目的：观察日戴和夜戴角膜塑形镜片的临床应用情况，评价角膜塑形术矫治青少年轻中度近视的安全性及有效性，分析其相关因素。

方法：收集2012/2014年配戴角膜塑形镜的青少年近视患者45例89眼，年龄9～20岁，屈光度≤-6.00D，顺规散光≤-1.50D，逆规散光≤-0.75D。随机分成两组，日戴组29眼，夜戴组60眼，戴镜时间8～10h，检查戴镜后1wk； 1，3，6mo患者裸眼视力、残余屈光度、角膜中央厚度及角膜曲率的变化情况，观察角膜有无损伤、感染等并发症。

结果：戴镜1wk后，裸眼视力明显提高，残余屈光度明显降低，与戴镜前比较差异均有显著统计学意义(P<0.01)； 角膜曲率明显变平坦，平均K值从42.28±1.13D下降为40.79±1.26D(日戴组)，42.18±1.03D下降为40.35±0.99D(夜戴组)，差异均有显著统计学意义(P<0.05)，而1，3，6mo与1wk比较差异均无统计学意义(P>0.05)。戴镜1mo后角膜中央厚度变薄最为显著，与戴镜前比较分别下降了7.26±1.38μm(日戴组)和15.15±0.50μm(夜戴组)，差异均有显著统计学意义(P<0.01)； 戴镜后角膜上皮染色阳性数增加，分别为9眼(31%，日戴组)和28眼(47%，夜戴组)。

结论：角膜塑形镜能有效降低近视度，显著提高裸眼视力； 但不能忽视验配带来的风险，应以规范的验配流程、熟练的验配技术提高配戴的安全性。

AIM:To evaluate the safety and effectiveness of Orthokeratology in correcting and curing mild and moderate myopia for teenager patients by investigating the clinical response of wearing Orthokeratology at day or night and further analyze the underlying factors.

METHODS: Eighty-nine eyes(spherical equivalent refraction≤-6.00D, astigmatism with the rule ≤-1.50D and astigmatism against the rule ≤-0.75D)of 45 teenagers aged between nine and twenty wearing Orthokeratology contact lens from 2012 to 2014 were selected and then randomly divided into two groups, twenty-nine eyes wearing at day and sixty eyes wearing at night. The lens were put on eight to ten hours each time. Uncorrected visual acuity, residual spherical equivalent refraction, central corneal thickness, corneal curvature were examined punctually in addition to checking any kind of eye damage or complication after Orthokeratology at 1wk, 1, 3 and 6mo.

RESULTS:Uncorrected visual acuity was markedly corrected while residual spherical equivalent refraction was reduced after one wk contact lens wearing treatment. The above results were of statistical significance(P<0.01). Notably corneal curvature became more flattened after one wk, and the average K value got decreased from 42.28±1.13D to 40.79±1.26D(wearing at day)and 42.18±1.03D to 40.35±0.99D(wearing at night)respectively. The corneal curvature results had a statistically significant difference comparing one wk after wearing Orthokeratology than before(P<0.05), but there was no such difference comparing one wk with one, three or six mo(P>0.05). Central corneal thickness at one mo had the most obvious change which decreased 7.26±1.38μm(wearing at day)and 15.15±0.50μm(wearing at night)respectively, showing great statistical significance(P<0.01). The positive cases of corneal epithelium dyeing after orthokeratology were nine(wearing at day)and twenty-eight(wearing at night), which correspondingly accounted for 31% and 47%.

CONCLUSION: Orthokeratology can effectively reduce myopic diopter and improve uncorrected visual acuity. However, we still can not neglect the risk and should make sure of the safety by standardizing the optometry process and improving the fitting skills.

河南省科技攻关资助项目基金资助(No.112102310312)