目的：探究基弧区非球面设计角膜塑形镜矫正青少年近视伴中高度散光的疗效及其对眼表形态与泪液的影响。

方法：选取2018-12/2020-03于本院接受治疗的近视伴中高度散光青少年患者232例464眼为研究对象，随机分为对照组(116例232眼)和观察组(116例232眼)，对照组采用基弧区球面设计角膜塑形镜矫正，观察组采用基弧区非球面设计角膜塑形镜矫正。配戴12mo后，比较两组患者矫正效果，配戴前后客观视觉质量、眼表形态、泪液相关指标及并发症发生率。

结果：与配戴前比较，两组患者配戴后裸眼视力(UCVA)、屈光度均明显改善，且观察组UCVA、屈光度均显著优于对照组(均P<0.05)； 与配戴前比较，两组患者配戴后全眼与角膜彗差、球差、高阶像差上升，而斯特列尔比值、调制传递函数下降，角膜三叶草差明显上升(均P<0.05)，观察组患者全眼与角膜彗差、球差、高阶像差、斯特列尔比值、调制传递函数均优于对照组，角膜三叶草差优于对照组(均P<0.05)； 与配戴前比较，两组患者配戴后角膜上皮荧光染色评分、眼表疾病指数(OSDI)量表评分均明显下降(P<0.05)，但两组间无差异(P>0.05)； 与配戴前比较，两组患者配戴后非侵入式泪膜破裂时间(NI-BUT)显著下降(P<0.05)，但两组间无差异(P>0.05)，且配戴前后两组患者泪液基础分泌量及泪河高度均无差异(P>0.05)。观察组与对照组配戴后并发症发生率无差异(6.9% vs 6.0%，P>0.05)。

结论：基弧区非球面设计角膜塑形镜矫正青少年近视伴中高度散光的矫正效果及客观视觉质量优于球面设计角膜塑形镜，而两种角膜塑形镜对眼表形态与泪液影响相当。

METHODS:A total of 232 adolescents(464 eyes)with myopia and moderate to high astigmatism treated in the hospital from December 2018 to March 2020 were selected as the research subjects. They were randomly divided into control group(116 patients, 232 eyes)and observation group(116 patients, 232 eyes). The control group was treated with base curve spheric orthokeratology lens, while the observation group was treated with base curve aspheric orthokeratology lens. Comparison was made between the two groups in terms of the correction effect, objective visual quality, ocular surface morphology, tears related indicators before and after wearing the lenses, and the incidence of complications after wearing the lenses for 12mo.

RESULTS:After wearing the lenses, the uncorrected visual acuity(UCVA)and diopter of the two groups were significantly improved. The UCVA and diopter of the observation group were significantly better than those of the control group(all P<0.05). After wearing the lenses, the whole-eye and corneal coma, spherical aberrations and high-order aberrations were significantly increased, while Strehl ratio and modulation transfer function were decreased in the two groups. Trefoil aberrations was significantly increased(all P<0.05). These indicators in the observation group were better than those in the control group(all P<0.05). After wearing the lenses, the epithelium fluorescence staining scores, ocular surface disease index(OSDI)scores were significantly decreased in the two groups(P<0.05), but there was no statistically significant difference between the two groups(P>0.05); The noninvasive tear breakup time(NI-BUT)of the two groups were significantly decreased after wearing the lenses(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). The Schirmer Ⅰ test and tear meniscus height of the two groups showed no statistically significant difference before and after wearing the lenses(P>0.05). The incidence rates of complications in the observation group and the control group after wearing the lenses were close(6.9% vs 6.0%, P >0.05).

CONCLUSION:Base curve aspheric orthokeratology lens is superior to base curve spheric orthokeratology lens in the treatment of adolescents with myopia and moderate to high astigmatism in terms of correction effect and objective visual quality. The two lenses have similar influence on ocular surface morphology and tears.