Clinical Efficacy Of Toric Orthokeratology In Myopic Adolescent With Astigmatism

Objective: To observe the efficacy and safety of Toric orthokeratology in patients with astigmatism myopia,and to observe the change of visual quality before and after wearing ok lens through OQAS visual quality analysis system.And Observing the decentration of the lens after wearing the orthokeratology with a pentacam corneal topograph.Methods: The prospective self-controlled study was used in the experimental group.From July to October 2016,40 patients(18 males and 22 females)were randomly selected from 8-16 years old(12.08±2.27 years old)in the ophthalmology prevention and control clinic of Tianjin Medical University.The diopter was-0.75 D to-6.00D(4.10±1.48D)and the astigmatism was(1.75±0.51).Each patient was measured Lenstar,OQAS,pentacam before wearing Ortho-K CL.Three measurements were taken for each examination.They are all operated by the same experienced inspector.OQAS and pentacam were also measured at 1 week,2 weeks,1month,3month,6month and 12 month with Orthokeratology,and Lenstar was included in 12 month.The OQAS check includes the modulation transfer function(MTF),the objective scatter index(OSI),and the OQAS values(OVQ%,OV100%,OV20%,OV9%,OV average)under different contrasts.Uniform 4mm bore diameters are used for OQAS measurements.Eye biometric lenstar and corneal topography pentacam examinations use standard inspection procedures and results.A retrospective study was performed in the control group.40 patients with large astigmatism using the same brand of lenses were selected from the previous patients who were fitted with the Spherical design Orthokeratology.The control group used the same group of lenses with no statistical difference in age,diopter and corneal morphology.The keratoplasty of the spherical design of the cornea,retrospective analysis of the visual acuity of 1 week,2 weeks,1 month,3 months,6 months,and 12 months after wearing the lens,corneal spotting,pentacam topography,lenstar axial length,Comparing the parameters of the same time point with the experimental group,the safety and effectiveness of the Orthokeratology and spherical design of the Orthokeratology in the correction of large astigmatic myopia patients were compared.The data were collected using spss22.0(IBM,USA),40 patients in group A(40 right eyes),40 patients in group B(40 right eyes)for statistical analysis,lenstar,OQAS,pentacam instruments.The difference in variation was analyzed by paired ttest.Perason correlation analysis was used to analyze the correlation between the decentration of the lens after wearing and the change of visual quality parameters and the growth length of the eye axis.P < 0.05 indicates that the difference was statistically significant.Result: In the group A,group B,the uncorrected visual acuity before wearing the lens was(1.15±0.42,1.18±0.35),and the lens was worn for 1 week(0.01±0.38,0.01±0.28),2 weeks(0.17±0.33,0.15±0.25).1 month(0.14±0.4,0.15±0.37),3 months(0.13±0.15,0.15±0.2),6 months(0.06±0.4,0.08±0.35),12 months(0.05±0.3,0.07±0.28)(A group,group B,naked eye vision,corneal vertex diopter at each measurement time point were not statistically different,and obtained corrected visual acuity 1 week after wearing the lens).1.2,group A,group B wearing glasses Anterior corneal astigmatism(1.73±0.5,1.82±0.4)d,1 week after wearing Orthokeratology(0.76±0.34,1.98±0.83)d,2 weeks(0.56±0.42,2.01±1.02)d,1 Month(0.65 ± 0.45,1.88 ± 0.76)d,3 months(0.70 ± 0.55,1.68 ± 0.78)d,6 months(0.55 ± 0.65,1.78 ± 0.88)d,12 months(0.75 ± 0.58,1.88 ± 0.98)mm,There was a statistical difference between all those time points(p <0.01),1.3,and the decentration of group A and group B was(0.86±0.1,1.22±0.5)mm 1 week,2 weeks(0.89±0.13,1.33±0.55)mm.1month(0.78±0.12,1.45±0.76)mm,3months(0.82±0.11,1.45±0.65)mm,6months(0.79±0.12,1.40±0.45)mm,12months(0.75±0.12,1.35±0.55)mm(P <0.01),there was a statistical difference in all those time points(p <0.01),There was no statistical difference in the group between 1 week and 2 weeks in group A.decentration was stable for 1 week.same to group B 1.4,group A,group B,there was no statistical difference in corneal spotting rate after wearing OKlens(p> 0.05).1.5,There was no statistical difference in 1 year axial growth group A(0.14 ± 0.25)mm,group B?(0.16±0.2)mm(p>0.05).1.6,there was no significant difference between the original endothelial cell count of group A and group B before and after one year of ok lens(p>0.05).2.1 The initial value of MTF cutoff in group A is(45.75±5.89,38.41±5.6,39.26±4.55,41.67±3.85,38.59±5.43,39.36± 4.73)in 1 week,2 weeks,1 month,3 months,6 months,and 12 months,the MTF cutoff value decreased from the initial one and stabilized at 1 month.2.2 Initial value of SR in group A,1 week,2 weeks,1 month,3 months,6 months,and 12 months,respectively 0.25±0.06,0.14±0.07,0.16±0.09,0.15±0.06,0.18±0.08,0.19±0.06? The SR value decreased from the initial one and stabilized at 1 month.2.3 The initial value of OSI in group A was 1.36±0.14,0.73±0.3,0.78±0.31,0.72±0.29,0.73±0.29,0.82±0.34 in 1 week,2 weeks,1 month,3 months,6 months and 12 months,respectively.),the OSI value increased from the initial level and stabilized at 1 month.Conclusion: Spherical design and Toric design Orthokeratology reached the predicted corrected visual acuity after wearing the plastic mirror for 1 week.The amount of astigmatism of the cornea and eccentricity were stable after wearing for 1 week.Adolescent myopic astigmatism patients use spherical design of Ortho-K CL and Toric designed Ortho-K CL to make no difference in controlling myopia growth,no difference in safety;spherical design is larger than Toric design Orthokeratology in decentration;The visual quality reduce after wearing the Toric designed orthokeratology,and the degree of decline was within the clinical acceptable range.