几种儿童屈光性眼病的接触镜应用  

Management of pediatric refractive errors with contact lenses.

作　　者：谢培英[1] 王丹[1] 杨丽娜[1] 

机构地区：[1]北京大学医学部眼视光学研究中心,100038

出　　处：《中国斜视与小儿眼科杂志》2005年第3期105-109,101,共6页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探讨各类接触镜在矫正不同儿童屈光异常眼病中的临床有效性和安全性。方法具体分析几种疑难性屈光性儿童眼病的接触镜选择、验配、使用方法,对比框架眼镜的矫正效果并观察戴镜后屈光度改变和眼部反应。结果(1)35例(62眼)圆锥角膜(包括穿透性角膜移植术后)患儿全部选择配戴了透气性硬性接触镜(RGPCL)。RGPCL 矫正视力(RGPVA)≥0.8者占70%,按轻、中、重度分组,各组RGPVA 均显著高于框架镜矫正视力(SPVA)。戴镜1.5年左右复查,可见部分病例近视度和散光度降低,部分视力尚有提高。(2)眼外伤术后51例(52眼),59.6%使用了软性接触镜(SCL),矫正视力>0.6的比例,框架镜25.8%,SCL 29.1%。40.4% 使用了RGPCL,RGPVA0.7～0.9占23.8%,1.0～1.2占23.8%,SPVA0.7～0.9占14.3%,1.0～1.2占4.8%,并使多数病例恢复了双眼单视。(3)RGPCL 对96只高度散光及高度近视眼,30只近视、散光眼,28例屈光参差矫正效果良好,RGPVA 均高于SPVA,高度散光眼最为显著。21例有复诊记录,近视度平均降低1.16D±0.97D,散光度平均降低1.22D±0.56D,5只眼视力提升1～2行。(4)SCL 用于7例屈光参差,8只高度近视眼和22只近视、散光眼,矫正视力与SPVA 相近,但明显消除了不等像视,扩大了视野。(5)低视力儿童8例(先天性虹膜、脉络膜缺损,先天性白内障术后无晶体,白化病,马凡综合征,眼球震颤,角膜白斑,高度近视,高度散光)选择配戴了加虹膜色彩的SCL 和RGPCL,并配合光学助视器有效提高了功能视力,使患儿能维持正常学习和生活。全部病例均对接触镜矫正满意,未发现明显角、结膜并发症而停用接触镜者。结论充分发挥接触镜的光学矫正优势,可有效提高矫正视力,促进儿童双眼视觉功能发育,并有可能不同程度控制近视和散光发展。儿童对接触镜的接受程度与成人无异,医师与患儿及其家长密切配合下的科学使用基本可保证戴镜安全。Objective To evaluate the effects and safety of contact lens fitting in pediatric eyes with different refractive errors. Methods We retrospectively analyzed date of some difficult pediatric refractive errors fitted with varied contact lenses. The lens performance, the visual acuity of contact lens compared with spectacles, changes of diopters and ocular surface were observed. Results 35 children （62 eyes） with keratoconus and post penetrating keratoplasty were fitted with RGPCL. RGP visual acuity （RGPVA） was 70%≥0.8, and each group （mild, moderate and severe） RGPVA was higher than spectacle visual acuity （SPVA） significantly. Decreases of myopia and astigmatism could be found in many cases about 1.5 years after wore contact lens. 51 children （52 eyes） with traumatic and post surgery, 59.6% were fitted with SCL, corrected visual acuity was about 0.6, 25.8% in spectacles, 29.1% in SCL. 40.4% were fitted with RGPCL, 23.8% RGPVA was 0.7～0.9, 23.8% RGPVA was 1.0～1.2. 14.3% SPVA was 0.7～0.9, only 4.8% SPVA was 1.0～1.2. 28 children with anisometropia, also 96 eyes with high myopia and high astigmatism, and 30 eyes with myopia and astigmatism were fitted with RGPCL. RGPVA was higher than SPVA in most cases, especially in high astigmatism eyes. 21 cases had follow up reports, myopia decreased 1.16D±0.97D and astigmatism decreased 1.22D±0.56D respectively, RGPVA also raised 1～2 line in 5 eyes. Another 7 children with anisometropia, 8 eyes with high myopia and 22 eyes with myopia and astigmatism were fitted with SCL, SCL corrected visual acuity was closed to SPVA, but it could enlarge visual field and decrease aberrations. 8 children with low vision were fitted with iris-color SCL and RGPCL, and plus using of optic aids. They were kept in normal learning and life. All children were satisfied with contact lens fitting. There were no remarkable corneal and conjunctival complications during wearing period. Conclusion Contact Lenses provided excellent optic corrections, and were effects to impr

关 键 词：儿童 近视眼 散光眼 接触镜 屈光矫正 硬性接触镜 儿童眼病 屈光性 RGPCL 高度近视眼 

分 类 号：R778[医药卫生—眼科]