【摘要】 目的:采用视功能训练联合不同光学矫正方式，观察儿童青少年眼调节功能和屈光相关参数的变化，评估其在近视防控中的作用。方法:纳入120例(240眼)儿童青少年近视患者为研究对象。根据矫正方式的不同分为6组，光学矫正组：单焦点框架眼镜(SVL)组、多区正向光学离焦框架眼镜(DIMS)组、角膜塑形镜(OK)组，及上述三种矫正方式分别联合视功能训练的SCVT组、DCVT组、OCVT组，每组各20例(40眼)。单纯光学矫正组仅配戴眼镜；联合组在戴镜的基础上行以调节训练为主的视功能训练。于干预前、干预治疗后3、6个月，观察比较眼轴长度(AL)、前房深度(ACD)、平均角膜曲率(Km)、调节幅度(AMP)、调节灵活度(AF)、正相对调节(PRA)和负相对调节(NRA)的变化。结果:干预后，光学矫正组中，SVL组各参数无明显变化；DIMS组AF改善(P<0.05);OK组AMP、AF、PRA改善，ACD、Km降低(P<0.05);光学矫正联合视功能训练组中，SCVT组各时间点AMP、AF均改善(P<0.05);DCVT组各时间点AMP、AF、PRA、NRA均改善(P<0.05);OCVT组各时间点AMP、AF、PRA、NRA均改善，ACD、Km均降低(P<0.05)。联合组与相应光学矫正组比较，联合组对AL增长的控制及AMP、AF、PRA改善效果更明显(P<0.05);联合组组间比较，DCVT、OCVT组对AMP、AF、PRA改善效果优于SCVT组(P<0.05);OCVT组对AMP的改善效果优于DCVT组(P<0.05)。干预6个月后，联合组组间眼轴增长量比较，OCVT<DCVT<SCVT组(P<0.05)。结论:以调节功能训练为核心的视功能训练方案可延缓AL增长并改善AMP、AF、PRA,但对ACD、Km无明显影响，当联合应用光学防控手段(如离焦框架镜、角膜塑形镜)时，其协同作用可进一步强化AL增长控制及调节功能改善的效能。更多还原

【Abstract】 Objective: To investigate the effects of combining visual function training with different optical correction modalities on ocular accommodative function and refractive-related parameters in myopic children and adolescents, aiming to evaluate their combined efficacy in myopia control and prevention.Methods:This study enrolled 120 patients(240 eyes) meeting inclusion criteria, they were divided into 6 groups according to different correction methods: single-vision lenses(SVL),defocus incorporated multiple segments(DIMS),orthokeratology(OK),and their respective combinations with vision training(SCVT,DCVT,OCVT),with 20 patients(40 eyes) in each group.Optical correction groups wore lenses only, while combined groups received additional accommodative training.Changes in axial length(AL),anterior chamber depth(ACD),mean keratometry(Km),accommodative amplitude(AMP),accommodative facility(AF),positive relative accommodation(PRA),and negative relative accommodation(NRA) were assessed before intervention and 3 and 6 months after intervention treatment.Results: After the intervention, in optical correction groups, SVL showed no significant changes, DIMS improved AF(P<0.05),OK improved AMP,AF,PRA,and reduced ACD,Km(P<0.05).In combined groups, SCVT improved AMP,AF(P<0.05),DCVT improved AMP,AF,PRA,NRA(P<0.05),OCVT improved AMP,AF,PRA,NRA,and reduced ACD,Km(P<0.05).Combined groups showed better AL control and AMP,AF,PRA improvements than in optical correction groups(P<0.05).Among combined groups, DCVT and OCVT outperformed SCVT in AMP,AF,PRA improvements(P<0.05),OCVT surpassed DCVT in AMP improvements(P<0.05).After 6 months of intervention, AL growth was OCVT < DCVT < SCVT(P<0.05).Conclusion:Visual function training based on accommodative function training has a significant effect on controlling AL growth and improving AMP,AF and PRA,but has no effect on ACD and Km, when combined with optical prevention and control methods(such as defocus-incorporated spectacles or orthokeratology),their synergistic effect can further enhance the effectiveness of AL control and accommodative function improvement.更多还原