近视青少年配戴角膜塑形镜前后调节参数变化

doi:10.3760/cma.j.cn115909-20200830-00347

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摘要目的：观察近视青少年配戴角膜塑形镜前后调节参数及隐斜度的变化，探讨角膜塑形镜延缓近视进展的机制及近视发病病因。方法：回顾性研究。收集2011年1月至2019年3月在中国医科大学附属第一医院眼科门诊进行角膜塑形镜配戴前后调节参数资料完整的患者51例（102眼），比较角膜塑形镜配戴前、配戴后1、12个月或以上的正负相对调节、调节滞后、调节幅度、调节灵敏度及隐斜度的变化。对角膜塑形镜配戴前及配戴后1、12个月的调节滞后、负相对调节采用Kruskal-Wallis秩和检验，正相对调节力、调节幅度、调节灵敏度及隐斜度采用单因素方差分析进行比较。结果：51例患者配戴角膜塑形镜1个月后裸眼视力均达1.0，1个月时正相对调节力为（-3.87±1.64）D，12个月时为（-4.39±1.45）D，均较配戴前[（-2.14±1.30）D]明显提高（F=32.515，P<0.001）；调节滞后量较配戴前降低（H=16.351，P<0.001）；双眼调节幅度较配戴前明显提高（F右眼=22.95，P<0.001；F左眼 =18.10，P<0.001）；40 cm处隐斜度较配戴前增加，差异有统计学意义（F=3.281，P=0.040）；负相对调节力、双眼调节灵敏度及5 m处隐斜度配戴前后差异无统计学意义。结论：配戴角膜塑形镜后，眼的正相对调节力明显增强，提高了调节的准确性，改善调节滞后，减少视网膜远视性离焦。正相对调节力下降可能是青少近视发病的病因。

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关键词 ： , 近视, 角膜塑形镜, 正相对调节力, 调节滞后

Abstract： Objective: To study the changes in accommodative parameters and phoria after wearing orthokeratology lenses for adolescent myopia and to explore the mechanism of wearing the lenses in delaying the progression of myopia and the etiology of myopia. Methods: A retrospective study was conducted. Fifty-one myopic patients (102 eyes) were selected from January 2011 to March 2019 in the First Affiliated Hospital of China Medical University. All patients had been wearing the orthokeratology lenses for more than one year and had complete records of accommodative parameters. The positive and negative relative accommodation, accommodative lag, amplitude of accommodation, accommodative facility, distance phoria and near lateral phoria were measured prior to lens wear and 1 and 12 months after wearing the lenses. The Kruskal-Wallis rank sum test was used for the accommodative lag and negative relative accommodation, and one-way ANOVA was used for the positive relative accommodation, accommodative lag, amplitude of accommodation, accommodative facility, distance phoria and near phoria. Results: The visual acuity of the naked eye of the 51 patients was 1.0 after 1 month of wearing the orthokeratology lens. Compared with before wearing lenses -2.14±1.30 D, the positive relative accommodation had significantly improved after wearing lenses for 1 month (-3.87±1.64 D) and 12 months (-4.39±1.45 D) (F=32.515, P<0.001). Accommodative lag was lower than before wearing lenses (H=16.351, P<0.001). The amplitude of accommodation in one and both eyes was significantly higher than before wearing lenses (FOD=22.95, P<0.001; FOS=18.10, P<0.001). The degree of lateral phoria at 40 cm had increased compared with that before wearing lenses, and the difference was statistically significant (F=3.281, P=0.040). There was no significant difference in negative relative accommodation, or accommodative facility for the degree of phoria at 5 m before and after wearing lenses. Conclusions: After wearing the orthokeratology lens, positive relative accommodation is obviously enhanced, which improves the accuracy of regulation, improves the accommodative lag, reduces retinal hyperopia defocus. The decrease in the positive relative accommodation may indicate the etiology of juvenile myopia.

Key words： myopia orthokeratology positive relative accommodation accommodative lag

收稿日期: 2020-12-30

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通讯作者: 徐艳春（ORCID：0000-0002-0392-1062），Email：xuyanchuneye@163.com

引用本文:

谷峰徐艳春张福生薛妍琦. 近视青少年配戴角膜塑形镜前后调节参数变化[J]. 中华眼视光学与视觉科学杂志, 2021, 23(3): 199-204. Feng Gu, Yanchun Xu, Fusheng Zhang, Yanqi Xue. A Clinical Study on the Effect of Orthokeratology on Accommodative Parameters in Myopic Adolescent. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(3): 199-204. DOI: 10.3760/cma.j.cn115909-20200830-00347

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200830-00347 或 https://www.cjoovs.com/CN/Y2021/V23/I3/199

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