角膜塑形术对近视患者眼调节参数及立体视觉的影响

The Influence of Orthokeratology on Adjustable Parameters and Stereo Vision of Myopia Patients

目的探讨角膜塑形术对近视患者眼调节参数以及立体视觉的影响。方法选取2014年6月至2015年6月三二〇一医院眼科收治的65例近视患者为研究对象。根据等效球镜度将患者分为低度近视组(26例,屈光度<-2.00 D),中度近视组(22例,屈光度-2.00 D^-4.00 D)和高度近视组(17例,屈光度>-4.00 D)。患者进行角膜塑形术,治疗3个月后比较患者的立体视觉指标(裸眼视力、屈光度、远、近视力及立体视锐度差值)及眼调节参数[调节幅度、调节灵敏度、调节集合与调节比值(AC/A)、正相对性调节(PRA)、负相对性调节(NRA)]。结果治疗后,患者球镜度数、柱镜度数及裸眼视力与治疗前比较,差异有统计意义[(-0.20±0.06)D比(-1.77±0.13)D,(-0.24±0.07)D比(-1.54±0.15)D,0.87±0.17比0.43±0.14,P<0.05];低度近视组、中度近视组以及高度近视组患者的远视力差值、近视力差值及立体视锐度差值比较差异均有统计意义(P<0.05)[(0.48±0.11)比(0.78±0.21)比(1.06±0.35),(0.22±0.07)比(0.43±0.13)比(0.45±0.14),(185±51)″比(147±30)″比(114±30)″],其中高度近视组患者近视力、远视力上升幅度最大,而低度近视组立体视锐度上升幅度最大;低、中、高度近视组患者眼部调节幅度、调节灵敏度比较差异有统计意义[(9.1±1.5)D比(9.3±1.6)D比(10.4±1.0)D,(12.6±2.8)D比(12.8±2.1)D比(15.7±2.5)D)](P<0.05),其中高度近视组患者眼部调节幅度与调节灵敏度变化最大;低、中、高度近视组患者的AC/A及PRA比较差异有统计意义[(4.17±1.25)比(2.61±0.75)比4.13±1.23),(-1.98±0.61)D比(-2.14±0.65)D比(-2.72±0.85)D](P<0.05),其中中度近视组患者的AC/A低于高、低度近视组(P<0.05),而高、低度近视组患者的AC/A比较,差异无统计学意义(P>0.05);NRA比较差异无统计学意义[(2.38±0.58)D比(2.63±0.72)D比(2.57±0.41)D](P>0.05)。结论角膜塑形术能有效改善患者的眼调节参数,提高远近视力及立体视锐度,尤其是高度近视组。

Objective To explore the influence of orthokeratology on eye＇ adjustable parameters and stereo vision of myopia patients. Methods Total of 65 myopia patients in 3201 Hospital from Jun. 2014 to Jun. 2015 were included in the study. The patients were divided into low myopia group（26 cases,diopter 〈 -2. 00 D）, moderate myopia group（22 cases, diopter from -2.00 D to -4. 00 D） and high myopia group （17 cases,diopter 〉 -4. 00 D）. All the patients were treated with orthokeratology, three months later the stereo visual（ unaided visual acuity,diopter, far and near visual acuity and stereopsis acuity difference） and ocular regulating parameters （ amplitude of accommodation, sensitivity adjustment, AC/A and PRA, NRA） of the patients were observed. Results The spherical degree, astigmatism diopter and naked eye vision before and after treatment were statistically significantly different E （ - 0. 20 ± 0.06 ） D vs （ - 1.77 ± O. 13 ） D, （ -0. 24 ±0. 07） D vs （ - 1.54 ±0. 15） D, （0. 87 ±0. 17） vs （0. 43 ± 0. 14） ,P 〈0.05 ]. The far sight, near vision and stereo visual±aeuity of the low myopia group, moderate myopia group and high myopia group were statistically significantly different [ （ 0.48 ± 0. 11 ） vs （ 0.78 ± 0.21 ） vs （ 1.06 ± 0. 35 ）, （ 0. 22 ± 0.07） vs （0.43±0. 13） vs （0.45 ±0. 14）,（185 ±51） vs （147 ±30） vs （114±30） ,P 〈0.05], the near vision, far sight of the high myopia group were higher than other groups, stereo visual acuity increase of the low myopia group was higher than other groups. Eyes＇amplitude of accommodation and sensitivity adjust- ment of the low, moderate and high myopia group had statistically significant difference [ （9. 1 ± 1.5 ） D vs （9.3±1.6） Dvs （10.4±1.0） D, （12.6＋ 2.8） D vs （12.8 ±2.1） D vs （15.7 ± 2.5） D,P〈 O. 05 ± ,among of which, the change of sensitivity adjustment and amplitude of accommodation of the high myopia group were most significant. The AC/A and PRA of the low, moderate and high myopia group had sta- tistically significant differences I （4. 17 ± 1.25 ） vs （ 2.61 ± 0. 75 ） vs （4. 13 ± 1.23 ）, （ - 1.98 ± 0. 61 ） D vs （ - 2. 14 ± 0. 65 ） D vs （ - 2.72 ± 0. 85 ） D, P 〈 0.05 ], among which, AC/A of the moderate myopia group was lower than the other two groups, while the difference between the low myopia and high myopia group was not statistically significant. The NRA among the three groups had no statistically significant differ- enter（2.38±0.58） Dvs （2.63±0.72） Dvs （2.57±0.41） D,P〉0.05].Conclusion Orthokeratology can effectively improve the adjustable parameters, enhance near and distant vision and stereopsis acuity of themyopia patients, especially for the high myopia group.