角膜塑形术对眼视觉质量、调节功能的动态影响

Dynamic changes of visual quality and accommodation after orthokeratology

目的探讨角膜塑形术对中低度近视眼的对比敏感度、调节近点、调节灵敏度、正负相对调节的影响及其动态变化过程。方法连续收集2009年8月至2013年8月就诊的青少年中、低度近视患者83例166眼。按戴镜时间分为4组:1组(戴镜前50例99眼),2组(戴镜后1~3个月36例72眼),3组(戴镜后时间>3~12个月38例76眼),4组(戴镜后时间>12~40个月42例84眼)。检查对比敏感度,采用移近法测定调节近点,测定正、负相对调节,±2.00 D翻转拍测定调节灵敏度。结果 (1)对比敏感度:与1组(3 c·d-1:1.80±0.16;6 c·d-1:2.06±0.15;12 c·d-1:1.84±0.15;18 c·d-1:1.42±0.15)比较,2、3、4组各空间频率均下降,差异均有统计学意义(均为P=0.000)。(2)调节近点变化:与1组(9.10±1.88)cm比较,2、3、4组调节近点分别为(7.74±1.90)cm、(7.43±1.35)cm、(7.03±1.26)cm,差异均有统计学意义(均为P=0.000)。(3)单眼调节灵敏度变化:与1组(8.70±2.46)周·min-1比较,2组差异无统计学意义(P=0.90);3组、4组调节灵敏度均增加,差异均有统计学意义(P=0.02、P=0.006)。(4)相对调节:正相对调节,与1组(-2.07±0.88)D比较,2组差异无统计学意义(P=0.110);3组、4组正相对调节均增加,差异均有统计学意义(P=0.001、0.006)。负相对调节:与1组(+2.57±0.58)D比较,2组、3组差异均无统计学意义(P=0.23、0.98),4组负相对调节减少(P=0.002)。结论角膜塑形术引起各空间频率对比敏感度阈值均下降,调节能力增加。调节灵敏度、正相对调节能力保持稳定后呈增加趋势,负相对调节能力保持稳定后呈下降趋势。

Objective To evaluate the dynamic changes of contrast sensitivity（CS）,accommodation nearpoint（NP）,accommodative facility（AF）,positive relative accommodation（PRA）,negative relative accommodation（NRA） after orthokeratology（OK）.Methods Retrospective clinical study.Eighty-three myopia subjects（166 eyes） from August 2009 to August 2013 in our hospital were enrolled.Four groups were divided based on wearing OK lens time：Group 1（before wearing,50 cases,99 eyes）,group 2（1-3 months after wearing,36 cases,72 eyes） group 3（〉3- 12 months after wearing,38 cases,76 eyes）,group 4（ 〉12-40 months after wearing,42 cases,84 eyes）.CSV-1000 E was used to measure CS,the subjective push-up method was used to test NP,Phoropter（Nidek RT-600） was used to measure PRA/NRA,±2.00 D flippers was used to measure AF.Results Compared with group 1（1.80 ±0.16,2.06 ±0.15,1.84 ±0.15,1.42 ±0.15）,CS at different spatial frequencies（3 c · d^（-1）,6 c· d^（-1）,12 c·d^（-1）,18 c·d^（-1）） in group 2,3,4 all decreased（all P=0.000）.NP in group 1,2,3,4 were（9.10 ± 1.88） cm,（7.74 ± 1.90） cm,（7.43 ± 1.35） cm and（7.03 ± 1.26） cm,respectively,there were significant differences of group 2,3 and 4 compared with group 1（all P=0.000）.Compared with group 1（8.70 ±2.46） circles per minute,there was no change in AF of group 2（P = 0.90）,and increased in group 3 and 4（P = 0.02,P = 0.006）.Compared with group 1（-2.07 ± 0.88） D,there was no change in PRA of group 2（P = 0.110）,and increased in group 3 and 4（P = 0.001,P = 0.006）.Compared with group 1,there was no change in NRA of group 2 and 3（P=0.23,P =0.98）,and decreased in group 4（P =0.002）.Conclusion All CS will be increased,and accommodation will be increased after wearing OK lens.AF and PRA present the increased tendency,and NRA present the decreased tendency.