光学治疗区偏心与角膜塑形镜配戴后泪膜功能及角膜形态的相关性分析

Correlative analysis of eccentricity of optical treatment zone with tear film function and corneal shape after wearing orthokeratology lenses

目的:探讨光学治疗区偏心与角膜塑形镜配戴后泪膜功能及角膜形态的相关性。方法:选取于本院配戴角膜塑形镜的80例80眼青少年近视患者为研究对象。于戴镜前后不同时间点分别对患者的光学治疗区偏心距离、泪膜功能及角膜形态指标进行检测。根据中位偏心距离,将患者分为低度偏心组和高度偏心组,比较两组患者戴镜前后不同时间点泪膜功能及角膜形态指标的差异。采用Pearson相关法分析戴镜后12mo时总偏心距离与泪膜功能及角膜形态指标的相关性。结果:与戴镜前相比,两组患者戴镜后1wk,3、6、12mo的角膜表面非对称性指数、角膜表面规则性指数均明显升高,差异均有统计学意义(P<0. 05),且高度偏心组患者较低度偏心组患者升高更为显著,差异均有统计学意义(P<0. 05);泪膜破裂时间、角膜曲率、基础泪液分泌量、中央角膜厚度均明显降低,差异均有统计学意义(P<0. 05),且高度偏心组患者较低度偏心组患者在泪膜破裂时间、基础泪液分泌量方面降低更为显著,差异均有统计学意义(P<0. 05),但角膜曲率、中央角膜厚度下降程度则较低(P<0. 05);角膜内皮细胞密度在戴镜后1wk和3mo无明显差异(P>0. 05),在戴镜后6、12mo差异有统计学意义(P<0. 05)。在戴镜后12mo,总偏心距离与角膜表面非对称性指数、角膜表面规则性指数均呈正相关(r=0. 869、0. 815,均P<0. 05),与泪膜破裂时间、角膜曲率、基础泪液分泌量、中央角膜厚度均呈负相关(r=-0. 865、-0. 745、-0. 912、-0. 713,均P<0. 05),与角膜内皮细胞密度未见明显相关性(r=0. 185,P=0. 199)。结论:光学治疗区偏心发生在戴镜起始阶段,且总偏心距离与角膜塑形镜配戴后泪膜功能及角膜形态的改变具有明显相关性。

AIM： To explore the correlation between eccentricity inthe optical treatment area and tear film function andcorneal morphology after orthokeratology.METHODS：Eighty patients （80 eyes） with myopia whowere treated with orthokeratology were selected assubjects. The eccentric distance, tear film function andcorneal morphology of the patient＇s optical treatment areawere detected at different time points before and afterwearing the lens. According to the median eccentricdistance, the patients were divided into low eccentricitygroup and high eccentricity group. The differences of tearfilm function and corneal morphology at different timepoints before and after wearing were compared betweenthe two groups. Pearson correlation coefficient was usedto analyze the correlation between total eccentricity andtear film function and corneal morphological parametersat 12mo after wearing glasses.RESULTS： Compared with before wearing lenses, thecorneal surface asymmetry index and corneal surfaceregularity index of the two groups were significantlyincreased at 1wk, 3, 6 and 12mo after wearing lenses （P〈 0. 05 ）. Patients in the high eccentric group were moresignificantly elevated than in the lower eccentric group,and the differences were statistically significant （P〈0. 05）.The time of tear film rupture, corneal curvature, basictear secretion, and central corneal thickness were significantly lower, and the differences were statisticallysignificant （ P 〈 0. 05 ）. Compared with the patients withlower eccentricity, the patients with high eccentricitygroup had more significant reduction in tear film rupturetime and basic tear secretion, and the difference wasstatistically significant （P〈0. 05）, however, the degree ofcorneal curvature and central corneal thickness decreasedless （ P 〈 0. 05 ）. There was no significant difference incorneal endothelial cell density between 1wk after wearinglenses and 3mo after wearing lenses （ P 〉 0. 05 ）. Thedifference was statistically significant at 6mo and 12moafter wearing lenses （P〈0. 05）. At 12mo after wearing thelens, the total eccentric distance was positively correlatedwith the asymmetry index of the corneal surface and theregularity index of the corneal surface （ r = 0. 869, 0. 815;P〈 0. 05 ）. At 12mo after wearing the lens, the totaleccentric distance was negatively correlated with tear filmrupture time, corneal curvature, basic tear secretion, andcentral corneal thickness （ r = - 0. 865, - 0. 745, - 0. 912,-0. 713; all P 〈 0. 05 ）, and there was no significantcorrelation with corneal endothelial cell density （r = 0. 185,P= 0. 199）.CONCLUSION：The eccentricity of the optical treatmentarea occurs at the beginning of wearing lenses. And thetotal eccentric distance has a significant correlation withthe changes of tear film function and corneal morphologyafter keratoplasty.