配戴角膜塑形镜后镜片偏心的两种测量方法比较

doi:10.3760/cma.j.cn115909-20200609-00248

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摘要目的：对比分析配戴角膜塑形镜后2种镜片偏心的测量方法。方法：回顾性临床研究。选取2016年 8月至2018年10月在温州医科大学附属眼视光医院完成角膜塑形镜验配并持续戴镜24个月的近视儿童77例，将戴镜前和戴镜3个月后的角膜地形图对比构建切向差异图，分析戴镜前和戴镜3个月后Kappa角距离的变化情况，然后通过MATLB编程分析，在切向差异图上模拟塑形圆并定位圆心即塑形区中心，分别测量角膜顶点及瞳孔中心与塑形区中心的距离，偏心距离1为角膜顶点与塑形圆圆心距离，偏心距离2为瞳孔中心与塑形圆圆心的距离，对比分析2种偏心测量方法值的差异。通过配对t检验分析戴镜前后角膜平坦子午线上的曲率值（Kf）、角膜陡峭子午线上的曲率值（Ks）、Kappa 角距离、偏心距离1、偏心距离2的差异，通过独立样本t检验分析2种方法测量的偏心距离（上下鼻颞）的差异。对眼轴变化与偏心距离相互之间关联的因素分析采用Pearson相关分析。结果：配戴角膜塑形镜前和2年后的眼轴分别为（25.25±0.81）mm、（25.63±0.76）mm，差异有统计学意义（t=-10.014，P<0.001）。角膜表面参数戴镜前的Kf为（42.80±1.23）D，Ks为（44.09±1.40）D，戴镜 3个月后的Kf为（41.00±1.73）D，Ks为（42.85±1.93）D，戴镜前后差异有统计学意义（tKf=8.893， PKf<0.001；tKs=5.903，PKs<0.001）。戴镜前和戴镜后的Kappa角距离分别为（0.27±0.21）mm和（0.29±0.21）mm，差异无统计学意义。偏心距离 1 和偏心距离 2 分别为（0.64±0.31）mm、（0.63±0.35）mm，二者差异无统计学意义，2种方法测量的偏心方向结果均以颞下方向偏心较多。 2种测量方法测得偏心距离均与眼轴变化呈负相关（偏心距离1：r=-0.332，P=0.003；偏心距离2： r=-0.310，P=0.006）。结论：配戴角膜塑形镜不引起Kappa角的变化。角膜顶点到塑形区中心的偏心距离和瞳孔中心到塑形区中心的镜片偏心距离无明显差异。

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关键词 ： , 近视, 角膜塑形镜, 偏心

Abstract： Objective: To compare the difference between two kinds of decentration methods for measuring changes after wearing orthokeratology lenses. Methods: In a retrospective analysis, about 77 children who met the criteria and insisted on wearing orthokeratology lenses for 24 months were recruited from August 2016 to October 2018 in the Eye Hospital, Wenzhou Medical University. Corneal tangential topography was used to compare changes from before wearing orthokeratology lenses to after wearing them for 3 months. The changes in angle kappa distance before wearing orthokeratology lenses and after wearing them for 3 months were compared. The degree of decentration on the tangential difference map was analyzed with MATLAB. There were two decentration measurement methods (method 1: The decentration distance from the corneal vertex to the center of the optical zone; method 2: The decentration distance from the pupil center to the center of the optical zone) and the difference between the measurement methods was compared. A paired t-test was used to analyze the corneal flat radial refractive power (Kf), the corneal steep radial refractive power (Ks), the angle kappa distance, and the decentration distance of decentration 1 and decentration 2 between baseline and after wearing orthokeratology for 3 months. An independent sample t-test was used to analyze the differences in the two measurement methods in different decentration directions (superior, temporal, inferior, nasal). Pearson correlation analysis was used to analyze the relationship between axial length and decentration distance. Results: There was a statistically significant difference in axial elongation between baseline and after wearing orthokeratology lenses for 2 years (25.25±0.81 mm vs. 25.63±0.76 mm; t=-10.014, P<0.001). The baseline flat radial refractive power (Kf: 42.80±1.23 D) and steep radial refractive power (Ks: 44.09±1.40 D) were significantly higher than the Kf (41.00±1.73 D) and Ks (42.85±1.93 D) measured after wearing orthokeratology lenses for 3 months (tKf=8.893, PKf<0.001; tKs=5.903, PKs<0.001). But there was no statistically significant difference in angle kappa distance between the baseline and after wearing orthokeratology lenses for 3 months (0.27±0.21 mm vs. 0.29±0.21 mm). The decentration distance in decentration 1 showed no statistically significant difference from the distance in decentration 2 (0.64±0.31 mm vs. 0.63±0.35 mm). The direction of the decentration was mainly turned to the temporal side in both methods. Both the decentration distance of decentration 1 (r=-0.332, P=0.003) and the distance of decentration 2 (r=-0.310, P=0.006) showed a negative correlation with axial length during orthokeratology lens wear for 2 years. Conclusions: After wearing orthokeratology lenses, the angle kappa does not show a significant change. The decentration distance measured from the corneal vertex to the optical center shows no statistically significant difference with the decentration distance from pupil center to optical center.

Key words： myopia orthokeratology decentration

收稿日期: 2020-06-09

PACS:

基金资助: 国家重点研发计划（2019YFC1710204）

通讯作者: 毛欣杰（ORCID：0000-0001-9446-548X），Email：364404004@qq.com

引用本文:

陈敏锋刘新婷郑苗然王倩毛欣杰. 配戴角膜塑形镜后镜片偏心的两种测量方法比较[J]. 中华眼视光学与视觉科学杂志, 2021, 23(4): 241-246. Minfeng Chen, Xinting Liu, Miaoran Zheng, Qian Wang, Xinjie Mao. Comparison of Two Kinds of Decentration Methods for Measuring Changes after Wearing Orthokeratology Lenses. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(4): 241-246. DOI: 10.3760/cma.j.cn115909-20200609-00248

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200609-00248 或 https://www.cjoovs.com/CN/Y2021/V23/I4/241

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