目的：探讨应用光学相干断层血管成像(OCTA)观察近视青少年配戴角膜塑形镜后角膜地形图改变与视网膜血管密度、厚度的关系。

方法：选取2023-01/12在我院诊治的配戴角膜塑形镜的近视青少年患者作为研究对象，并对其临床资料进行回顾性分析，选取配戴环曲面角膜塑形镜(环曲面组)50例50眼及配戴球面角膜塑形镜(球面组)50例50眼。检测两组配戴前及配戴后3、6 mo角膜地形图指标、视网膜血管密度及视网膜厚度变化。分析角膜地形图指标与视网膜血管密度、厚度间的关系。

结果：相较于配戴前，配戴后3、6 mo两组Avek明显降低(均P<0.05)，SRI、SAI明显升高(均P<0.05)。相较于配戴前，配戴后3、6 mo两组黄斑全区视网膜深层血管密度、黄斑旁中心凹视网膜浅层血管密度明显升高(均P<0.05)，环曲面组黄斑中心凹及黄斑旁中心凹视网膜浅层血管密度明显升高(均P<0.05)，球面组黄斑旁中心凹视网膜浅层血管密度明显升高(均P<0.05)。相较于配戴前，配戴后3、6 mo两组黄斑全区、黄斑旁中心凹视网膜厚度明显增加(均P<0.05)。配戴后3 mo，环曲面组Avek与黄斑全区、黄斑旁中心凹视网膜深层血管密度，黄斑中心凹、黄斑旁中心凹视网膜浅层血管密度及黄斑全区、黄斑旁中心凹视视网膜厚度均呈负相关(均P<0.05)，SRI、SAI均与黄斑中心凹、黄斑旁中心凹视网膜浅层血管密度及黄斑全区、黄斑旁中心凹视网膜厚度均呈正相关(均P<0.05)。配戴后3 mo，球面组Avek与黄斑全区、黄斑旁中心凹视网膜深层血管密度，黄斑旁中心凹视网膜浅层血管密度均呈负相关(均P<0.05)，SRI、SAI与黄斑全区、黄斑中心凹、黄斑旁中心凹视网膜深层及黄斑旁中心凹浅层血管密度均呈正相关(均P<0.05)，SRI与黄斑全区视网膜厚度呈正相关(P<0.05)，SAI与黄斑旁中心凹视网膜厚度呈正相关(P<0.05)。

结论：青少年近视患者配戴环曲面与球面角膜塑形镜后角膜地形图发生改变，视网膜血流密度及视网膜厚度明显增加，改善眼底血液循环，且角膜地形图改变与视网膜血流密度及视网膜厚度存在显著关系，对近视的控制有一定的指导意义。

METHODS:Myopic adolescents who treated and wore orthokeratology lenses in our hospital between January and December 2023 were selected for the study, and their clinical data were retrospectively analyzed. Totally 50 cases(50 eyes)of toric orthokeratology lenses(toric group)and 50 cases(50 eyes)of spherical orthokeratology lenses(spherical group)were selected. Changes in corneal topographic indices, retinal vascular density and retinal thickness were examined in the two groups before and at 3 and 6 mo after wear. The relationship between corneal topographic indexes and retinal vessel density and thickness was analyzed.

RESULTS: Compared with the pre-wear, average value of ks and kf(Avek)was significantly lower(all P<0.05), and surface regularity index(SRI)and surface asymmetry index(SAI)were significantly increased(both P<0.05)in the two groups at 3 and 6 mo post-wear. Compared with the pre-wearing period, deep retinal vessel density in whole macular area and superficial retinal vessel density in paracentral retina of macula were significantly higher in the two groups at 3 and 6 mo after wearing(both P<0.05), and the superficial retinal vessel density in macular fovea and paracentral fovea of macula of the toric group was significantly higher(all P<0.05), and the superficial retinal vessel density in paracentral macular fovea of the spherical group was significantly increased(all P<0.05). Compared with the pre-wearing period, the thickness of retina in whole macula and paracentral retina of the macula was significantly increased in the both groups at 3 and 6 mo post-wearing(all P<0.05). After wearing lenses for 3 mo, the Avek of the toric group was negatively correlated with the deep vascular density in whole macular area and paracentral macular fovea, the superficial vascular density in macular fovea and paracentral macular fovea, and the thickness of whole macular and paracentral macular fovea(all P<0.05). The SRI and SAI were positively correlated with the superficial retinal vascular density in macular fovea and paracentral macular fovea, and the retinal thickness in whole macular area and paracentral macular fovea(all P<0.05). The spherical group showed a negative correlation between Avek and the deep retinal vessel density in whole macular area and paracentral macular fovea, as well as the superficial retinal vessel density in paracentral macular fovea after wearing lenses for 3 mo(all P<0.05). SRI and SAI were positively correlated with the deep retinal vessel density in whole macular area, macular fovea and paracentral macular fovea, and the superficial retinal vessel density in paracentral macular fovea(all P<0.05). SRI was positively correlated with the retinal thickness in whole macular area(P<0.05), and SAI was positively correlated with the retinal thickness in paracentral macular fovea(P<0.05).

CONCLUSION: After wearing toric and spherical corneal orthokeratology lenses, the corneal topography of myopic adolescents changes, and the retinal blood flow density and retinal thickness increase significantly, improving retinal blood circulation. Moreover, there is a significant correlation between changes in corneal topography and retinal blood flow density and retinal thickness, which has certain guiding significance for the control of myopia.