不同光学设计角膜塑形镜控制近视进展的临床观察．

The effect of different optical designs for orthokeratology in .controlling the development of myopia in pre-adolescents

目的观察不同光学设计角膜塑形镜控制近视发展的临床效果。方法前瞻性临床研究。7—14岁低中度青少年近视患者254例（254眼），按照角膜塑形术的验配程序，根据患儿及家属的选择给予验配不同光学设计的角膜塑形镜（设计1、设计2、设计3），分别测量戴镜前以及戴镜1年后的眼轴长度。对相关数据进行配对t检验、独立样本t检验以及单因素方差分析。结果角膜塑形镜矫治1年后，眼轴增长（0．11±0．16）mm，其中低度近视、中度近视眼轴分别增长（0．20±o．18）mm及（0．09±0．14）mm，与戴镜前相比，差异均有显著统计学意义（￡-11．41，P〈0．01；t=-8．33，P〈0．叭；f=-8．73，P〈0．01）。低度近视配戴角膜塑形镜1年后眼轴改变大于中度近视，两者差异有统计学意义（t=-4．212，P〈0．01）。无论低度近视或中度近视，设计1组与设计3组眼轴增长差异有统计学意义，设计3组具有更明显的延缓近视进展的作用（F=4．32，P=-0．018；F=5．58，P=-0．004）。结论不同光学设计的角膜塑形镜控制近视进展的作用不尽相同。其原因可能是不同光学设计的角膜塑形镜所导致的周边屈光的模式不同。

Objective To evaluate the effect of different optical designs for orthokeratology in controlling the development of myopia in pre-adolescents. Methods In this prospective study, different optical designs for orthokeratology （design 1, design 2, design 3） were used in the correction of refractive errors for 254 eyes of 254 low to moderate myopic patients. Axial length （AL） was measured before and after orthokeratology. Data were analyzed with a paired t test, independent samples t test and one-way ANOVA. Results After 1 year, AL increased by （0.11±0.16）mm, （0.20±0.18）mm in the low myopia group and （0.09±0.14）mm in the moderate myopia group, indicating a statistically significant difference compared with those before lens wear （t=-11.41, P〈0.01; t=-8.33, P〈0.01; t=-8.73, P〈0.01）. The change in AL in the low myopia group was greater than in the moderate myopia group （t=-4.212, P〈0.01）. The rate of increase in AL showed significant differences for the 3 designs, with design 3 having the slowest rate （F=4.32, P=-0.018; F=5.58, P=-0.004）. Conclusion Different optical designs for orthokeratology have different effects in reducing myopia progression. Different peripheral refractive patterns induced by different optical designs could be the active mechanisms.