角膜像差与角膜前表面Q值对角膜塑形术近视控制的影响

目的探讨角膜像差与角膜前表面Q值改变对角膜塑形术控制近视效果的影响。方法前瞻性临床研究。对配戴角膜塑形镜治疗的8~16岁青少年儿童中低度近视患者85例（85眼），分别进行配戴前及配戴1年后的眼轴和角膜像差、角膜前表面Q值测量。眼轴由IOLMaster测得，角膜像差和Q值由角膜地形图仪测得，角膜像差取6 mm瞳孔直径下的数据。采用logistic回归分析、独立样本t检验、配对t检验对数据进行分析。结果73例受检者完成1年的随访检查。初始眼轴长度和配戴1年后眼轴长度分别为（25.17±0.88）mm和（25.42±0.83）mm，差异具有统计学意义（t=8.387，P<0.01）。眼轴年增长幅度低于均值组和高于均值组间差异具有统计学意义的因素有初始戴镜年龄、角膜前表面Q值差值、初始角膜球差、初始水平角膜彗差、初始近视程度。行logistic回归分析，角膜塑形镜控制眼轴增长幅度主要的影响因素有：初始近视程度（?茁=3.709，P<0.01）、初始角膜球差（?茁=-12.881，P<0.01）、角膜前表面Q值差值（?茁=-4.349，P<0.01）。影响近视程度的主要因素有初始戴镜年龄（?茁=0.441，P<0.05）和初始角膜球差（?茁=8.762，P<0.05）。结论年龄和角膜球差影响近视进展。随访1年，角膜塑形镜对中度近视的眼轴控制效果优于低度近视，角膜塑形镜通过改变角膜前表面Q值及角膜球差影响近视控制效果。

Impact of corneal aberration and anterior corneal surface Q value on controlling the development of myopia in orthokeratology

Objective To evaluate the corneal aberration and Q value on controlling the development of myopia in orthokeratology.Methods This was a prospective clinical study.Eighty-five children aged 8-16 years with low and moderate myopia were enrolled in this study.The ocular axis and aberrations of the cornea,corneal anterior surface Q measurements were measured before and after wearing 1 year.The ocular axis was measured by IOLMaster,the corneal aberrations and Q value were measured by corneal topography,and the corneal aberrations were measured under 6 mm pupil diameter.The data were analyzed by binary logistic regression,independent samples t test.Results Seventy-three subjects completed the 1-year follow-up.The mean axial length significantly increased from 25.17±0.88 mm at baseline to 25.42±0.83 mm 1 year after treatment.There were significant differences in age,the difference of anterior corneal surface Q value,the corneal spherical aberration,the horizontal corneal coma and the degree of myopia between two different axial length growth groups.The main factors of controlling axial length elongation in orthokeratology were the difference of anterior corneal surface Q value (β=-4.349,P＜0.01),the corneal spherical aberration (β=-12.881,P＜0.01) and the degree of myopia (β=3.709,P＜0.01) using logistic regression analysis.The factors of myopia included age (β=0.441,P＜0.05) and the corneal spherical aberration (β=8.762,P＜0.05).Conclusion Age and corneal spherical aberration have an impact on myopia progression.After one-year follow-up,the impact of orthokeratology on controlling of the axial elongation is better in moderate myopia than in low myopia.Orthokeratology have a considerable effect on slowing axial length elongation through changing anterior corneal surface Q values and corneal spherical aberration.