方法：选取青少年高度近视患者36例69眼，年龄9～15岁，等效球镜≥-6.00D，球镜度数≥-5.50D，夜间戴四区五弧设计的OK镜，目标降度(TP)=5.00D。戴OK镜至少1mo后，残余度数稳定后予框架眼镜矫正。随访观察2a的裸眼视力、屈光度、眼轴长度以及角膜健康状况。

结果：(1)裸眼视力的变化：矫正前的裸眼视力为0.09±0.05，矫正1夜； 1wk； 1，3mo后裸眼视力分别为0.27±0.14，0.54±0.18，0.78±0.24，0.81±0.19； 矫正1夜； 1wk； 1mo后裸眼视力逐渐提高(P<0.05)，1mo后视力趋于稳定；(2)屈光度的变化：矫正前的屈光度为-6.82±0.71D， 联合矫正1a后的屈光度为-6.86±0.77D，差异无统计学意义(P>0.05)； 联合矫正2a后的屈光度为-7.11±0.81D，比联合矫正前增加-0.29±0.37D，差异有统计学意义(P<0.05)。(3)眼轴的变化：矫正前的眼轴为26.18±0.57mm，患者联合矫正6mo为26.19±0.54mm，1a为26.21±0.47mm，眼轴长度与矫正前的眼轴长度差异无统计学意义(P>0.05)； 联合矫正2a后眼轴长度为26.37±0.59mm，比矫正前增长0.19±0.28mm(P<0.05)；(4)轻度角膜点染发生率较高：经停戴、清洁镜片及使用保护角膜眼药水均能改善。未发现严重眼部并发症。

结论：青少年高度近视眼行角膜塑形联合框架眼镜矫正后1a，近视未进展； 联合矫正2a，近视仅有轻度进展。未发现严重眼部并发症。该方法相对安全，长期疗效仍需进一步观察。

METHODS: Sixty-nine eyes of 36 high myopic adolescent(aged 9～15 years)with spherical equivalent refraction ≥-6.00 diopters(D)(spherical component ≥-5.50D)were fitted with custom-made four-zone/five-curve Ortho-K lenses. The target of reduction was to achieve -5.00D for both eyes. The residual refractive errors after at least one month of Ortho-K wear were corrected with single-vision spectacles for clear vision in the daytime. The unaided visual acuity(UVA), refractive error(RE), axial length(AL), and ocular health were assessed before the Ortho-K lens wear, and followed up for 2a after Ortho-K.

RESULTS:(1)Changes in UVA: The mean UVA was 0.09±0.05 at baseline before Ortho-K; the mean UVA was 0.27±0.14, 0.54±0.18, 0.78±0.24, and 0.81±0.19, respectively after Ortho-K wear for l night, 1wk, 1, and 3mo. The differences of UVA were significant with baseline(P<0.05), and became stable 1mo after the treatment.(2)Changes in RE: The mean RE was -6.82±0.71D at baseline before Ortho-K and -6.86±0.77D after Ortho-K wear for 1a(P>0.05 compared to baseline). The mean RE was -7.11±0.81D after Ortho-K wear for 2a, and the amount of myopia increased -0.29±0.37D compared to baseline(P<0.05).(3)Changes in AL: The mean AL was 26.18±0.57mm at baseline before Ortho-K, and it was not significantly different(P>0.05)from the AL after Ortho-K wear for 6mo(26.19±0.54mm)and for 1a(26.21±0.47mm). The AL was 26.37±0.59mm after Ortho-K wear for 2a, and the mean increase was 0.19±0.28mm compared to baseline(P<0.05).(4)Grade 1 corneal staining was observed in some subjects at each visit. However, the staining was improved after lens cleaning, discontinuing lens wear, or applying artificial tears. No other adverse events were reported in all subjects during the 2a study.

CONCLUSION:Combining partial reduction Ortho-K and spectacles completely slowed myopic progression in high myopic adolescent after receiving the treatment for 1a, and partially reduced myopia progression after 2a of treatment. No severe ocular complications were found throughout the treatment. The combination treatment appeared to be effective and safe, but its long-term effect needs to be further assessed.