摘要
目的观察圆锥角膜患者配戴透气性硬性角膜接触镜(RGPCL)3年以上的视力矫正效果,屈光度和处方参数变化以及角膜塑形效果。设计回顾性病例系列。研究对象配戴RGPCL连续观察3年以上的圆锥角膜患者73例(136眼)。方法患者于戴镜前、戴镜1、2、3年检测视力,自动验光仪/角膜曲率仪和角膜地形图仪的圆锥角膜筛查软件检测。观察戴镜前后屈光度、角膜曲率、角膜散光和其他角膜形态学改变;对比RGPCL处方基弧、屈光度的变化。根据病变程度按轻度圆锥角膜组(A组)和中、重度组(B组)分级进行分析。主要指标视力,屈光度数,RGPCL基弧,角膜地形图的各项指标。结果患者平均戴镜(49.3±15.3)个月(36～76个月)。初诊裸眼视力(UVA)平均3.76±0.45,框架镜矫正视力(SPVA)4.57±0.53,RGPCL矫正视力(RGPVA)4.89±0.14,视力有显著提高(F=171.994,P=0.000);末诊RGPVA 4.95±0.11,与初诊比较有显著提高(t=-6.733,P=0.000)。B组比A组提高更显著。RGPVA可达0.8或以上的比率,戴镜初期、1年、2年和3年后分别为85.13%、86.76%、85.60%和84.62%。初诊与末诊检查相比较,近视度为(7.13±4.01)D和(6.23±3.42)D(P=0.014),角膜散光度为(6.23±3.24)D和(4.42±2.34)D(P=0.000)。初诊与末诊RGPCL处方基弧为(7.38±0.50)mm和(7.54±0.42)mm(P=0.000),RGPCL处方度为(-6.22±3.59)D和(-5.33±3.09)D(P=±0.000)。与A组比较,B组的屈光度与镜片弧度的变化更显著。角膜地形图各项表面参数除SAI、IAI和AA 3项其初、末诊之间无显著差异外,其余9项参数值均有显著降低(P均<0.05)。结论圆锥角膜患者科学合理地长期配戴RGPCL,能较好地获得持久的矫正视力,并可获得显著角膜塑形效果,明显降低近视度和散光度,有效控制圆锥角膜的发展。
Objective To observe the 3 years or more effects on optical correction, refraction, and orthokeratology with rigid gas permeable contact lens （RGPCL） wearing in patients with keratoconus. Design Retrospective case series. Participant 73 keratoconus patients （136 eyes） fitted with RGPCL. Methods Patients wearing RGPCL for 3 years or more in Peking University Optometry ＆ Ophthahnology Center were observed. Correct visual acuity was determined before and at 1, 2 and 3 years of lens wearing, and the refractive power, corneal curvature, corneal astigmatism and corneal morphological changes were measured with auto-refractomer/keratometer and keratoconus screening analysis system of computer-assisted corneal topography at the same time. The changes of base curve and RGPCL power were also compared. All patients were divided into mild keratoeonus group （Group A）, moderate and severe keratoconus group （Group B）. Main Outcome Measures Visual acuity, refractive power, base curve of RGPCL, corneal topography parameters. Results The patients wore RGPCL for 49.3±15.3 months （36-76 months）. At the initial visit, uncorrected visual acuity （UVA） was 3.76±0.45, corrected visual acuity with spectacles （SPVA） was 4.57±0.53, and with RGPCL （RGPVA） was 4.89±0.14. RGPVA was improved significantly （F = 171.994, P=0.000）. RGPVA at last visit （4.95±0.11） was better than that at initial visit （t = -6.733, P=0.000）, which was more significant in group B than that in group A. The rate for RGPVA more than 0.8 at the initial, 1 year, 2 years and 3 years of lens wearing was 85.13%, 86.76%, 85.60% and 84.62% respectively. At the initial visit and last visit, the myopia diopters and the corneal astigmatism were 7.13±4.01D vs. 6.23±3.42D （P=0.014） and 6.23±3.24D vs. 4.42±2.34D （P=0.000） respectively. The RGPCL base curve and lens power were 7.38±0.50 mm vs. 7.54±0.42 mm （P=0.000）, and -6.22±3.59 D vs. - 5.33±3.09 D （P=0.000） respectively. The changes of power and base curve of lens in group B were more significant than that in group A. The decrease of 9 corneal topography parameters between initial visit and last visit was significant statistically （all P〈0.05） except SAI, IAI and AA. Conclusions The patients with keratoconus can obtain much better and stable visual acuity and remarkable orthokeratology effect for a long-tern1 RGPCL wearing in scientific way. Myopia and astigmatism power can be decreased significantly. The results show the keratoconus control is efficient.
出处
《眼科》
CAS
2009年第5期297-300,共4页
Ophthalmology in China
关键词
圆锥角膜
透气性硬性接触镜
角膜地形图
角膜塑形
keratoconus
rigid gas permeable contact lens
corneal topography
orthokeratology
