近视青少年儿童配戴角膜塑形镜后角膜生物力学的变化与短期塑形效果的相关性研究
Changes of Corneal Biomechanics in Myopic Children after Wearing Orthokeratology Lenses and the Correlation with the Short-Term Shaping Effect

目的：观察低度、中度近视青少年儿童佩戴角膜塑形镜后早期的角膜生物力学的变化规律及其与早期角膜塑形效果的相关性。方法：本研究为前瞻性临床研究。收集汕头国际眼科中心29名近视青少年儿童，选择右眼入组，其中男性12例，女性17例，年龄(11.72 ± 2.33)岁。将所有样本对象根据等效球镜度数分为低度近视组(低于？3.0 D)和中度近视组(？3.0 D~？6.0 D)，其中低度近视组14人，中度近视组15人。使用Corvis ST测量3次，取平均值进行后续分析。通过角膜地形图获得屈光力数据。采用单因素重复测量方差分析比较各随访时间点的角膜生物力学指标，采用Pearson线性相关分析基线资料、Corvis参数与角膜顶点屈光力的变化(Change in corneal aPical refractive Power, CARP)、角膜相对屈光力总和(Summed corneal power change, SCPC)的相关性。结果：两组患者配戴角膜塑形镜后1周、1月的视力无显著差异(P > 0.05)，裸眼视力均达到0.1 LogMAR及以上。戴角膜塑形镜1周时，低度近视组CARP、SCPC分别为2.36 ± 0.92 D、8.56 ± 5.98 D？mm，中度近视组CARP、SCPC分别为3.43 ± 0.77 D、13.73 ± 4.26 D？mm，1周与1月时两组内的CARP、SCPC无显著差异(P > 0.05)。低度组戴角膜塑形镜1周、1月的PD、IR、CBI均较戴前升高(P < 0.05)，SPA、ARTH、IOP、bIOP均较戴前降低(P < 0.05)，戴镜1周与1月时对比均无显著差异(P > 0.05)，中度组戴角膜塑形镜1周、1月CBI均较戴前升高(P均 < 0.05)，RHC、ARTH、CCT均较戴前降低(P < 0.05)，RHC、ARTH、CCT在戴镜1周与1月时对比无显著差异(P均> 0.05)。两组患者的戴角膜塑形镜1周的SCPC与戴镜前的L1A、RHC正相关(r = 0.557, P = 0.002; r =0.369, P = 0.049)、IR负相关(r = ？0.419, P = 0.024)，戴角膜塑形镜1月CARP、SCPC均与戴镜前等效球镜度负相关(r = 0.6, P < 0.01; r = ？0.43, P = 0.02)。结论：低、中度近视儿童配戴角膜塑形镜后CARP、SCPC的变化主要发生在1周内，该时期伴随着角膜生物力学特性的降低，戴镜1周至1个月时角膜生物力学特性保持相对稳定。角膜生物力学L1A、DR、IR参数对角膜塑形镜的早期塑形效果有影响。
Objective: To observe the changes in early corneal biomechanics and their correlation with early corneal shaping effects in adolescents and children with low to moderate myopia after wearing orthokeratology lenses. Methods: This study is a clinical study prospectively. 29 nearsighted adolescents and children who visited the Joint Shantou International Eye Center from were selected, and their right eyes were included in the group. Among them, 12 were males and 17 were females, aged (11.72 ± 2.33) years old. All sample subjects were divided into low myopia group (lower than ？3.0 D) and moderate myopia group (？3.0 D~？6.0 D) based on Spherical Equivalent Refraction, with 14 individuals in the low myopia group and 15 individuals in the moderate myopia group. Measure 3 times using Corvis ST and take the average for subsequent analysis. Obtain refractive power data through corneal topography, and subtract the refractive power at the vertex of the cornea before wearing the lens from the refractive power at this point after wearing the lens to obtain the change in corneal apical refractive power (CARP). SCPC (summed corneal power change) is defined as the sum of refractive power changes relative to the corneal apex within a diameter range of 0.5 mm to 7.2 mm. Single factor repeated measurement analysis of variance was used to compare corneal biomechanical indicators at various follow-up time points. We used the Pearson linear