摘要目的 观察和分析近视患者配戴夜戴型角膜塑形镜(orthokeratology)后,角膜形态及全眼像差的变化及日间波动情况,评估其对视觉质量的影响.方法 选取温州医学院的17例(34只眼)中低度近视患者,平均等效屈光度为-0.75～-4.50 D.采用夜戴型角膜塑形镜矫治双眼近视,分别在配戴角膜塑形镜前、戴镜后一天、一周、一月进行检查,每次检查均在复查日摘镜后0、4、8h三个时间点进行,项目包括裂隙灯检查、未校正视力、主觉验光,I-trace视觉功能分析仪测量全眼像差,Pentacam眼前节分析系统测量角膜地形图,CSV-1000对比敏感度测试灯箱测量对比敏感度并计算对比敏感度函数曲线下面积值(ALUCSF).结果 未矫正视力(logMAR)与基线水平的(0.91±0.30)相比,戴镜一月后显著提高至(0.02±0.16) (P ＜0.05).角膜3 mm范围平均曲率与基线水平的(43.53±1.11)D相比,戴镜一月后降至(41.39±1.14)D(P ＜0.05).对比敏感度函数曲线下面积值(AULC-SF)与基线水平的(1.43±0.07)相比,一月后降至(1.33±0.14) (P ＜0.05).总的高阶像差、球差、彗差均增高(P＜0.05),而低阶像差降低.配戴角膜塑形镜后,未矫正视力及对比敏感度的日间波动一周后趋于稳定.而角膜形态,总的高阶像差,球差日间波动持续存在统计学差异,彗差的日间波动在戴镜一个月后处于稳定状态.结论 夜戴型角膜塑形镜能快速、有效的降低屈光不正,提高裸眼视力.尽管配戴夜戴型角膜塑形镜一周后角膜形态及像差存在日间回退现象,但日间视觉质量并未受其波动的影响.

abstractsObJective To investigate the changes and daily fluctuation of corneal shape and ocular aberrations in myopic eyes undergoing overnight orthokeratology,and to analyze the relationship among comeal shape,ocular aberrations and vision.Methods Seventeen young myopic subjects (34eyes) were recruited with myopia from-0.75D to-4.50D.Subjective refraction,uncorrected visual acuity,ocular aberrations,corneal curvature,corneal thickness and contrast sensitivity were performed at baseline and 1 day,1 week and 1 month after lens were wom.Except for baseline,all the parameters were collected at three different times during the day,immediately following lens removal and 4,8 hours after lens removal.Results Orthokeratology significantly improved logMAR uncorrected visual acuity from 0.91±0.30 to 0.02±0.16 (P ＜0.05),decreased the corneal curvature of 3mm from 43.53±1.11D to 41.39± 1.14D (P ＜0.05).But significantly increased ocular higher-order aberrations and decreased contrast sensitivity function.The AULCSF decreased from 1.43±0.07 to 1.33±0.14 (P ＜0.05).The daily fluctuations of visual acuity and AULCSF were stable after 1 week.But the significant changes of daily fluctuations on comeal curvature,corneal thickness and ocular aberration were still observed after 1 month (P ＜0.05).Conclusions Overnight orthokeratology is effective in the reduction of myopic refractive error.Although the regression of corneal shape and ocular aberrations existed in the daytime after one month,vision quality changes remain stable.