目的：观察屈光参差儿童单眼配戴角膜塑形镜后双眼调节功能的变化，探讨调节在角膜塑形镜控制近视进展中的机制。

方法：前瞻性自身对照研究，对2016-09/2018-09在我院门诊就诊的屈光参差儿童单眼配戴角膜塑形镜的青少年22例44眼，将配戴角膜塑形镜的眼作为戴镜组，未作处理的另一眼作为未戴镜组。戴镜眼组22眼，等效球镜度-2.75±1.16D； 未戴镜眼组22眼，等效球镜度-0.10±0.32D。观察戴镜前和戴镜12mo后双眼屈光度差值、单眼调节幅度、调节灵敏度和调节反应的变化情况。

结果：戴镜组戴镜前的调节幅度和调节灵敏度低于未戴镜组(P<0.01)，调节滞后高于未戴镜组(P<0.05)。戴镜组配戴12mo后的单眼调节幅度15.63±1.66D高于戴镜前11.25±3.15D(t=3.63，P<0.01)，与未戴镜组无差异(t=0.75，P=0.46)。戴镜组配戴12mo后的单眼调节灵敏度14.63±1.58cyc/min高于戴镜前9.25±3.38cyc/min(t=2.83，P=0.01)，与未戴镜组无差异(t=0.38，P=0.71)。戴镜组配戴12mo后的调节滞后0.62±0.29D较戴镜前1.35±0.26D减少(t=2.57，P=0.02)，与未戴镜组无差异(t=0.61，P=0.55)。戴镜12mo后，未戴镜组的平均屈光度为-0.75±0.35D，戴镜组屈光度增长了-0.15±0.22D(t=2.90，P<0.01)，未戴镜组屈光度增长了-0.65±0.39D(t=4.24，P<0.01)，两组间屈光度的变化差值有差异(t=5.30，P<0.01)。未戴镜组12mo前后调节功能的变化无差异(P>0.05)。

结论：屈光参差儿童单眼配戴角膜塑形镜后戴镜眼的调节功能较戴镜前明显改善，且与对侧眼一致，戴镜眼的屈光状态更稳定，未戴镜眼逐渐呈现轻度近视屈光状态，但调节功能未出现明显变化。

METHODS: It was a prospective self-control study. A total of 22 anisometropic children(44 eyes), aged 8-13 years, who wore an orthokeratology lens in only one eye were enrolled in the outpatient clinic of Hainan Provincial Eye Hospital from September 2016 to September 2018. The eyes with an orthokeratology lens had a mean spherical equivalent refraction of -2.751±1.16 diopter(D), and fellow eyes without a lens had a refraction of -0.10±0.32D. The eyes wearing orthokeratology lens were used as the lens wearing group, and the fellow eyes without a lens were used as non-wearing lens group. During the follow-up period,we measured changes of diopter difference, monocular accommodative amplitude(MAA), monocular accommodative facility(MAF)and accommodative response(AR)before wearing the lens and wearing the lens for 12mo.

RESULTS: The monocular accommodative amplitude and monocular accommodative facility of the wearing group before wearing the lens were lower than those of the non-wear group(P<0.01), and the accommodative lag were higher than that of the non-wear group(P<0.05). The monocular accommodative amplitude 15.63±1.66D after wearing the lens for 12mo was higher than that before wearing the lens 11.25±3.15D(t=3.63, P<0.01), and the difference was not statistically significant(t=0.75, P=0.46)compared with the non-wearing group. The monocular accommodative facility 14.63±1.58 cyc/min after wearing the lens for 12mo was higher than that before wearing the lens 9.25±3.38cyc/min(t=2.83, P=0.01), and the difference was not statistically significant(t=0.38, P=0.71)compared with the non-wearing group. The accommodative lag 0.62±0.29D of the wearing group after 12mo was reduced compared with that before wearing the lens 1.35±0.26D(t=2.57, P=0.02),and compared with the non-wearing group, the difference was not statistical significance(t=0.61, P=0.55). The mean equivalent diopter of the non-lens group was -0.75±0.35D after 12mo, and the number of diopter group increased by -0.65±0.39D(t=4.24, P<0.01). The diopter of the wearing group increased by -0.15±0.22D(t=2.90, P<0.001), there was a statistically significant difference in the change of diopter between the two groups(t=5.30, P<0.01). There was no statistically significant difference in the change of the accommodation before and after 12mo in the non-wear group(P>0.05).

CONCLUSION: The accommodation function of anisometropic children in correcting anisometropia by monocular orthokeratology was significantly improved compared with that before wearing the lens and was consistent with the contralateral eyes without lens group. The refractive state of the group wearing orthokeratology lens was more stable, and the contralateral eyes without lens gradually showed mild myopia refractive state, but the accommodation did not change significantly.