配戴离焦RGPCL对高度近视儿童角膜屈光力及散光量的影响  

Effect of wearing defocus rigid gas permeable contact lens on corneal refractive power and astigmatism in children with high myopia

作　　者：李盼 张学辉[1] 黎彦宏[1] 艾欣 李彤 王若馨 王瑾[1] Pan Li;Xue-Hui Zhang;Yan-Hong Li;Xin Ai;Tong Li;Ruo-Xin Wang;Jin Wang(Department of Ophthalmology,Xi'an No.1 Hospital,Shaanxi Institute of Ophthalmology,Shaanxi Key Laboratory of Ophthalmology,Clinical Research Center for Ophthalmology Disease of Shaanxi Province,Xi'an 710002,Shaanxi Province,China)

机构地区：[1]中国陕西省西安市第一医院眼科陕西省眼科研究所陕西省眼科学重点实验室陕西省眼科疾病临床医学研究中心,710002

出　　处：《国际眼科杂志》2023年第1期132-137,共6页International Eye Science

基　　金：陕西省重点研发计划项目-一般项目-社会发展领域(No.2022SF-155);西安市创新能力强基计划-(3)医学研究项目(No.21YXYJ0034)。

摘　　要：目的:对比观察高度近视儿童配戴离焦硬性透气性角膜接触镜(RGPCL)前后角膜屈光力改变,并分析配戴后镜片对角膜屈光力及散光量的影响。方法:自身前后对照研究。收集2019-06/2020-06在西安市第一医院眼视光中心就诊并验配离焦RGPCL的8~12岁高度近视儿童30例60眼。使用TMS-4N角膜地形图仪测量基线及戴镜0.5、1a时戴镜状态下角膜切向屈光力,分析角膜鼻侧(N)、颞侧(T)、上方(S)和下方(I)角膜最大屈光力值及中央顶点处角膜屈光力改变情况,同时以1mm为间隔采集前述4个方位角膜屈光力以及角膜顶点处屈光力,采集范围为1~4mm,分析戴镜前后各点位屈光力变化情况。戴镜0.5,1a时后要求停戴1wk后复测眼轴、屈光度和角膜地形图,分析戴镜后较基线时眼轴、等效球镜度、散光和角膜屈光力等改变情况。结果:配戴离焦RGPCL时鼻侧(N)、颞侧(T)、上方(S)和下方(I)的角膜最大屈光力在0.5、1a时较戴镜前均显著增加,与角膜顶点处屈光力相比均表现为正相对屈光力,与戴镜前的负相对屈光力相比具有显著差异。在戴镜0.5、1a时复诊时戴镜状态下角膜相对周边屈光力朝正屈光力方向改变,除T1点位周边负屈光力增加外,其余各轴向各点位周边屈光力均显著增加。配戴0.5a后角膜陡K值变平0.11±0.10D,simK值减少0.20±0.18D,1a后角膜陡K值变平0.10±0.12D,平均K值变平0.02±0.05D,simK值减少0.16±0.13D。戴镜0.5、1a时后角膜平K较基线变化无差异。结论:配戴离焦RGPCL状态下角膜最大屈光力较角膜顶点处均表现为正相对屈光力,且4条轴向上各点位角膜相对周边负屈光力均由负值转变为正值。戴镜1a内眼轴和等效球镜度均较基线时增加,而散光量减少,角膜屈光力呈陡K变平趋势。·AIM: To compare the changes of corneal refractive power before and after wearing defocus rigid gas permeable contact lens(RGPCL) in children with high myopia, and to analyze its influence on corneal refractive power and astigmatism after wearing glasses.·METHODS: Self-controlled before-after study. A total of 30 cases(60 eyes) of children aged 8-12, with high myopia who were treated and fitted with defocus RGPCL in the Optometry Center of Xi’an First Hospital from June 2019 to June 2020 were collected. Using TMS-4 N corneal topography instrument to measure the corneal tangential refractive power at baseline and wearing lens for 0.5 and 1 a, and analyze the nasal side(N), temporal side(T), superior(S) and inferior(I) of the maximum corneal refractive power values at the 4 axial directions and the changes of the corneal refractive power at the center were collected at the same time at 1 mm intervals. The changes of corneal refractive power at each point before and after wearing glasses were analyzed. The axial length, diopter and corneal topography were required to be measured after 0.5 and 1 a, and the changes in axial length, spherical equivalent, astigmatism and corneal refraction compared with baseline were analyzed.·RESULTS: The maximum corneal refractive power of nasal(N), temporal(T), superior(S) and inferior(I) side was significantly increased at 0.5 and 1 a when wearing defocus RGPCL compared with that before wearing glasses, which all showed positive relative refractive power compared with the corneal refractive power at center and was significantly different from the negative relative refractive power before wearing lenses. The relative peripheral refractive power of the cornea changed in the direction of positive refractive power when the lenses were worn for 0.5 and 1 a. Except for the increase in the peripheral negative refractive power at the T1 point, the peripheral refractive power at all points in the other axes increased significantly. After wearing for 0.5 a, the corneal steep K value beca

关 键 词：离焦硬性透气性角膜接触镜 角膜屈光力 散光 高度近视 

分 类 号：R778.11[医药卫生—眼科]