adults) were reviewed to collect information on demographics, corneal and refractive parameters, visual acuity, residual refraction and adverse effects. Predictability was defined as the percentage of eyes with absolute values of spherical equivalent refraction ≤ 0.5 D of emmetropia, and efficacy as the ratio of post-orthokeratology uncorrected and pre-orthokeratology corrected distance visual acuity.

Results

Median duration of treatment was 37 and 28.5 months in children and adults, respectively (p = 0.022). During the first year, 17.2% of children and 33% of adults ceased lens wear (p < 0.001). For children and adults with a successful ortho-k treatment of at least one year of duration, 88.7% and 95.9% of eyes had a predictable refractive outcome, and efficacy was 0.98 and 1.01, respectively. A larger percentage of children (65.7%) were free of complications than of adults (55.4%) (p = 0.015). One event of microbial keratitis occurred in adults (6.8 cases per 10,000 patient-years) and none in children. Corneal staining was the most frequent complication, with a higher incidence in adults (p = 0.007) and in higher myopia (p < 0.001), higher anterior corneal eccentricity (p = 0.019) and smaller anterior horizontal radius (p = 0.027).

Conclusion

Orthokeratology is a safe and predictable long-term procedure in children and adults, with a low incidence of serious adverse effects. Corneal staining episodes are relatively frequent throughout the course of the treatment, thus highlighting the relevance of education of experienced users.

中文翻译：

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长期角膜塑形术的疗效、可预测性和安全性：一项为期 18 年的随访研究

目的

确定儿童和成人长期角膜塑形术的疗效、可预测性和安全性。

方法

回顾了 300 名角膜塑形术患者（596 只眼；34.3% 的儿童；65.7% 的成人）的病历，以收集有关人口统计、角膜和屈光参数、视力、残余屈光和不良反应的信息。可预测性定义为正视球面等效屈光度绝对值≤ 0.5 D 的眼睛百分比，而疗效定义为角膜塑形术后未矫正和角膜塑形术前矫正远视力的比率。

结果

儿童和成人的中位治疗时间分别为 37 个月和 28.5 个月（p = 0.022）。在第一年，17.2% 的儿童和 33% 的成人停止佩戴镜片（p < 0.001）。对于成功矫正的儿童和成人-k 治疗至少一年，88.7% 和 95.9% 的眼睛有可预测的屈光结果，疗效分别为 0.98 和 1.01。与成人（55.4%）相比，更大比例的儿童（65.7%）没有并发症（p = 0.015）。成人发生 1 起微生物角膜炎事件（每 10,000 患者年 6.8 例），而儿童则没有。角膜染色是最常见的并发症，成人发病率较高（p = 0.007），近视度数较高（p < 0.001），角膜前部偏心率较高（p = 0.019）和前水平半径较小（p = 0.027）。

结论

角膜塑形术在儿童和成人中是一种安全且可预测的长期手术，严重不良反应的发生率较低。角膜染色事件在整个治疗过程中相对频繁，因此突出了对有经验的用户进行教育的相关性。