目的：观察缩小角膜塑形镜后表面光学区直径后角膜高阶像差与相对屈光力值的改变。

方法：选取8-12岁适合且愿意配戴角膜塑形镜的近视患者，随机分为6.0 mm后表面光学区直径塑形镜组和5.0 mm后表面光学区直径塑形镜组，研究两组患者戴镜后1 d，1 wk，1、3 mo的角膜高阶像差、相对屈光力值与治疗区直径大小，对角膜高阶像差增加量与相对屈光力值大小进行相关性分析。

结果：两组患者不同直径的角膜总高阶像差、球差与彗差增量会随着戴镜时长出现变化(均P<0.001)，两组间的总高阶像差与彗差变化值比较均无差异(均P>0.05)。两组患者5 mm范围的球差增量存在显著差异，增量随时间的变化趋势有显著差异(F_时间=40.179，P_时间<0.001； F_分组=11.948，P_分组=0.001； F_交互=3.262，P_交互=0.03)。4 mm范围的两组球差增量存在显著差异(F_时间=34.462，P_时间<0.001； F_分组=13.094，P_分组<0.001； F_交互=1.372，P_交互=0.25)。相对屈光力会随着戴镜时长出现变化(F_时间=40.030，P_时间<0.001)，两组间的相对屈光力值无差异(F_分组=0.048，P_分组=0.83； F_交互=1.208，P_交互=0.31)。治疗区直径随着戴镜时长出现变化，两组间的治疗区直径大小有差异(F_时间=11.212，P_时间<0.001； F_分组=74.073，P_分组<0.001； F_交互=0.312，P_交互=0.82)。4、5、6 mm范围内的总高阶像差增量、球差增量、彗差增量与相对屈光力值均呈正相关(均P<0.001)。戴镜3、6、12 mo后，两组眼轴比较有差异(F_时间=185.398，P_时间<0.001； F_分组=5.618，P_分组=0.02； F_交互=2.315，P_交互=0.11)。

结论：配戴角膜塑形镜增加高阶像差，角膜塑形镜的后表面光学区直径缩小，治疗区直径变小，4、5 mm范围内角膜球差增大。角膜前表面高阶像差与角膜相对屈光力正相关。配戴后表面光学区直径更小的角膜塑形镜，眼轴增长更缓慢，近视控制效果更好。

METHODS: Myopic children aged 8-12 years, deemed suitable and willing to wear orthokeratology lenses, were randomly allocated to wear lenses with a 6.0 mm BOZD or a 5.0 mm BOZD. Data collection included changes in higher-order aberrations, relative refractive power and the treatment zone diameter of the two groups after wearing lenses for 1 d, 1 wk, 1, and 3 mo. The correlation of increase in corneal higher-order aberrations with refractive power was analyzed.

RESULTS: The increases in total higher-order aberrations, spherical aberrations and coma aberrations varied over time following lens wear(all P<0.001), and there were no statistically significant differences in the changes of total higher-order aberrations and coma aberrations between the two groups of patients(all P>0.05). A significant difference was observed in the increment of spherical aberrations in the 5 mm range between the two groups of patients, which varied over time(F_time=40.179, P_time<0.001; F_group=11.948, P_group=0.001; F_interaction=3.262, P_interaction=0.03). A significant difference was observed in the increment of spherical aberrations in the 4 mm range between the two patient groups(F_time=34.462, P_time<0.001; F_group=13.094, P_group<0.001; F_interaction=1.372, P_interaction=0.25). There was no statistically significant distinction in relative refractive power between the two groups(F_group=0.048, P_group=0.83; F_interaction=1.208, P_interaction=0.31); however, relative refractive power changed over time(F_time=40.030, P_time<0.001). The difference in treatment zone diameter between the two groups was statistically significant, with changes over time(F_time=11.212, P_time<0.001; F_group=74.073, P_group<0.001; F_interaction=0.312, P_interaction=0.82). The total higher-order aberrations, spherical aberrations, and coma aberrations in 4, 5 and 6 mm range showed a positive correlation with relative refractive power values(all P<0.001). Statistically significant difference was observed in the axial length between the two groups after wearing lenses for 3, 6 and 12 mo(F_time=185.398, P_time<0.001; F_group=5.618, P_group=0.02; F_interaction=2.315, P_interaction=0.11).

CONCLUSION: Orthokeratology lenses leaded to elevated higher-order aberrations. Orthokeratology lenses with smaller BOZD produced significantly greater spherical aberrations at 4 and 5 mm range and smaller treatment zone diameters. The corneal total higher-order aberration was positively correlated with relative refractive power. Wearing orthokeratology lenses with a smaller BOZD can cause slower axial growth and better myopia control.