目的 比较中高度散光患者配戴框架眼镜和透气性硬性接触镜（RGPCL）的主客观视觉质量。 方法 选取2008年6月－2011年5月中高度角膜散光20例共40只眼进行角膜地形图、综合验光仪验光等检查后，选择合适试戴片作配适评估并定制RGPCL。要求患者戴镜后1周、1个月、3个月和6个月复查，记录矫正视力、镜片配适、眼部情况，并在第4次复查时进行对比敏感度视力检查及主观问卷调查。 结果 RGPCL矫正视力优于框架眼镜，但两者对比敏感度视力在各空间频率均无明显差异。主观评分时，远视力两者无明显差别；中距离视力框架眼镜评分（3.825 ± 0.245）分，RGPCL评分（3.525 ± 0.302）分，差异有统计学意义（t=5.339，P=0.000）；近距离视力框架眼镜评分（3.795 ± 0.233）分，RGPCL评分（3.690 ± 0.194）分，差异有统计学意义（t=3.462，P=0.030）。有45%患者选择RGPCL为主要配戴方式；40%患者选择RGP CL和框架眼镜交替使用的方式；10%患者选择仅在有特殊社交需求时使用RGPCL；另5%患者放弃使用RGPCL。 结论 RGPCL和框架眼镜矫正中高度角膜散光均能取得较满意效果，在中近距离精细作业时框架眼镜矫正视力更为稳定清晰。但由于RGPCL在成像质量和外观上的优势，多数患者仍愿意坚持配戴RGPCL。
ObjectiveTo compare the changes of corneal astigmatism after long-term spherical and toric orthokeratology wearing, and to investigate the effects of different orthokeratology design on corneal astigmatism.MethodsThe medical records of myopic adolescent patients who have been prescribed spherical and toric orthokeratology in the contact lens clinic of West China Hospital, Sichuan University between January 2019 and December 2021 were analyzed retrospectively.The differences of corneal astigmatism changes after wearing spherical and toric orthokeratology for a long time and one month discontinuation were compared. The influencing factors of corneal astigmatism changes were analyzed. ResultsA total of 156 patients were included. There were 76 cases (76 eyes) in spherical orthokeratology group and 80 cases (80 eyes) in toric orthokeratology group. There was no significant difference between the two groups in age, gender, baseline myopia diopter and total lens wearing time (P>0.05). There were statistically significant differences between the spherical orthokeratology group and the toric orthokeratology group in the baseline corneal flat K value [42.1 (41.3, 43.3) vs. 43.1 (42.0, 44.1) D], baseline corneal steep K value [(43.4±1.3) vs. (44.6±1.5) D], baseline corneal astigmatism [(1.1±0.5) vs. (1.6±0.6) D], and baseline total eye astigmatism [−0.6 (−1.2, 0.0) vs. −1.4 (−1.8, −1.0) D] before wearing the orthokeratology (P<0.05). Compared with the baseline value, 1 month after the two groups stopped wearing the orthokeratology, the corneal flat K values became flatter [spherical orthokeratology group: 42.09 (41.28, 43.34) vs. 41.73 (40.98, 43.16) D, toric orthokeratology group: 43.09 (41.95, 44.10) vs. 42.61 (41.52, 43.56) D; P<0.05], the changes of corneal steep K values were not statistically significant (P>0.05), but the corneal astigmatism values increased [spherical orthokeratology group: (1.05±0.49) vs. (1.37±0.56) D, toric orthokeratology group: (1.62±0.57) vs. (1.99±0.63) D; P<0.05]. There was no significant difference in the changes of corneal flat K value, corneal steep K value and corneal astigmatism between the two groups (P>0.05). Multivariate analysis showed that age (P=0.011) and the total duration of orthokeratology wearing (P=0.004) were the main factors affecting the changes of corneal astigmatism. ConclusionAfter 1 month of non-wearing, the flat K value of the cornea becomes flat, the steep K value remains unchanged, and the corneal astigmatism increases. There is no difference in the effect of the spherical and toric orthokeratology on corneal astigmatism. The change of corneal astigmatism is related to the patient’s age and the total duration of wearing the orthokeratology. The younger the age, the longer the duration of orthokeratology wearing, the more significant the increase of corneal astigmatism after stopping wearing the orthokeratology.