摘要
目的观察硬性透氧性隐形眼镜(RGPCL)矫治圆锥角膜的临床疗效。方法回顾性研究。32例(62只眼)圆锥角膜患者,男24例,女8例,年龄15~38岁,平均年龄23.25岁。I期,角膜屈光度数≤48.00 D,共22只眼;Ⅱ期,角膜屈光度数≤53.00 D,未见角膜瘢痕,角膜厚度≥400μm,共15只眼;Ⅲ期,近视和/或散光度数-8.00^-10.00 D,角膜屈光度数>53.00 D,未见中央部瘢痕,角膜厚度200~400μm,共13只眼;Ⅳ期,屈光度无法测量,角膜瘢痕,共12只眼。除Ⅳ期中有3只眼等待角膜移植外,余59只眼行框架眼镜、RGPCL验配,比较框架眼镜与RGPCL矫正视力的情况。复诊观察角膜情况,随访时间3~24个月。结果 (1)I、Ⅱ、Ⅲ、Ⅳ期框架眼镜平均视力分别为0.823±0.182、0.468±0.248、0.289±0.178、0.151±0.147;I、Ⅱ、Ⅲ、Ⅳ期佩戴RGPCL后平均视力分别为0.955±0.106、0.933±0.123、0.831±0.197、0.678±0.277。I、Ⅱ、Ⅲ、Ⅳ期随病变严重程度,框架眼镜矫正视力和佩戴RGPCL的矫正视力均下降。各期比较均为RGPCL矫正视力优于框架眼镜视力(I、Ⅱ、Ⅲ、Ⅳ期分别比较框架眼镜和RGPCL的矫正视力行配对t检验:t=-3.321,P=0.003;t=-8.882,P=0.000;t=-7.408,P=0.000;t=-8.262,P=0.000)。(2)59只眼平均框架眼镜矫正视力为0.513±0.324,佩戴RGPCL的平均矫正视力为0.880±0.190,两者比较差别有统计学意义(t=-10.218,P=0.000),佩戴RGPCL后视力明显优于框架眼镜视力。(3)佩戴特殊设计圆锥片有29只眼(占49.2%),其余30只眼佩戴球面或非球面RGPCL(占50.8%)。(4)随访时间内均未发现角膜缘新生血管、角膜溃疡严重并发症,角膜点状染色发生率为23%,Ⅲ、Ⅳ期患者多见。结论 RGPCL矫治圆锥角膜的临床疗效显著,早期治疗视力效果更佳。
Objective To study the therapeutic effects of rigid gas permeable ontact lenses（RGPCL） on the treatment of refractory errors in keratoconus. Methods This was a retrospective study. Thirty-two patients（62 eyes） with keratoconus were included. There were 24 males and 8 females,aged from 15 to 38 years old and averaged at 23. 3 years.Subjects were divided into 4 groups according to the severity of keratoconus： phase I group（ n = 22）,corneal refraction was ≤48. 00 D; phase II group（ n = 15）,corneal refraction ≤53. 00 D,no corneal scar,and corneal thickness ≥400μm; phase III group（ n =13）,cornealrefraction 53.00 D,the refractive error of myopia or astigmatism was up to-8.00 -- 10. 00 D,and the corneal thickness was thinned to 200 - 400μm,but no corneal scar; phase IV group（ n = 12）,corneal refraction was not measureable and there were corneal scars. Except 3 eyes in phase IV groupthat were waiting forelective keratoplasty,other 59 eyes were prescribed with RGPCL,and best corrected visual acuity（BCVA） were compared for spectacles and RGPCL wearing using a paired t-test. The follow-up periods were between 3 and 24 months afterwards.Results（1） BCVA achieved with spectacles in phase I,II,III,and IV groups were 0. 823 ± 0. 182,0. 468 ± 0. 248,0. 289 ± 0. 178,and 0. 151 ± 0. 147,respectively. Accordingly,BCVA achieved with RGPCL were 0. 955 ± 0. 106,0. 933± 0. 123,0. 831 ± 0. 197,and 0. 678 ± 0. 277. Both spectacles and RGPCL BCVA generally deteriorated with the severity of keratoconus. BCVA achieved with RGPCL was significantly better than with spectacles at every disease phase. Paired ttest results in phase I,II,III,and IV were t =- 3. 321,P = 0. 003; t =- 8. 882,P = 0. 000; t =- 7. 408,P = 0. 000;and t =- 8. 262,P = 0. 000. 2） BCVA achieved with RGPCL was significantly better than with spectacles in all 59 eyes as a whole group（ t =- 10. 218,P = 0. 000）. 3） There were 29 eyes（49. 2%） prescribed with specially designed RGPCL and 30 eyes（50. 8%） prescribed w
出处
《临床眼科杂志》
2014年第5期426-428,共3页
Journal of Clinical Ophthalmology
