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目的:通过角膜地形图检查初步探讨角膜塑型术(orthokeratology)中出现镜片偏位的原因。方法:回顾性分析随访≥6个月的OK镜治疗患者84例162眼,平均年龄(15.59±3.29)岁,原始平均等效球镜度(-4.18±1.48)D,平均角膜水平屈光力(43.23±1.30)D。根据患者的屈光度、角膜地形图和试戴情况,选配DK值为58,HDS材料的一副OK镜片,连续夜戴6个月以上。定期给予包括角膜地形图在内的常规眼科检查,数据资料录入电脑,采用SPSS10.0中χ2检验及SAS中的单变量方差分析,分析镜片偏位的原因。结果:对治疗前角膜地形图资料分析发现角膜颞侧与鼻侧的水平屈光力有较明显的不对称,即鼻侧平,颞侧陡,且越向周边相差越明显。治疗6个月后,原角膜前表面屈光力颞侧比鼻侧大的66眼中有38眼出现镜片颞侧偏位(占57.58%),颞侧与鼻侧基本对称的93眼中有17眼出现颞侧偏位(占18.28%),两组比较差异有非常显著性(P<0.001)。而鼻侧比颞侧屈光力大的3眼中有2眼出现镜片鼻侧偏位,因病例数少未列入统计学分析。结论:治疗中镜片易向陡区偏位,角膜前表面的水平屈光力颞侧高于鼻侧的不对称性可能是造成角膜塑形术中镜片容易出现颞侧偏位的重要原因之一。
OBJECTIVE: To investigate the causes of lens deviation in orthokeratology through corneal topography. Methods: Retrospective analysis of 84 patients with 162 eyes with OK mirror treated at ≥6 months of follow-up, mean age (15.59 ± 3.29) years, original mean spherical equivalent (-4.18 ± 1.48) D, mean corneal refractive power (43.23 ± 1.30) D. According to the patient’s refraction, corneal topography and try on the situation, the optional DK value of 58, HDS material OK lenses, continuous night wear more than 6 months. Regular ophthalmological examinations including corneal topography were regularly given. The data were entered into a computer. The χ2 test in SPSS10.0 and univariate analysis of variance (ANOVA) in SAS were used to analyze the causes of lens deviation. Results: The data of corneal topography before treatment showed that there was obvious asymmetry in the horizontal refraction of the cornea on the temporal and nasal sides, that is, the nasal flattening and temporal steepness were more obvious. Six months after treatment, 38 eyes 66 (66.5%) of the original anterior corneal surface refractive power had a temporal shift of 57.58%, while 17 eyes 93 of the temporal and nasal sides were symmetrical Lateral deviation (18.28%), the difference between the two groups was significant (P <0.001). The nasal than the temporal side of the refractive power of 3 eyes appear in 2 cases of nasal deviation, due to the small number of cases were not included in the statistical analysis. CONCLUSIONS: In the treatment, the easy deflection of the lens to the steep area and the asymmetry of the horizontal temporal power of the anterior corneal surface to the nasal side may be one of the important causes of the temporal deviation of the lens in orthokeratology.