【摘要】 目的 使用超长扫描深度谱域OCT（UL-OCT）评估夜戴型角膜塑形镜镜片在位时的偏心量及配适特点。方法 前瞻性队列研究。本研究共纳入33例（33眼）被检者，其中男10例，女23例，年龄22～37岁，平均（26.0±3.2）岁。被检者双眼戴角膜塑形镜1夜。分别在戴镜前及戴镜后对被检者进行镜片在位时的UL-OCT图像拍摄，应用自行编写程序量化分析镜片偏心量。同时，使用裂隙灯显微镜照相系统进行荧光素染色镜片配适评估。采用Kappa检验比较2种评估方法之间的一致性。并且观察镜片与眼表的断层关系。结果 以UL-OCT成像方式进行评估的镜片平均偏心量为（0.62±0.31）mm，其中42％（14/33）为理想配适，42％（14/33）为可接受的中等偏心状态，15％（5/33）为严重偏心。以荧光素染色进行评估则显示有58％（19/33）的被检者为理想配适，33％（11/33）为可以接受的中等偏心状态，9％（3/33）为严重偏心。对2种方法的一致性进行Kappa检验，结果为0.647。镜片与眼表的关系可在OCT图像上得以显示。镜片配适不良时可见角膜上皮的异常变形。结论 OCT可以量化角膜塑形镜在眼时的镜片偏心程度，与传统荧光素染色评估有中等程度一致性。
【关键词】 角膜塑形术； 镜片配适； 体层摄影术，光学相干
DOI：10.3760/cma.j.issn.1674-845X.2014.02.002
基金项目：国家自然科学基金（81170869）；国家基础研究项目（973项目，2011CB504601）；浙江省重点科技创新团队计划（2009R50039/2009R50039-19）；浙江省高校重大科技攻关项目（ZD2007006）
作者单位：325027 眼视光学院（连燕、姜珺、沈梅晓、王耀增、黄胜海、毛欣杰、吕帆）；美国 佛罗里达州，迈阿密Bascom Palmer眼科研究所（王建华）
通信作者：毛欣杰，Email：mxj@mail.eye.ac.cn
Evaluation of overnight orthokeratology lens fitting using ultra-long scan depth spectral domain optical coherence tomography
Lian Yan*， Jiang Jun， Shen Meixiao， Wang Yaozeng， Huang Shenghai， Wang Jianhua， Mao Xinjie， Lyu Fan. * Eye Hospital of Wenzhou Medical University， School of Ophthalmology and Optometry， Wenzhou Medical University， Wenzhou 325027， China
Corresponding author：Mao Xinjie，Email：mxj@mail.eye.ac.cn
【Abstract】 Objective To quantitatively evaluate the centration and fitting characteristics of the overnight orthokeratology lens using ultra-long scan depth spectral domain optical coherence tomography （UL-OCT）. Methods This was a prospective cohort study. Thirty-three subjects （33 eyes， 23 women and 10 men； mean age： 26.0±3.2 years， range： 22-37 years） were enrolled in the study to wear the reverse-geometry orthokeratology lenses in both eyes for one night. Images with the lens on the eye were acquired by a custom-built UL-OCT before and after one night of orthokeratology lens wear. Custom software was used to quantify lens decentration. At the same time， lens fitting under fluorescein staining patterns was evaluated by a slit-lamp microscope imaging system. A Kappa test was used. Results The mean decentration was 0.62±0.31 mm based on the UL-OCT evaluation method. Results showed that 42%（14/33） had optimal fitting， 42%（14/33） had moderate decentration which was clinically acceptable， and 15%（5/33） had severe decentration. The fluorescein patterns showed 58%（19/33） had optimal fitting， 33%（11/33） had moderate decentration， and 9%（3/33） had severe decentration. A Kappa test result for the consistency of the two methods was 0.647. The interactions between the orthokeratology lens and ocular surface were observed through the OCT images. Abnormal deformation of the corneal epithelium occurred when the fitting was not optimal. Conclusion OCT could quantify the orthokeratology lens under the condition lens on eye. The result of OCT evaluation matched with the traditional fluorescein staining by moderate consistency.
【Key words】 Orthokeratology； Lens fitting； Tomography，optical coherence
