散光是儿童视力发育的重要威胁之一，很多情况下其发生与眼表疾病的进展密切相关。非先天性眼表疾病如睑缘炎相关性角结膜病变、春季角结膜炎、干眼、感染性角膜炎和眼外伤等可通过慢性炎症介导的眼表微环境失衡、角膜瘢痕产生、泪膜稳定性破坏及角膜生物力学结构异常重塑等途径，导致角膜表面不规则性的产生和角膜曲率的改变。先天性眼表疾病如圆锥角膜、睑内翻和眼表肿瘤等则可通过遗传或发育异常改变眼睑结构、改变角膜曲率的对称性和机械压迫角膜产生散光，例如遗传疾病圆锥角膜的进行性角膜变薄与发生春季角结膜炎时眼表微环境的炎症性改变可协同作用加剧散光进展。针对不同病因，局部糖皮质激素滴眼液、免疫抑制剂环孢素滴眼液等药物使用和手术治疗均可改善患儿本身的病情和散光情况，只是不同疾病的治疗和散光矫正方案不尽相同。现有研究虽指出了部分儿童眼表疾病与散光的关联，但对于儿童的特异性机制部分如发育过程中免疫系统的变化、角膜可塑性差异及各种因素交互作用效应尚未完全解析。

Astigmatism is a significant threat to children's visual development and is often closely linked to the progression of ocular surface diseases. Non-congenital conditions, such as blepharitis-associated keratoconjunctivitis, vernal keratoconjunctivitis, dry eye, infectious keratitis, and ocular trauma, can induce irregularities on the corneal surface and changes in corneal curvature. This occurs through mechanisms like the ocular surface microenvironment imbalance mediated by chronic inflammation, corneal scarring, tear film instability, and abnormal corneal biomechanical remodeling. Congenital disorders, including keratoconus, entropion, and ocular surface tumors, can also lead to astigmatism. These conditions do so by causing genetic or developmental abnormalities that alter the eyelid structure, disrupt corneal symmetry, or exert mechanical pressure. Notably, there can be synergistic effects between progressive corneal thinning seen in hereditary keratoconus and the inflammatory microenvironment changes associated with vernal keratoconjunctivitis. Therapeutic interventions, such as topical corticosteroids, cyclosporine eye drops, and surgical procedures, can improve both the primary conditions and the astigmatism. However, treatment strategies vary depending on the different etiologies. Current research has established associations between pediatric ocular surface diseases and astigmatism. Nevertheless, the specific developmental mechanisms, including the  maturation of the immune system, differences in corneal plasticity, and the interactive effects of multiple factors, remain incompletely understood.

目的：探究球面塑形镜、环曲面塑形镜在矫治近视复合散光的有效性及安全性。方法：回顾分析宜昌市第一人民医院2016年3月至2018年3月角膜塑形镜治疗青少年近视94例(178眼)，按佩戴塑形镜类型分为球面塑形镜组(48例，90眼)与环曲面塑形镜组(46例，88眼)。记录配镜前、佩戴1年后、停戴1周后的视力、角膜散光、眼轴长、球镜屈光度、眼压、泪膜破裂时间及角膜着染率。结果：戴镜1年后，2组组内相比，散光、球镜度数、眼压、泪膜破裂时间均降低，但2组组间相比，仅散光度数差异有统计学意义(P<0.01)。戴镜1年后，两组视力较戴镜前显著提高，停戴后近视度数较佩戴前增加，但组间差异无统计学意义(P>0.05)；2种塑形镜角膜着染发生率差异无统计学意义(P>0.05)。结论：2种塑形镜均能够降低近视复合散光患者度数，有效提高患者视力，但并不能完全阻止近视的进展。虽然环曲面塑形镜在矫正散光方面有优势，但总有效性与安全性并不占优势。

Objective: To observe the effectiveness and safety of orthokeratology lens and toric design othokeratology treatment for compound myopic astigmatism. Methods: From March 2016 to March 2018, 94 teenagers(178 eyes) were selected as the subjects of study. They were divided into two groups according to the type of orthokeratology: the orthokeratology lens group (48 cases, 90 eyes) and the toric design othokeratology group(46 cases, 88 eyes). Visual acuity, corneal astigmatism, axial length, spherical lens refraction, intraocular pressure,tear film rupture time and corneal staining rate were recorded before, after 1 year and after 1 week. Results: After 1 year of wearing the lens, astigmatism, spherical lens degree, intraocular pressure and tear film rupture time were all decreased in the 2 groups compared with each other, but only astigmatism degree was statistically significant between the 2 groups compared with each other (P<0.01). After wearing the glasses for 1 year, the visual acuity of the two groups was significantly improved compared with that before wearing the glasses, and the myopia degree was increased after stopping wearing the glasses compared with that before wearing the glasses, but the difference between the two groups was not statistically significant (P>0.05). There was no statistical significance in the incidence of corneal staining between the two types of shaping lenses (P>0.05). Conclusion: Both of the two shaping lenses can reduce the degree of myopic patients with complex astigmatism and effectively improve the visual acuity of patients, but they can not completely prevent the progress of myopia. Although toroidal shaping mirror has advantages in correcting astigmatism, its overall effectiveness and safety are not.

随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。

With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.