不同透镜设计的角膜塑形镜对青少年中高度散光近视患者角膜地形图指标的影响

Effect of different lens designs of orthokeratology on corneal topography in adolescents with moderate to high astigmatism and myopia

目的探究不同透镜设计的角膜塑形镜对青少年中高度散光近视患者角膜地形图指标的影响。方法回顾性分析2019年3月至2021年3月南平市第一医院眼科收治的120例(共238眼)青少年中高度散光近视患者的临床资料,按照不同类型的角膜塑形镜分别纳入球面镜片组(62例,122眼)与环曲面镜片组(58例,116眼),比较两组患者的角膜地形图指标、戴镜前后裸眼视力(UCVA)、角膜3 mm治疗区散光以及角膜治疗区偏心量。结果佩戴后,球面镜片组3 mm处平坦K值低于佩戴前,环曲面镜片组3、5 mm处平坦K值低于佩戴前,差异有统计学意义(P<0.05);环曲面镜片组佩戴后的3、5、7 mm处平坦K值均低于球面镜片组,差异有统计学意义(P<0.05)。两组患者佩戴后的表面规则性指数(SRI)、表面非对称性指数(SAI)、UCVA均高于本组佩戴前,差异有统计学意义(P<0.05);两组患者佩戴后的SRI、SAI、UCVA比较,差异无统计学意义(P>0.05)。两组患者佩戴后的角膜3 mm治疗区散光及角膜治疗区偏心量均低于本组佩戴前,且环曲面镜片组低于球面镜片组,差异有统计学意义(P<0.05)。结论采用环曲面角膜塑形镜与球面角膜塑形镜对青少年中高度散光近视患者进行干预,两者改善青少年中高度散光近视患者的UCVA效果相当,前者可改善患者角膜地形图相关指标、降低治疗区散光能力以及提升镜片稳定性,可用于临床推广。

Objective To investigate the effect of different lens designs of orthokeratology on corneal topography in adolescents with moderate to high astigmatism and myopia.Methods The clinical data of 238 eyes of 120 adolescent patients with moderate to high astigmatism and myopia admitted to the Department of Ophthalmology,the First Hospital of Nanping from March 2019 to March 2021 were retrospectively analyzed.According to different types of orthokeratology lenses,they were divided into spherical lens group(62 cases,122 eyes)and toric lens group(58 cases,116 eyes).The corneal topography index,uncorrected visual acuity(UCVA),astigmatism at the 3 mm treatment area and decentration of the treatment area were compared between the two groups.Results After wearing,the flat K value at 3 mm in the spherical lens group was lower than that before wearing,and the flat K value at 3 and 5 mm in the toric lens group were lower than those before wearing,and the differences were statistically significant(P<0.05).Toric lens group after wearing flat at 3,5,7 mm K values were lower than those of spherical lens group,and the differences were statistically significant(P<0.05).After wearing,the surface regularity index(SRI),surface asymmetry index(SAI)and UCVA of two groups were higher than those before wearing,and the differences were statistically significant(P<0.05),while there were no significant differences in SRI,SAI,and UCVA between the two groups after wearing(P>0.05).The corneal astigmatism and decentration in the 3 mm treatment area of the two groups after wearing were lower than those before wearing,and that of the toric lens group was lower than that of the spherical lens group,and the differences were statistically significant(P<0.05).Conclusion Toric orthokeratology and spherical orthokeratology have the same effect on improving UCVA in adolescents with moderate to high astigmatism and myopia.The former can improve the related indexes of corneal topography,reduce the ability of astigmatism in the treatment area and improve the stability of the lens,which can be used for clinical promotion.