目的：观察角膜塑形镜联合视觉训练及云夹对调节不足近视儿童调节功能的影响。

方法：前瞻性非随机对照研究。选择 2022-04/2023-01在廊坊爱尔眼科医院就诊的调节不足的近视患者99例99眼(均纳入右眼数据，如果单眼配戴角膜塑形镜，则此眼入组)，根据治疗方式不同分为三组：联合组39例采用角膜塑形镜联合视觉训练及云夹治疗(给予训练室训练3 mo，家庭训练 3 mo，前3 wk给予云夹用眼习惯监测及提醒)，角膜塑形镜组30 例仅配戴角膜塑形镜治疗，单光框架眼镜组30 例仅配戴单光框架眼镜治疗。比较三组患者治疗前，治疗后3、6、12 mo 调节幅度和调节灵敏度。

结果：治疗3、6、12 mo联合组患者调节幅度明显优于角膜塑形镜组和单光框架眼镜组(均P<0.05)，角膜塑形镜组优于单光框架眼镜组(均P<0.05)； 联合组治疗6、12 mo调节灵敏度明显优于角膜塑形镜组和单光框架眼镜组，角膜塑形镜组优于单光框架眼镜组(均P<0.05)。联合组治疗3、6、12 mo调节幅度和调节灵敏度均较治疗前明显提高(均P<0.05)。治疗12 mo时联合组13%(5/39)患者重新出现调节幅度下降，而无患者出现调节灵敏度下降。

结论：对于调节不足的配戴角膜塑形镜的近视患者，视功能训练及云夹用眼习惯提醒能够改善其调节幅度和调节灵敏度，且效果能保持长期稳定。

METHODS: A prospective, non-randomized control study was conducted on 99 myopic children(99 eyes)with dysfunctional accommodation at the optometry center were of Langfang Aier Eye Hospital from April 2022 to January 2023. and they selected and divided into three groups: 39 children in OCVTC group, 30 in orthokeratology(Ortho-k)group, and 30 in single vision spectacle lens(SVL)group. The OCVTC group received office-based accommodative therapy for 3 mo and home reinforcement for 3 mo, and Clouclip was used in the first 3 wk to monitor and remind children of eye habits; the accommodative amplitudes and facility were measured at baseline, 3, 6, and 12 mo after treatment.

RESULTS: The OCVTC group showed significantly better improvement in accommodative amplitude compared with both the Ortho-k group and the SVL group(all P<0.05), and the Ortho-k group was better than the SVL group at 3, 6, and 12 mo after the intervention(both P<0.05). Similarly, accommodative facility was significantly enhanced in the OCVTC group compared with the other groups at 6 and 12 mo after intervention, and the Ortho-k group was better than the SVL group(all P<0.05). Both accommodative amplitude and facility in the OCVTC group were significantly improved at 3, 6, and 12 mo after the intervention compared with the baseline(all P<0.05). Additionally, 13%(5/39)of cases in the OCVTC group showed a decrease in accommodative amplitude at 12 mo after treatment, with no cases showing a decrease in accommodative facility.

CONCLUSION: For myopic patients with dysfunctional accommodation, orthokeratology combining with visual training and Clouclip will enhance accommodative amplitude and facility, and maintain a stable effect over a long time.