目的：分析不同近视程度患儿戴角膜塑形(OK)镜前后角膜滞后量(CH)和角膜阻力因子(CRF)的动态变化。

方法：回顾性分析2019-01/2020-01于我院收治的近视儿童40例80眼，依据等效球镜度数(SE)水平将试验对象分为低度组、中度组，均选择夜戴型OK镜配戴治疗，分别于戴镜前、戴镜1wk，1、6mo，1a检测并记录患儿的裸眼视力(LogMAR)，眼部A超监测患儿中央角膜厚度(CCT)和眼轴长度(AL)水平，综合验光仪验光测量SE水平，角膜地形图测量角膜曲率(K)值，采用ORA分析仪测量角膜补偿眼压(IOPcc)水平，同时计算出CH和CRF数值。

结果：戴镜后1wk，1、6mo，1a裸眼视力(LogMAR)水平明显低于戴镜前(均P<0.05)，SE、角膜曲率明显低于戴镜前(均P<0.05)。戴镜后1wk，1、6mo，1a CH及CRF明显低于戴镜前(均P<0.05)。与戴镜后1wk相比，戴镜后1、6mo，1a CH明显升高(t=6.010、6.447、6.556，均P<0.05)、CRF明显升高(t=6.429、6.786、7.143，均P<0.05)。戴镜后1wk，1mo， CH、CRF分别与K、CCT呈明显正相关(P<0.05)。戴镜后1wk，1、6mo，1a低度组CH明显低于戴镜前(t=8.330、3.922、3.432、3.334，均P<0.05)、中度组CH明显低于戴镜前(t=13.276、4.964、4.052、4.387，均P<0.05)。与戴镜后1wk相比，戴镜后1、6mo，1a低度组CH明显升高(t=4.413、4.903、5.001，均P<0.05)、中度组CH明显升高(t=8.312、8.773、8.889，均P<0.05)。戴镜后1wk，中度组患儿CH水平明显低于低度组(t=2.089，P<0.05)。戴镜后1wk，1、6mo，1a低度组CRF明显低于戴镜前(t=8.684、3.928、3.618、3.308，均P<0.05)、中度组CRF明显低于戴镜前(t=15.432、5.576、5.057、4.668，均P<0.05)； 与戴镜后1wk相比，戴镜后1、6mo，1a低度组CRF明显升高(t=4.755、5.065、5.376，均P<0.05)、中度组CRF明显升高(t=9.856、10.374、10.764，均P<0.05)。戴镜后1wk，中度组患儿CRF水平明显低于低度组(t=2.610，P<0.05)。

结论：配戴OK镜后CH及CRF水平均出现不同程度的降低，其中戴镜后1wk时CH及CRF水平最低，戴镜后1mo恢复至稳定状态，配戴OK镜不影响角膜生物学性能。随着近视度数的增加，CH及CRF水平下降更为明显，以达到最佳矫正效果，此现象与角膜曲率存在一定联系。

METHODS: Totally 40 cases(80 eyes)of myopic children treated in our hospital from January 2019 to January 2020 were retrospectively analyzed. The subjects were divided into low-grade group and medium-grade group according to the spherical equivalent(SE)level. They were all treated with night wearing OK glasses. The LogMAR naked eye vision of the children was detected and recorded before and 1wk, 1, 6mo and 1a after wearing glasses. The levels of central corneal thickness(CCT)and axial length(AL)were monitored by ocular a-ultrasound, the SE level was measured by comprehensive optometry, the corneal curvature(K)was measured by corneal topography, the corneal compensated intraocular pressure(IOPcc)level was measured by ORA analyzer, and the values of CH and CRF were calculated at the same time.

RESULTS:The naked visual acuity of LogMAR at 1wk, 1, 6mo and 1a after wearing glasses was significantly lower than that before wearing glasses(all P<0.05), and the SE and corneal curvature were significantly lower than that before wearing glasses(all P<0.05). CH and CRF at 1wk, 1, 6mo, 1a after wearing glasses were significantly lower than those before wearing glasses(all P<0.05). Compared with 1wk after wearing glasses, CH was significantly increased at 1, 6mo and 1a after wearing glasses(t=6.010, 6.447, 6.556, all P<0.05), CRF was significantly increased(t=6.429, 6.786, 7.143, all P<0.05). One week after wearing glasses, CH and CRF were positively correlated with K and CCT(P<0.05); 1mo after wearing glasses, CH and CRF were positively correlated with K and CCT(P<0.05). At 1wk, 1, 6mo and 1a after wearing glasses, CH in low degree group was significantly lower than that before wearing glasses(t=8.330, 3.922, 3.432 and 3.334, all P<0.05), and CH in moderate degree group was significantly lower than that before wearing glasses(t=13.276, 4.964, 4.052 and 4.387, all P<0.05). Compared with 1wk after wearing glasses, CH in low-grade group was significantly higher(t=4.413, 4.903, 5.001, all P<0.05)and in moderate group was significantly higher(t=8.312, 8.773, 8.889, all P<0.05)at 1, 6mo and 1a after wearing glasses. One week after wearing glasses, the CH level of moderate group was significantly lower than that of low group(t=2.089, P<0.05). CRF in low-grade group was significantly lower than that before wearing glasses(t=8.684, 3.928, 3.618, 3.308, all P<0.05), CRF in moderate group was significantly lower than that before wearing glasses(t=15.432, 5.576, 5.057, 4.668, all P<0.05), CRF in low-grade group was significantly higher than that after wearing glasses(t=4.755, 5.065, 5.376, all P<0.05), and CRF in moderate group was significantly higher than that after wearing glasses(t=9.856, 10.374, 10.764, all P<0.05). One week after wearing glasses, the CRF level of moderate group was significantly lower than that of low group(t=2.610, P<0.05).

CONCLUSION: The levels of CH and CRF were decreased after wearing OK lens, which reached the lowest level 1wk after wearing OK lens and returned to a stable state 1mo after wearing OK lens. With the increase of myopia, the levels of CH and CRF will decrease to achieve the best correction effect.