透气性硬性接触镜矫正圆锥角膜的视觉质量评价  

The evaluation of visual quality in keratoconus eyes corrected by rigid gas-permeable contact lens

作　　者：谢培英[1] 王丹[1] 杨丽娜[1] 周文娟[1] 

机构地区：[1]北京大学医学部眼视光学研究中心,100083

出　　处：《中华眼科杂志》2005年第12期1086-1091,共6页Chinese Journal of Ophthalmology

摘　　要：目的评价透气性硬性接触镜(RGPCL)和框架眼镜矫正圆锥角膜的视觉质量差异。方法对27例(54只眼)轻、中、重度圆锥角膜患者利用计算机辅助的角膜地形图,主观式波阵面像差仪和对比敏感度仪观察框架眼镜和RGPCL矫正时的角膜形态和视觉质量变化。结果轻度圆锥角膜30只眼,中度圆锥角膜13只眼,重度圆锥角膜11只眼,总体平均近视度和散光度分别为(6.92±3.66)和(5.75±1.85)D。66.6%的患眼裸眼视力≤0.15,96.3%的患眼裸眼视力≤0.3。矫正视力≥0.6者,戴用框架眼镜者为59.3%,戴用RGPCL者为100.0%;矫正视力≥1.0者,戴用框架眼镜者为20.4%,戴用RGPCL者为66.7%。配戴RGPCL后角膜地形图显示,角膜散光基本消除(<0.75D),表面形态显著球面化和规则化。圆锥角膜随病变程度加深,总体波阵面像差和各阶像差均显著增加。戴RGPCL的波阵面像差比裸眼明显降低,各阶RMS差异均有统计学意义(P<0.01),总体RMS从3.63μm降至1.39μm,2阶RMS从2.64μm降至0.81μm,去除2阶的总高阶RMS从2.35μm降至1.10μm,3阶RMS从1.78μm降至0.68μm,最为显著。对比敏感度及眩光对比敏感度曲线在全频段特别是中、高频段RGPCL比框架眼镜有显著升高。结论角膜前突变形引起的角膜不规则散光是圆锥角膜视觉功能低下,像差增大的主要原因,框架眼镜往往无法矫正,配戴适宜的RGPCL通过与泪液镜的有效弥合重塑成新的圆滑的中心光学界面,因而可有效消除角膜散光,减少像差,提高视力和对比敏感度曲线,明显改善视觉质量,使患者迅速回归正常学习与生活。Objective To evaluate the visual quality in keratoconus eyes corrected by rigid gaspermeable contact lens （RGPCL） and spectacles. Methods Corrected visual acuity, corneal topography, wavefront aberration and contrast sensitivity were measured in 27 keratoconus patients （54 eyes） before and after the fitting of RGPCL. Results The inclusive keratoconus eyes were diveded mild 30 eyes, moderate 13 eyes and sever 11 eyes. The average myopia and average astigmatism were （6. 92 ±3.66） D and（5.75 ± 1.85）D respectively. Uncorrected visual acuity （VA） in 96. 3% keratoconus eyes was ≤0. 3. RGPCL corrected VA was increased significantly compared with spectacles corrected VA. The VA in 59. 3% of eyes corrected by spectacles were ≥ 0. 6, while 100% by RGPCL. The VA in 20. 4% of eyes corrected by spectacles were ≥ 1.0, while 66. 7% by RGPCL. Corneal topography study showed corneal toricity decreased to ≤0. 75 D in RGPVA group. Ocular surface was changed to spherical and regular shapes. Rootmean-square （RMS） of wavefrent aberration decreased significantly from （ 3.63 ±2. 08 ） μm （ without RGPCL） to （1.39 ± 0. 82） μm （with RGPCL） （P 〈 0. 01 ）. RMS of Zernike function in each order was decreased as well, second order from （2. 64 ± 1.74） μm to （0. 81 ± 0. 66） μm, total high order from （2. 35±1.57） μmto （1.10 ±0.62） μm, third order from （1.78 ±1.28） I.Lm to （0.68±0.39） μm With RGPCL fitting, contrast sensitivity curve （ light on and light off） were significantly higher than that with spectacles in whole range of frequency , especially in middle and high frequency. Conclusions Corneal distortion induced high corneal irregular astigmatism is the most frequent cause of increase of aberration and reduced ocular optical quality in keratoconus. Proper RGPCL fitting provides an effective method in reshaping of ocular surface combined with tear film. RGPCL could reduce aberrations and corneal astigmatism, improve optical quality, and finally,

关 键 词：圆锥角膜 视力测定法 对比敏感度 接触镜 视觉质量 

分 类 号：R772.21[医药卫生—眼科]