近视青少年的视网膜周边离焦及角膜塑形镜对周边离焦的影响

Peripheral Refraction Difference Value in Myopic Adolescents and the Effect of Orthokeratology on Peripheral Refraction Difference Value

目的探讨不同屈光度近视青少年的视网膜不同区域周边离焦值(RDV)的差异,并观察近视青少年配戴角膜塑形镜(OK)前后的周边离焦变化。方法前瞻性临床研究。收集2021年4—9月就诊于郑州大学第一附属医院的102例(184眼)近视青少年的临床资料纳入研究。根据验光结果将其分为高度、中度、低度近视组,测量其视网膜不同区域的RDV。在佩戴OK镜的近视青少年中随机选取33例(33只右眼),测量其戴镜前、戴镜1d、戴镜1个月时的RDV。结果高度及中度近视组周边离焦总值(TRDV)均呈远视性离焦,差异有统计学意义(P<0.05),高度近视组周边远视性离焦更明显。高度近视组TRDV远视性离焦最大(P<0.05),且颞侧远视性离焦最大(P<0.05)。中度近视组颞侧、鼻侧及下侧均呈远视性离焦状态,差异无统计学意义(P>0.05)。在低度近视组,仅距黄斑区15°视场范围内离焦值(RDV-15)呈远视性离焦,其余区域均呈近视性离焦。戴镜后各时间点的视网膜各范围RDV与戴镜前比较,差异有统计学意义(P<0.05)。戴镜1个月时TRDV离焦变化值最大(P<0.05),且颞侧最明显(P<0.05)。结论青少年近视度数越大,周边远视性离焦越明显,距黄斑区越远远视性离焦越明显,且颞侧最明显。配戴OK镜后,视网膜各范围周边远视离焦值均变小,距黄斑越远离焦变化量越大,且颞侧最明显。

Objective To investigate the difference of peripheral refraction difference value(RDV)in various dioptric myopia of adolescents,and observe the RDV changes before and after wearing orthokeratology(OK).Methods Prospective case series studies.The clinical data of 102 myopic adolescents(184 eyes)who were treated in the First Affiliated Hospital of Zhengzhou University from April to September 2021 were collected and studied.According to the optometry,all patients were divided into high myopia group,moderate myopia group and low myopia group,and the RDV of different areas of retinas of these adolescents were measured.And 33 children(33 right eyes)who choose to wearing OK lens were enrolled randomly,and measured the RDV before and 1 day,1 month after wearing OK lens.Results The total refraction difference value(TRDV)in high and moderate myopia groups showed hyperopic RDV and the difference was statistically significant(P<0.05),and high myopic group showed more hyperopic RDV.In high myopia group,TRDV had maximum hyperopic RDV(P<0.05),and the temporal side had maximum hyperopic RDV(P<0.05).In moderate myopia group,the temporal,nasal and inferior sides were hyperopic RDV and there were no statistical differences(P>0.05).In low myopia group,only within a 15-degree field of view from the macular area RDV(RDV-15)was hyperopic RDV,and the rest of the areas were myopic RDV.The differences of RDV of each area before and after wearing OK lens at each time point were statistically significant(P<0.05).After wearing OK lens 1 month,the change was more obvious in TRDV(P<0.05),and the most obvious area was the temporal side(P<0.05).Conclusion The higher the degree of adolescent myopia,the more obvious hyperopic RDV,and the farther distant from the macular,the larger in the hyperopic RDV,and the most obvious area is the temporal side.The hyperopic RDV show smaller at each side of the retina after wearing OK lens,the farther distance from the macular,the larger RDV change,and the most obvious area is the temporal side.