目的：探讨对于角膜表面具有较大高度差异的近视患者，采用环曲面设计与球面设计的角膜塑形镜在临床疗效上是否存在差异。

方法：回顾性研究。收集2016-07/2017-12到广西中医药大学附属瑞康医院视光中心就诊的青少年近视患者48例94眼，所有患者角膜地形图计算与角膜中心部分相离4mm处水平轴与垂直轴的高度差≥30μm，其中A组环曲面角膜塑形镜组25例48眼(其中2例为单眼配镜)，B组球面角膜塑形镜组23例46眼。在配戴1wk，1、3mo时观察配镜后的裸眼视力(UCVA)、3mm区角膜散光降幅以及角膜治疗区偏心量大小等。

结果：两组戴镜后裸眼视力均有明显提高，但两组间比较差异无统计学意义(P>0.05)，配戴角膜塑形镜1wk，1、3mo后，3mm区角膜散光均有明显改变，A组3mm区角膜散光降幅较B组明显，两组比较差异有统计学意义(P<0.05)。A组治疗区偏心量较B组小，两组比较差异有统计学意义(P<0.05)。

结论：环曲面角膜塑形镜对于角膜表面水平与垂直高度差较大的近视患者，在降低治疗区散光的能力及镜片稳定性方面优于普通球面镜片。

METHODS: A retrospective analysis of 48 moderate myopia patients(94 eyes), who went to the optometry center of Ruikang Hospital Affiliated to Guangxi University of Chinese Medical form July 2016 to December 2017. The height difference between the horizontal axis and the vertical axis away from the central cornea at 4mm was ≥30μm calculated in all patients with corneal topography. In Group A, 25 cases(48 eyes)with toric design orthokeratology, Group B(23 cases, 46 eyes)with regular spherical. After wearing orthokeratology 1wk, 1, 3mo, the uncorrected visual acuity(UCVA), the changes of corneal astigmatism in 3mm corneal center, the eccentricity of corneal treatment area were observed.

RESULTS: The UCVA was improved of both groups after operation, while was not significantly different between the two groups(P>0.05). The corneal regular astigmatism in 3mm corneal center were decreased after wearing orthokeratology 1wk, 1, 3mo, the changes were more obvious in Group A than Group B(P<0.05). the eccentricity of corneal treatment area in Group A were less than Group B(P<0.05).

CONCLUSION: For myopic patients with height difference between the horizontal axis and the vertical axis from the central cornea, the toric design orthokeratology is superior to regular spherical design orthokeratology in reducing astigmatism and stability of treatment area.