目的：探讨光学治疗区偏心与角膜塑形镜配戴后泪膜功能及角膜形态的相关性。

方法：选取于本院配戴角膜塑形镜的80例80眼青少年近视患者为研究对象。于戴镜前后不同时间点分别对患者的光学治疗区偏心距离、泪膜功能及角膜形态指标进行检测。根据中位偏心距离，将患者分为低度偏心组和高度偏心组，比较两组患者戴镜前后不同时间点泪膜功能及角膜形态指标的差异。采用Pearson相关法分析戴镜后12mo时总偏心距离与泪膜功能及角膜形态指标的相关性。

结果：与戴镜前相比，两组患者戴镜后1wk，3、6、12mo的角膜表面非对称性指数、角膜表面规则性指数均明显升高，差异均有统计学意义(P<0.05)，且高度偏心组患者较低度偏心组患者升高更为显著，差异均有统计学意义(P<0.05)； 泪膜破裂时间、角膜曲率、基础泪液分泌量、中央角膜厚度均明显降低，差异均有统计学意义(P<0.05)，且高度偏心组患者较低度偏心组患者在泪膜破裂时间、基础泪液分泌量方面降低更为显著，差异均有统计学意义(P<0.05)，但角膜曲率、中央角膜厚度下降程度则较低(P<0.05)； 角膜内皮细胞密度在戴镜后1wk和3mo无明显差异(P>0.05)，在戴镜后6、12mo差异有统计学意义(P<0.05)。在戴镜后12mo，总偏心距离与角膜表面非对称性指数、角膜表面规则性指数均呈正相关(r=0.869、0.815，均P<0.05)，与泪膜破裂时间、角膜曲率、基础泪液分泌量、中央角膜厚度均呈负相关(r=-0.865、-0.745、-0.912、-0.713，均P<0.05)，与角膜内皮细胞密度未见明显相关性(r=0.185，P=0.199)。

结论：光学治疗区偏心发生在戴镜起始阶段，且总偏心距离与角膜塑形镜配戴后泪膜功能及角膜形态的改变具有明显相关性。

METHODS:Eighty patients(80 eyes)with myopia who were treated with orthokeratology were selected as subjects. The eccentric distance, tear film function and corneal morphology of the patient's optical treatment area were detected at different time points before and after wearing the lens. According to the median eccentric distance, the patients were divided into low eccentricity group and high eccentricity group. The differences of tear film function and corneal morphology at different time points before and after wearing were compared between the two groups. Pearson correlation coefficient was used to analyze the correlation between total eccentricity and tear film function and corneal morphological parameters at 12mo after wearing glasses.

RESULTS:Compared with before wearing lenses, the corneal surface asymmetry index and corneal surface regularity index of the two groups were significantly increased at 1wk, 3, 6 and 12mo after wearing lenses(P<0.05). Patients in the high eccentric group were more significantly elevated than in the lower eccentric group, and the differences were statistically significant(P<0.05). The time of tear film rupture, corneal curvature, basic tear secretion, and central corneal thickness were significantly lower, and the differences were statistically significant(P<0.05). Compared with the patients with lower eccentricity, the patients with high eccentricity group had more significant reduction in tear film rupture time and basic tear secretion, and the difference was statistically significant(P<0.05), however, the degree of corneal curvature and central corneal thickness decreased less(P<0.05). There was no significant difference in corneal endothelial cell density between 1wk after wearing lenses and 3mo after wearing lenses(P>0.05). The difference was statistically significant at 6mo and 12mo after wearing lenses(P<0.05). At 12mo after wearing the lens, the total eccentric distance was positively correlated with the asymmetry index of the corneal surface and the regularity index of the corneal surface(r=0.869, 0.815; P<0.05). At 12mo after wearing the lens, the total eccentric distance was negatively correlated with tear film rupture time, corneal curvature, basic tear secretion, and central corneal thickness(r=-0.865, -0.745, -0.912, -0.713; all P<0.05), and there was no significant correlation with corneal endothelial cell density(r=0.185, P=0.199).

CONCLUSION:The eccentricity of the optical treatment area occurs at the beginning of wearing lenses. And the total eccentric distance has a significant correlation with the changes of tear film function and corneal morphology after keratoplasty.