目的：通过多光谱屈光地形图(MRT)观察近视儿童配戴单焦点框架眼镜、周边近视离焦定制框架眼镜、角膜塑形镜后的离焦状态及近视控制效果。

方法：选取2022年6月至2023年12月在成都爱尔眼科医院就诊的近视患者279例，年龄8-14岁，等效球镜度(SE)为-7.00--0.50 D，随访1 a。按照自愿原则，分为三组，94例采用配戴单焦点框架眼镜(SVL组)、90例采用周边近视离焦定制框架眼镜(IORC组)、95例采用角膜塑形镜(OK镜组)，同时将三组儿童根据SE不同分为低度近视(-3.00--0.50 D)、中度近视(-6.00--3.25 D)和高度近视(-7.00--6.25 D)组。使用MRT测量，比较三组在不同近视区间视网膜4个象限上方、下方、鼻侧、颞侧(RDV-S、RDV-I、RDV-N、RDV-T)和3个视场角范围0-15°、15°-30°、30°-45°(RDV-15、RDV-30、RDV-45)的离焦变化(相连区域的分界线数据归后一组)。取右眼数据纳入统计分析，采用单因素方差分析比较组间离焦量，采用单因素和多因素线性回归分析干预1 a后眼轴(AL)改变的相关变化因素。

结果：干预前后SVL组、IORC组、OK镜组患者在低度、中度、高度近视区间戴镜1 a等效球镜和AL增长差值比较均有差异(P<0.001)。低度近视区间戴镜1 a SE、AL增长差值两两比较，SVL组与IORC组、OK镜组比较均有差异(P<0.001)，而IORC组与OK镜组无明显差异(P>0.05)； 中度近视区间戴镜1 a，OK镜组与IORC组、SVL组SE和AL增长差值两两比较均有差异(P<0.001)； 高度近视区间戴镜1 a，OK镜组与IORC组、SVL组SE和AL增长差值比较均有差异(P<0.001)，而IORC组与SVL组无明显差异(P>0.05)。三组患者在低度、中度、高度近视区间的4个象限和3个视场角周边视网膜离焦量(RPRE)差值比较均有差异(P<0.001)。低度近视区间戴镜1 a视场角D-RDV-15增长差值两两比较，SVL组与IORC组、OK镜组比较均有差异(P<0.001)，而IORC组与OK镜组无明显差异(P>0.05)； 中度近视区间戴镜1 a视场角D-RDV-30，SVL组与IORC组、OK镜组比较均有差异(P<0.001)，IORC组与OK镜组无明显差异(P>0.05)； 高度近视区间戴镜1 a视场角D-RDV-15，OK镜组与IORC组、SVL组比较均有差异(P<0.001)，而IORC组与SVL组无明显差异(P>0.05)。单因素和多因素线性回归模型分析显示IORC组、OK镜组戴镜1 a D-TRVD、D-RDV-45、D-RDV-N、D-RDV-I变化与戴镜1 a AL增长差值具有相关性。

结论：MRT在临床控制近视方面具有指导性，近视发展与周边视网膜离焦状态有关，视场角范围30°-45°的鼻下侧离焦量差异可能是控制近视快速进展的因素之一。

METHODS: A total of 279 myopic patients aged 8-14 years old, with a spherical equivalent(SE)from -7.00 to -0.50 D, treated at the Chengdu Aier Eye Hospital from June 2022 to December 2023. Patients who volunteered for the study were assigned to three groups. A total of 94 cases were provided with single-vision spectacle lenses(SVL group), 90 cases received individualized ocular refraction customization(IORC group), and 95 cases received orthokeratology lenses(OK group). Simultaneously, the three groups were further categorized into low(-3.00 to -0.50 D), moderate(-6.00 to -3.25 D), and high myopia(-7.00 to -6.25 D)groups according to different SE. MRT was used to measure and compare the defocus changes of the retina in supperior, inferior, nasal, and temporal quadrants(RDV-S, RDV-I, RDV-N, RDV-T), and three angles of field of view, including 0-15°, 15°-30°, and 30°-45°(RDV-15, RDV-30, RDV-45)in the three groups(the data divide for the connected regions is grouped to the latter group). A one-way analysis of variance was used for intergroup comparisons. Univariate and multivariate linear regression analyses were used to analyze the factors related to changes in the axial length(AL)at 1 a after intervention.

RESULTS:There were significant differences in 1-year SE and AL growth among patients in the SVL, IORC, and OK groups before and after intervention(P<0.001). The 1-year SE and the difference of AL growth in patients with low myopia was significantly different among SVL, IORC, and OK groups(P<0.001); however, there was no significant difference between the IORC and OK groups(P>0.05); there were significant differences in the SE and AL growth changes between the OK group and the IORC and SVL groups in moderate myopia(P<0.001); and there were significant differences between the OK group and the IORC and SVL groups in SE and AL growth of high myopia group after wearing lenses for 1 a(P<0.001), while there were no significant differences between the IORC and SVL groups(P>0.05). In addition, there were significant differences in the relative peripheral refractive errors(RPRE)of 4 quadrants and 3 eccentric regions among the three groups of patients in different degrees of myopia groups(P<0.001). Pair-wise comparison of the growth difference of eccentric D-RDV-15 in low myopia group after wearing lenses for 1 a showed significant differences between the SVL, IORC, and OK groups(P<0.001), but no significant differences between the IORC and OK groups(P>0.05). The angle of field of view D-RDV-30 in moderate myopia subgroups was statistically different between the SVL group and the IORC and OK groups after wearing lenses for 1 a(P<0.001), while the IORC and OK groups showed no significant differences(P>0.05); the angle of field of view D-RDV-15 in high myopia subgroups was statistically different between the OK group and the IORC and SVL groups after wearing lenses for 1 a(P<0.001), but there was no significant difference between the IORC and SVL groups(P>0.05). Univariate and multivariate linear regression model analysis showed that the changes in D-TRVD, D-RDV-45, D-RDV-N, and D-RDV-I correlated with the increase in the difference in 1 a AL.

CONCLUSION: MRT can be used to guide the clinical control of myopia. Myopia development is related to the peripheral retinal defocus state, and the difference of defocus quantity in the inferior nasal side at 30°-45° eccentricity may be a factor regulating the rapid progression of myopia.