CAJ | 학술논문

目的观察分析配戴角膜塑形镜后角膜光学压平区偏中心状态及不同瞳孔直径下人眼高阶像差的动态变化,探索偏心性质和程度对视觉的影响.方法前瞻性临床研究.30例年龄为(23.6±2.3)岁的中低度近视患者配戴夜戴型角膜塑形镜,等效球镜度为-0.75～-4.00 D,平均(-2.61±0.83)D.在戴镜前和戴镜后1周、1个月、3个月分别检测角膜地形图,检测波前像差(在自然瞳孔下检查,分别提取3 mm和6 mm瞳孔直径下的全眼高阶像差结果),并通过分析戴镜后的角膜地形图形态,测量出角膜塑形镜压平区中心相对于瞳孔中心的偏心量(包括偏心距离和角度),只取右眼数据进行研究.采用Pearson相关性分析、重复测量资料方差分析对数据进行分析.结果配戴角膜塑形镜后1周、1个月、3个月时的平均偏心距离分别为(0.53±0.26)mm、(0.54±0.32) mm和(0.60±0.35)mm,偏心的方向主要集中于颞上方,偏心距离和角度在戴后3个时间点之间差异无统计学意义;戴后各时间点,偏心距离与戴前等效球镜度、初始散光量均不相关.在3 mm与6 mm瞳孔直径下,总高阶像差、总三阶像差、总四阶像差、总彗差(包括垂直彗差和水平彗差)、总三叶草和球差均方根值在戴后1周、1个月、3个月时均比戴前有明显增加,但各项像差在戴后各时间点之间差异均无统计学意义;在戴后的各个时间点,6 mm瞳孔直径的像差结果都较3 mm时大.戴后不同瞳孔直径下,垂直或水平偏心距离与相应方向彗差在戴后各时间点均呈正相关;而总偏心距离与总高阶像差、总三阶像差、总四阶像差、总彗差、总三叶草和球差在戴后各时间点均不相关.结论配戴角膜塑形镜后偏心客观存在,程度较小并在1周后稳定;术后偏心会造成人眼高阶像差显著增加.
목적 관찰분석배대각막소형경후각막광학압평구편중심상태급불동동공직경하인안고계상차적동태변화,탐색편심성질화정도대시각적영향.방법 전첨성림상연구.30례년령위(23.6±2.3)세적중저도근시환자배대야대형각막소형경,등효구경도위-0.75～-4.00 D,평균(-2.61±0.83)D.재대경전화대경후1주、1개월、3개월분별검측각막지형도,검측파전상차(재자연동공하검사,분별제취3 mm화6 mm동공직경하적전안고계상차결과),병통과분석대경후적각막지형도형태,측량출각막소형경압평구중심상대우동공중심적편심량(포괄편심거리화각도),지취우안수거진행연구.채용Pearson상관성분석、중복측량자료방차분석대수거진행분석.결과 배대각막소형경후1주、1개월、3개월시적평균편심거리분별위(0.53±0.26)mm、(0.54±0.32) mm화(0.60±0.35)mm,편심적방향주요집중우섭상방,편심거리화각도재대후3개시간점지간차이무통계학의의;대후각시간점,편심거리여대전등효구경도、초시산광량균불상관.재3 mm여6 mm동공직경하,총고계상차、총삼계상차、총사계상차、총혜차(포괄수직혜차화수평혜차)、총삼협초화구차균방근치재대후1주、1개월、3개월시균비대전유명현증가,단각항상차재대후각시간점지간차이균무통계학의의;재대후적각개시간점,6 mm동공직경적상차결과도교3 mm시대.대후불동동공직경하,수직혹수평편심거리여상응방향혜차재대후각시간점균정정상관;이총편심거리여총고계상차、총삼계상차、총사계상차、총혜차、총삼협초화구차재대후각시간점균불상관.결론 배대각막소형경후편심객관존재,정도교소병재1주후은정;술후편심회조성인안고계상차현저증가.
Objective To evaluate the status of orthokeratology decentration and dynamic changes in higher-order aberrations with different pupil diameters and to discuss its effect on visual quality.Methods This was a prospective clinical study.Thirty myopic subjects (30 right eyes) were fitted with overnight orthokeratology lenses.The mean age was 23.6±2.3 years and the initial mean spherical equivalent (SE) refractive error was-2.61±0.83 D.All subjects underwent corneal topography measurements and wavefront aberration measurements before orthokeratology and 1 week,1 month and 3 months after orthokeratology.The decentration (distance and angle) of the center of the flattened corneal area after orthokeratology was calculated relative to the pupil center.The higher-order aberrations under 3 mm and 6 mm pupil diameters were evaluated.Data were analyzed using pearson correlation,repeated measured ANOVA.Results The decentrations at 1 week,1 month,and 3 months after orthokerato1oty were 0.53±0.26 mm,0.54±0.32 mm and 0.60±0.35 mm,respectively.The decentration was mainly located in the superior temporal quadrant.There were no statistically significant differences in the decentration measurements at different timepoints after orthokeratology.The location and magnitude of decentration had no correlation with initial SE or astigmatism.Total higher-order aberrations,third order,fourth order,combined coma,and spherical-like aberrations under 3 mm and 6 mm pupil diameters significantly increased after orthokeratology treatment (P＜0.05).However,there were no statistically significant differences in wavefront aberrations at different timepoints after orthokeratology.The aberrations under a 6 mm pupil diameter had increased significantly compared to a 3 mm pupil diameter (P＜0.05) after orthokeratology treatment.The magnitude of decentration in the horizontal or vertical direction was positively correlated with the coma in the corresponding direction.However,no correlations were found between the total magnitude of decentration and other higher-order aberrations.Conclusion The decentration from orthokertology present throughout the entire process,but it is very subtle and became stable after 1 week.Decentration increase higher-order aberrations.