配戴角膜塑形镜早期角膜高阶像差变化及其影响因素  

Changes in corneal high-order aberrations and their influencing factors in early stages following orthokeratology contact lens wear

作　　者：张旭 王雁[1] 徐路路[1] Zhang Xu;Wang Yan;Xu Lulu(Clinical College of Ophthalmology,Tianjin Medical University,Tianjin Eye Hospital,Tianjin Key Lab of Ophthalmology and Visual Science,Tianjin Eye Hospital,Tianjin 300020,China;Baoding Yinghua Eye Hospital,Baoding 071000,China)

机构地区：[1]天津医科大学眼科临床学院,天津市眼科医院,天津市眼科学与视觉科学重点实验室,300020 [2]保定鹰华眼科医院,保定071000

出　　处：《中华实验眼科杂志》2020年第2期101-108,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81873684)。

摘　　要：目的观察近视患者配戴角膜塑形镜早期角膜前后表面高阶像差的变化特点及其影响因素。方法采用系列病例观察研究设计。连续收集2018年1—4月在保定鹰华眼科医院成功验配角膜塑形镜的近视患者46例46眼,分别进行戴镜前及戴镜后1个月的角膜像差、角膜离心率e值测量。应用Pentacam三维眼前节分析仪测量并分析角膜形态,记录6 mm内角膜前后表面鼻侧、颞侧、上方、下方各方向e值,Zernike分析计算以角膜顶点为中心6 mm直径范围内的前表面、后表面和全角膜Z33、Z3-3、Z31、Z3-1和Z40值。结果配戴角膜塑形镜后,角膜前表面和全角膜水平彗差、垂直彗差和球差的值向正向漂移,角膜后表面水平彗差、球差的值向负向漂移,与戴镜前比较差异均有统计学意义(均P<0.05)。戴镜前eNf、eTf、eIf、eSf、eMf分别为0.580(0.450,0.670)、0.455(0.378,0.513)、0.485(0.268,0.553)、0.665(0.578,0.740)、0.505±0.015,戴镜后分别为0.285(-0.635,0.665)、-0.605(-0.813,-0.335)、-0.545(-0.765,0.305)、-0.335(-0.705,0.423)、-0.247±0.058,戴镜后各个方向角膜前表面由陡峭变为平坦,与戴镜前比较差异均有统计学意义(均P<0.05)。多元逐步线性回归分析结果显示,配戴角膜塑形镜后全角膜球差与角膜e值、初始屈光度均呈中度负相关(rs=-0.626、-0.450,均P<0.05),水平彗差与颞侧e值中度负相关(rs=-0.391,P=0.004);戴镜后角膜前表面球差与角膜e值、初始屈光度呈中度负相关(rs=-0.612、-0.432,均P<0.05),水平彗差与颞侧e值中度负相关(rs=-0.400,P=0.003);戴镜后角膜后表面水平彗差与角膜前表面水平彗差呈负相关(rs=-0.380,P=0.009)。结论配戴角膜塑形镜后,全角膜和前表面球差、彗差正向漂移;角膜后表面球差、水平彗差负向漂移。戴镜前屈光度和角膜前表面变化大小是引起角膜高阶像差变化的重要影响因素。Objective To evaluate changes in corneal high-order aberrations after the wearing of orthokeratology contact lenses and to study the factors influencing those changes.Methods A series of case-observational method was used.Data on 46 right myopic eyes of 46 children fitted for orthokeratology were continuously collected from January to April 2018.The corneal morphology,the e values of the anterior and posterior corneal surface in the nasal,temporal,superior and inferior zones within 6 mm were measured with Pentacam Anterion Segment Analysis System before and one month after the wearing of orthokeratology contact lens.Zernike Analysis System was used to calculate the values of Z33,Z3-3,Z31,Z3-1,and Z40 on the anterior and posterior surfaces and on the total cornea within a diameter of 6 mm.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Baoding Yinghua Eye Hospital(No.YKLL-2018-1-01).Written informed consent was obtained from each child and their guardians prior to entering the study cohort.Results Compared to the values recorded prior to orthokeratology contact lens wear,the horizontal coma,vertical coma,and spherical aberration of the total cornea and anterior corneal surface were drifted positively after lens wear;the horizontal coma and spherical aberration of the posterior corneal surface were drifted negatively after lens wear;and the differences were statistically significant(all at P<0.05).Before wearing orthokeratology contact lenses,eNf,eTf,eIf,eSf and eMf values were 0.580(0.450,0.670),0.455(0.378,0.513),0.485(0.268,0.553),0.665(0.578,0.740)and 0.505±0.015,respectively,and after wearing orthokeratology contact lenses,eNf,eTf,eIf,eSf and eMf values were 0.285(-0.635,0.665),-0.605(-0.813,-0.335),-0.545(-0.765,0.305),-0.335(-0.705,0.423)and-0.247±0.058,respectively.Compared with the conditions prior to wearing orthokeratology contact lens,the anterior corneal surface in all parts changed from steep to flat after lens wear,with st

关 键 词：近视/治疗 角膜塑形镜 高阶像差 角膜e值 

分 类 号：R77[医药卫生—眼科]