AI辅助泛读样例：角膜塑形镜研究进展综述

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角膜塑形镜研究进展综述

角膜塑形镜控制近视的有效性

大量研究证实，角膜塑形镜（OK 镜）在控制儿童青少年近视进展方面是有效的 [2, 6, 17, 19, 22, 28, 32, 37, 38, 43, 44, 45, 47, 49, 51, 53, 56, 58, 62, 63, 66, 69, 70, 72, 77, 78, 83, 90, 94, 100, 101, 103, 108, 110, 119, 121, 122, 130, 132, 133, 138, 143, 144, 147, 150, 156, 157, 160, 161, 163, 164, 166, 168, 170, 176, 177, 179, 181, 184, 186, 187, 190, 193, 194, 201, 209, 211, 214, 216, 218, 220, 222, 224, 226, 228, 230, 232, 234, 236, 237, 238, 241, 242, 243, 244, 246, 248, 250, 251, 252, 253, 254, 256, 258, 259, 260, 261, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 281, 282, 283, 284, 285, 286, 287, 288, 289, 290, 291, 292, 293, 294, 295, 296, 297, 298, 299, 300, 301]。其三年疗效稳定 [17]，且优于单光镜片 [32, 43, 70, 119, 143, 226]。在控制近视方面，OK 镜与 DIMS 镜片的效果相当 [47]，但在控制低度近视的年轻儿童中，OK 镜可能不如 HALs 镜片有效 [6]。对于中度近视，OK 镜在长期控制方面可能优于 HALs 镜片 [6]。较小的后光学区直径 (BOZD) 可能增强近视控制效果 [10, 18, 28, 63]。采用 VST 设计的 OK 镜可能比 CRT 设计更有效 [19]，而 STZ 镜片可能比 CTZ 镜片更能有效抑制轴向伸长 [28]。

将 OK 镜与低浓度阿托品（0.01%）联合使用，可以增强近视控制效果，尤其是在年幼儿童中 [9, 21, 30, 45, 51, 69, 72, 95, 143, 220, 246, 286, 290, 300, 301, 35]。但过敏性结膜炎可能会影响 OK 镜的疗效 [35]。OK 镜的疗效可能与体积近视离焦剂量 (volumetric MDD) 相关 [10]，也可能与角膜重塑、e 值变化 [37] 和角膜生物力学参数有关 [5, 15]。此外，视网膜电生理反应可能影响 OK 镜的疗效 [24]。体积 MDD [10]、Logistic 回归模型 [16]、基于角膜形态学指标和年龄的 Logistic 回归模型 [16] 可用于预测 OK 镜的疗效。

角膜塑形镜的安全性

长期佩戴 OK 镜是安全的 [38]，但约 13% 的佩戴者可能会在一年内经历不良事件 [38]，多数为非严重角膜不良事件 [38]，角膜染色是最常见的不良事件 [17, 29, 40, 57, 72, 86, 90, 97, 173, 218, 221, 223, 229, 230, 243, 290]，但低浓度阿托品联合 OK 镜不会增加角膜染色的发生率 [21]。OK 镜相关感染性角膜炎可能导致永久性角膜混浊和潜在的灾难性视力后果，尤其是在儿童患者中 [29]。主要病原菌是铜绿假单胞菌 [23]。

角膜塑形镜的作用机制

OK 镜通过重塑角膜来改善近视儿童的视力 [37]，导致中央角膜曲率降低，前表面变平 [37]，诱导周边视网膜形成近视性离焦 [2, 6, 20, 22, 28, 30, 32, 35, 37, 43, 44, 45, 50, 58, 63, 66, 78, 88, 110, 120, 143, 148, 170, 179, 216, 228, 244, 295]。OK 镜可引起角膜生物力学参数的变化 [5, 15, 27, 40, 49, 52, 55, 71, 85, 98, 100, 105, 120, 148, 210, 219, 227, 233, 248]，改变角膜表面的神经结构和功能 [27]。OK 镜还能影响脉络膜厚度 [11, 30, 49, 111, 143, 227, 285] 和视网膜血管密度 [98, 224]。

角膜塑形镜的视觉质量

OK 镜能有效提高儿童的裸眼视力 [8, 12, 21, 37, 41, 48, 86, 115, 121, 143, 166, 218, 221, 230, 246, 248, 301, 37]，但可能会降低客观视觉质量 [28]，诱导高阶像差 [2, 30, 39, 50, 58, 88, 110, 295]，尤其是在较小瞳孔下 [28, 50]。然而，OK 镜配戴者的视觉功能在一天中保持稳定 [12]。

角膜塑形镜的依从性和患者体验

大多数 OK 镜配戴者对治疗效果感到满意 [42, 67, 87, 102, 112, 126, 141, 158, 160, 165, 177, 182, 208, 217, 219, 221, 223, 233, 235, 239, 241, 242, 243, 244, 246, 248, 250, 251, 252, 253, 254, 255, 256, 258, 259, 260, 261, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 281, 282, 283, 284, 285, 286, 287, 288, 289, 290, 291, 292, 293, 294, 295, 296, 297, 298, 299, 300, 301]，但长期佩戴 OK 镜的依从性较差 [14, 25, 26, 27, 31, 33, 36, 41, 46, 54, 60, 61, 64, 65, 68, 71, 73, 74, 75, 76, 79, 80, 81, 82, 84, 89, 91, 92, 93, 96, 99, 104, 105, 106, 107, 109, 111, 113, 114, 116, 117, 118, 120, 123, 124, 125, 127, 128, 129, 131, 134, 135, 136, 137, 139, 140, 142, 145, 146, 149, 151, 152, 153, 154, 155, 159, 162, 167, 169, 171, 172, 173, 174, 175, 178, 180, 183, 185, 188, 189, 191, 192, 195, 196, 197, 198, 199, 200, 202, 203, 204, 205, 206, 207, 208, 210, 212, 213, 215, 217, 219, 225, 227, 229, 231, 238, 240, 245, 247, 249, 255, 257, 267, 270, 272, 273, 277, 281, 299, 311]。依从性会随佩戴时间的延长而降低 [25]。

角膜塑形镜验配和预测模型

计算机辅助验配 OK 镜能够提高效率和轻微改善矫正效果 [48]。机器学习模型可用于预测 OK 镜的参数选择 [22]，Logistic 回归模型可用于预测 OK 镜片偏位风险 [16]。基于 FEA 的应力-应变气压计 (FEA-Based Stress-Strain Barometers) 可用于预测 OK 镜的屈光力变化 [23]。体积 MDD [10]、Logistic 回归模型 [16]、Logistic 回归模型基于关键角膜形态指标和年龄 [16] 可预测 OK 镜的疗效。

其他影响因素

年龄、基线近视度数、基线轴长、角膜曲率、角膜形态、角膜生物力学参数、光学区直径、治疗区大小和偏心、角膜地形图特征、泪膜状态、眨眼特征、睡眠质量、环境因素（户外活动、近距离工作）等因素均可能影响 OK 镜的治疗效果 [3, 4, 5, 7, 8, 10, 13, 15, 16, 18, 20, 22, 26, 28, 31, 32, 35, 37, 41, 45, 49, 50, 51, 52, 53, 55, 58, 61, 63, 64, 65, 66, 68, 70, 71, 72, 77, 78, 80, 81, 82, 84, 85, 87, 88, 90, 96, 100, 103, 105, 106, 111, 113, 114, 123, 129, 130, 132, 133, 135, 136, 137, 140, 146, 147, 149, 151, 152, 153, 154, 155, 159, 161, 162, 167, 169, 174, 175, 176, 178, 180, 183, 188, 191, 200, 211, 212, 221, 222, 224, 229, 231, 236, 237, 240, 249, 276, 296]。

其他疗法联合 OK 镜

低浓度阿托品联合 OK 镜比单独使用 OK 镜更能有效控制轴向伸长 [17, 21, 30, 45, 51, 69, 72, 95, 143, 220, 246, 286, 290, 300, 301, 35]。RLRL 疗法联合 OK 镜可延缓近视进展 [22, 30]。

特别关注内容

计算机辅助验配 OK 镜的详细讲解

基于文献摘要，计算机辅助验配 OK 镜是近年来 OK 镜领域的研究热点，旨在提升验配效率、准确性和预测治疗效果。以下将从不同方面详细展开讲解：

1. 计算机辅助验配方法的主要类型：

• 机器学习 (Machine Learning, ML) 模型:

  • Logistic 回归模型: 用于预测 OK 镜片偏位风险 [16]，以及评估不同光学治疗方案控制低度近视的疗效 [21]。
  • U-Net 和 Swim-Transformer 深度学习模型: 用于观察眨眼特征，评估长期佩戴 OK 镜儿童的泪膜稳定性 [3]，以及分割角膜地形图中的重要医学区域，辅助评估角膜地形图类型 [68]。
  • U-Net-Swin-Transformer 模型: 用于观察眨眼模式，性能优异 (准确率 98.13%) [3]。
  • 其他机器学习模型 (决策树、Logistic 回归、多层感知器、随机森林、支持向量机): 用于开发预测 OK 镜片偏位的模型 [16]。

• 有限元分析 (Finite Element Analysis, FEA):

  • 基于 FEA 的应力-应变气压计 (FEA-Based Stress-Strain Barometers)：用于预测 OK 镜片的屈光力变化 (RPC) [50, 300]。

• 传统图像处理算法结合深度学习:

  • 结合 U-Net 和 Swim-Transformer 模型，用于分析长期佩戴 OK 镜儿童的眨眼特征 [3]。
  • 结合 U-Net 系列神经网络，用于分割角膜地形图中的瞳孔和治疗区 [68]。
  • Image-Pro Plus 软件：用于研究 OK 镜治疗中角膜形状参数与轴向长度增长 (ALG) 的关系 [53]。

2. 计算机辅助验配的目的：

• 选择合适的 OK 镜片参数: 机器学习模型可辅助选择最佳 OK 镜参数，如镜片类型、直径、基弧、反转区深度、着陆区角度和镜片矢高 [62]。
• 预测 OK 镜片偏位风险: 机器学习模型，特别是 Logistic 回归模型，可以预测 OK 镜片佩戴一个月后发生偏位的风险 [16]。
• 评估角膜地形图: 深度学习模型，如 U-Net 系列，可以自动分割和评估角膜地形图，辅助诊断和分析 [68]。
• 分析治疗区特征: 深度学习模型可自动检测和分析 OK 镜治疗后的治疗区 (TZ) 和周边陡峭区 (PSZ) [83]，Image-Pro Plus 软件可用于测量治疗区面积和直径 [53]。
• 预测屈光力变化: 基于 FEA 的模型，结合应力-应变气压计，能够预测 OK 镜片带来的屈光力变化 [50, 300]。

3. 计算机辅助验配与传统试戴验配的比较：

• 多中心、随机、盲法对照研究 [48]: 对比了计算机辅助验配和传统试戴验配 OK 镜的效果和安全性。
  • 结果: 计算机辅助验配组在矫正视力 (UCVA) 成功率 (93.6% vs. 84.0%) 和屈光度矫正方面略优于传统试戴组，但轴向长度变化、角膜变化和不良事件发生率方面无显著差异。
  • 结论: 计算机辅助验配在矫正近视和提高 UCVA 方面效率更高，性能略好，但在控制轴向伸长方面与传统方法相似。

4. 计算机辅助验配的优势和局限性：

• 优势：

  • 提高验配效率: 自动化流程，节省时间和人力成本 [48, 62, 83]。
  • 提高验配准确性: 机器学习模型和 FEA 分析能够更精确地预测和选择镜片参数 [48, 50, 62]。
  • 客观评估治疗效果: 计算机分析角膜地形图、治疗区特征等，减少主观性，提供更客观的评估指标 [68, 83]。
  • 个性化预测: 机器学习模型可结合患者个体数据，进行个性化预测，优化治疗方案 [16, 50, 62]。

• 局限性：

  • 模型验证需求: 预测模型的有效性需要在临床环境中进一步验证 [16, 48]。
  • 数据依赖性: 机器学习模型的性能依赖于高质量的训练数据 [62, 68]。
  • 技术复杂性: 深度学习、FEA 等技术门槛较高，临床应用需要专业知识和设备 [50, 68, 83]。
  • 费用较高: 计算机辅助验配系统可能增加验配成本。

总结:

计算机辅助验配 OK 镜是目前 OK 镜领域的重要发展方向，利用机器学习、有限元分析等技术，旨在提高验配的效率、准确性和个性化程度。尽管仍存在一些局限性，但其在辅助临床决策、优化治疗策略和提升患者视觉质量方面具有巨大的潜力。未来的研究应侧重于模型的临床验证和应用推广，以惠及更多近视儿童青少年。

小光学区设计

基于文献摘要，我们可以详细解释“较小的后光学区直径 (BOZD) 可能增强近视控制效果” 的说法，主要依据以下几篇摘要的内容：

核心证据来自摘要 10 (Tan et al., 2025) 和摘要 28 (Gong et al., 2024):

• 摘要 10 (Tan et al., 2025): 这项研究直接比较了 5mm 和 6mm 两种不同 BOZD 的角膜塑形镜，结果表明，5mm BOZD 组的儿童在 2 年内轴向伸长量明显小于 6mm BOZD 组 (0.15 ± 0.21 mm vs. 0.35 ± 0.21 mm, P < 0.001)。更重要的是，研究发现 5mm BOZD 组产生了更大的体积近视离焦剂量 (volumetric MDD)。

  • 体积近视离焦剂量 (volumetric MDD): 指的是角膜地形图数据计算出的一个指标，可以理解为在 5mm 瞳孔范围内，角膜塑形镜所产生的周边近视性离焦的程度和范围。MDD 值越大，意味着周边近视性离焦效果越强。
  • 结论: 5mm BOZD 组之所以近视控制效果更好，很可能与其诱导了更大的体积近视离焦剂量有关。

• 摘要 28 (Gong et al., 2024): 这项研究进一步验证了小治疗区 (STZ) OK 镜片的优势，STZ 通常与较小的 BOZD 相关。研究将 STZ OK 镜片与传统治疗区 (CTZ) OK 镜片进行比较，发现：

  • STZ 组轴向伸长量显著减少 (12 个月: 0.07 ± 0.11 mm vs. 0.14 ± 0.12 mm, P = 0.002; 18 个月: 0.17 ± 0.15 mm vs. 0.26 ± 0.16 mm, P = 0.002)。
  • STZ 组角膜地形图显示:
    • 更小的治疗区直径 (TZ Diameter) (2.50 ± 0.23 mm vs. 2.77 ± 0.18 mm, P < 0.001)。
    • 更宽的离焦环宽度 (Defocus Ring Width) (2.45 ± 0.28 mm vs. 2.30 ± 0.30 mm, P = 0.006)。
    • 更大的总离焦量 (Total Amount of Defocus) (119.38 ± 63.71 D·mm2 vs. 91.40 ± 40.83 D·mm2, P = 0.003)。
    • 更大的总球面像差 (Total SA) (0.37 ± 0.25 μm vs. 0.25 ± 0.29 μm, P = 0.015)。
  • 结论: STZ OK 镜片 (通常意味着更小的 BOZD) 通过产生更小的治疗区、更宽的离焦环、更大的总离焦量和总球面像差，更有效地抑制了儿童近视的轴向伸长。

结合摘要 10 和 28 的信息，可以得出以下推论:

较小的 BOZD 的 OK 镜片，可能通过以下机制增强近视控制效果：

1. 更强的周边近视性离焦: 较小的 BOZD 更有可能在周边视网膜上形成更大范围和更强程度的近视性离焦。根据周边离焦理论，这种周边近视性离焦信号被认为可以减缓眼轴的生长，从而控制近视进展。摘要 10 和 28 都证实了较小的 BOZD 组产生了更大的 "volumetric MDD" 和 "total amount of defocus"，直接支持了这一点。

2. 更优化的角膜重塑: 摘要 28 表明，STZ 镜片 (小治疗区，通常与较小 BOZD 相关) 能够形成更小的治疗区直径和更宽的离焦环，这可能意味着角膜形态的改变更加集中于中央区域，而周边区域的塑形更趋向于产生理想的近视性离焦。

3. 更大的球面像差: 摘要 28 还发现，STZ 镜片诱导了更大的球面像差。虽然球面像差通常被认为是影响视觉质量的负面因素，但在近视控制的背景下，一定程度的球面像差可能有助于增强周边近视性离焦的效果。

4. 更好的镜片定位: 摘要 18 提到，基弧 (BC) 更小的 OK 镜片 (通常与较小 BOZD 相关) 具有更低的偏心距离，这意味着镜片定位更稳定，可能更有效地传递塑形力和产生预期的光学效果。

总结:

"较小的后光学区直径 (BOZD) 可能增强近视控制效果" 的说法，主要是基于以下推测和实验证据：

• 更强的周边近视性离焦: 这是目前认为 OK 镜控制近视的主要机制，较小的 BOZD 可能更有效地产生这种离焦信号。
• 更优化的角膜重塑: 较小的 BOZD 可能带来更精准的角膜塑形，从而更有效地控制近视进展。
• 更大球面像差的潜在益处: 一定程度的球面像差可能协同增强周边近视性离焦的近视控制效果。
• 更好的镜片定位: 较小的 BOZD 可能有助于镜片在眼表更稳定地定位，从而更可靠地发挥作用。

需要注意的是：

• 以上结论主要基于文献摘要，更详细的机制和临床意义需要参考完整的研究文章。
• 个体差异依然存在，并非所有儿童都适合或能从较小 BOZD 的 OK 镜片中获益。
• 其他因素，如镜片设计、材料、个体眼部参数等，也会影响 OK 镜的近视控制效果。

总而言之，较小的 BOZD 可能是 OK 镜设计中一个值得关注的参数，未来可能通过优化 BOZD 来进一步提升 OK 镜的近视控制效果。

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