Toric设计角膜塑形镜矫治青少年复合性近视散光的临床观察

Clinical observation of adolescent compound myopic astigmatism treated by toric design orthokeratology

目的 探讨Toric设计角膜塑形镜矫治青少年复合性近视散光的临床疗效及安全性.方法 对2014年1月至2015年12月在中国医科大学第一医院眼视光中心门诊就诊的9～14岁复合性近视散光（近视度-1.50～5.00 D,散光度-1.50～3.5 D）患者36例（68只眼）给予Toric设计角膜塑形镜进行矫正.分别测量戴镜前及戴镜后1d、1周、1个月、3个月、6个月、12个月的裸眼视力、屈光度、角膜地形图、眼前节健康状况检查及Toric设计角膜塑形镜的配适状况.结果 戴镜1周、1个月、3个月、6个月及12个月后的裸眼视力均≥0.8,较戴镜前明显提高,差异有统计学意义（P＜0.05）;戴镜后屈光度1周、1个月、3个月、6个月及12个月较戴镜前明显降低,差异有统计学意义（P＜0.05）;戴镜前后角膜地形图3 mm区域前表面平坦及陡峭K值差异有统计学意义（P＜0.05）,后表面K值差异无统计学意义（P＞0.05）.角膜中央3～5 mm最薄点的厚度差异无统计学意义（P＞0.05）;角膜地形图后表面高度差异无统计学意义（P＞0.05）;角膜塑形镜配适状态良好,配戴角膜塑形镜后眼前节未发生感染、角膜薄化前突,主观视觉质量满意.结论 Toric设计角膜塑形镜矫治一定屈光度的青少年复合性近视散光安全有效,但散光矫正的范围仍有一定的局限.

Objective To investigate the clinical effects and safety of Toric design orthokeratology on compound myopic astigmatism in adolescents.Methods Toric design orthokeratology were performed to correct 68 compound myopic astigmatism eyes of 36 （9-14 years old） cases,with myopic degree：-1.50～-5.00 D,and astigmatism：-1.50～-3.50 D.The naked vision,diopter,corneal topography,the survey of the health status in ocular anterior segment,and the wearing status of toric design orthokeratology,were measured and recorded at baseline,and 1 day,1 week,1 month,3 months,6 months,as well as 12 months post treatment.Results The naked vision （≥0.8） was larger than that of baseline significantly （P 〈0.05）,from 1 week to 12 months.In addition,the diopters of naked eyes decreased in 1 week,1 month,3 months and 12 months significantly （P 〈0.05）,compared with the baseline.Moreover,there was a significant difference in flat and steep K value of anterior 3mm surface （P 〈0.05）,instead of posterior surface.Besides,the thickness of central 3-5mm cornea,as well as the height of posterior surface in corneal topography failed to show the significant difference （P 〉0.05）.Finally,the satisfaction of subjective visual quality based on the good wearing status of toric design orthokeratology,non-infection of ocular anterior segment,and non-thinning of cornea post treatment.Conclusions Toric design orthokeratology can correct compound myopic astigmatism in adolescents to some degree,effectively and safely,in spite of the limited range of astigmatism correction.