单眼配戴角膜塑形镜对调节功能及生物学参数的影响

The Influence of Wearing Orthokeratology Lenses in One Eye on Accommodative Function and Biological Parameters

摘要: 目的：探讨单眼配戴角膜塑形镜对其调节功能及生物学参数的影响。方法：选取2022年3月至2024年4月期间，在本院接受因单眼近视初次验配角膜塑形镜的屈光参差[双眼等效球镜(SE)差值 ≥ 1.00D]儿童70例(140只眼)，年龄7~16岁，近视眼的SE为−5.00D~−1.00D，随访时间为1年，采用前瞻性非随机自身对照研究，双眼根据是否配戴角膜塑形镜分为观察组(配戴角膜塑形镜)，对照组(不配戴塑形镜的对侧眼)。比较两组生物学参数及调节功能的变化。结果：单眼配戴角膜塑形镜1年后，观察组屈光度、眼轴长度增长量较对照组明显减少，组间差异具有统计学意义(P < 0.05)，双眼屈光参差及眼轴差值均明显下降(P < 0.001)；调节功能方面，单眼检测，观察组调节灵活度、调节幅度均提升，与对照组相比差异具有统计学意义(P < 0.05)，双眼相关差值缩小(P < 0.001)；双眼同时检测，正相对调节及调节反应较基线时有所改善，差异有统计学意义(P < 0.001)；调节灵活度虽无变化，但数据离散分布特征显著转变(Z = −4.899, P < 0.001)；负相对调节及调节幅度较基线时无明显改变，差异无统计学意义(均P > 0.05)。随访期间未发生严重角膜并发症，临床安全性良好。结论：单眼配戴角膜塑形镜可安全有效减轻青少年近视性屈光参差、延缓眼轴增长，且能针对性提升调节储备量，改善调节滞后；优化调节功能，随访期间应密切关注对侧眼的相关变化。

Abstract: Objective: To investigate the effects of single-eye wearing of corneal reshaping lenses on the accommodative function and biological parameters. Methods: From March 2022 to April 2024, 70 children (140 eyes) with anisometropia [difference in spherical equivalent between both eyes ≥ 1.00D] who received the initial fitting of corneal reshaping lenses due to unilateral myopia at our hospital were selected. The age ranged from 7 to 16 years old, with the SE of myopia ranging from −5.00D to −1.00D. The follow-up period was 1 year. A prospective non-randomized self-controlled study was conducted. The eyes were divided into the observation group (wearing corneal reshaping lenses) and the control group (the contralateral eye without wearing the lens). The changes in biological parameters and accommodative function were compared between the two groups. Results: One year after single-eye wearing of corneal reshaping lenses, the refractive power and the increase in axial length in the observation group were significantly less than those in the control group, and the differences between the groups were statistically significant (P < 0.05). The SE of anisometropia and the axial difference of both eyes decreased significantly (P < 0.001); In terms of accommodative function, single-eye detection showed that the accommodative flexibility and amplitude in the observation group improved compared with the control group, and the differences were statistically significant (P < 0.05), and the related differences in both eyes were reduced (P < 0.001); When both eyes were simultaneously detected, the positive relative accommodation and accommodation response improved compared with the baseline, and the differences were statistically significant (P < 0.001); Although the accommodative flexibility did not change, the distribution characteristics of the data significantly changed (Z = −4.899, P < 0.001); The negative relative accommodation and accommodation amplitude did not change significantly compared with the baseline, and the differences were not statistically significant (all P > 0.05). No serious corneal complications occurred during the follow-up period, and the clinical safety was good. Conclusion: Single-eye wearing of corneal reshaping lenses can safely and effectively alleviate myopic anisometropia in adolescents, delay the elongation of the eye axis, and specifically improve the accommodative reserve and alleviate accommodative lag. The optimization of accommodative function may be one of the mechanisms for controlling myopia progression. During the follow-up period, the related changes in the contralateral eye should be closely monitored. Monocular orthokeratology (OK) lenses can safely and effectively reduce myopic anisometropia in adolescents, delay axial length progression, and specifically enhance accommodative reserve while improving accommodative lag. They optimize accommodative function, and close monitoring of contralateral eye changes is required during follow-up.