特殊设计的透气性硬性角膜接触镜矫治继发性圆锥角膜的临床研究  

Clinical study on treatment of secondary keratoconus with special designed rigid gas permeable contact lens

作　　者：王丹 谢培英 周建兰 

机构地区：[1]北京北医眼视光学研究中心,100083

出　　处：《中华眼科杂志》2013年第4期327-333,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨特殊设计的透气性硬性角膜接触镜（RGPCL）矫治继发性圆锥角膜的效果。方法回顾性研究。对89例（102只眼）来北京北医眼视光学研究中心就诊的继发性圆锥角膜患者通过病史询问和裂隙灯检查法、角膜地形图、综合验光仪、角膜内皮细胞检查及A超和角膜厚度测量进行综合分析，同时针对不同的角膜形变选择不同材料和设计的角膜接触镜进行屈光矫正，并定期观察视力的稳定性和角膜改变。采用配对t检验对框架眼镜与RGPCL矫正视力，戴镜前与戴镜后的角膜曲率和角膜地形图各参数进行比较。结果角膜屈光手术后继发圆锥角膜有56例（67只眼），其中准分子激光原位角膜磨镶术后53只眼，光学性角膜切削术后4只眼，放射状角膜切开术后10只眼。病变区域角膜厚度〈400μm，有些存在薄翳或斑翳，角膜地形图显示角膜局域性前突，角膜强主径线屈光力（sK）为47．56—69．72D，角膜散光度数4．00～14．ooD，不规则形变明显，可见不同程度基质条纹样改变和Fleischer环。外伤术后继发圆锥角膜有31例（31只眼），除有角膜损伤的瘢痕混浊，角膜内皮密度降低和多形变之外，尚有15只眼为无晶状体眼，另外存在不同程度的虹膜、瞳孔、玻璃体和视网膜的损伤。抗青光眼手术、白内障摘除及人工晶状体植人术后继发圆锥角膜1例（2只眼）。另有1例（2只眼）病毒性角膜炎反复发作后继发性圆锥角膜，病变区大片斑翳，轻度薄化，多量新生血管侵入，角膜表面凹凸不平。上述102只眼裸眼视力均较低下，采用非球面、中心及周边多弧面、RoseK、Piggyback等特殊设计高透氧或超高透氧RGPCL配戴后，90％视力可提高至4．9或以上。随访发现RGPCL矫正视力基本保持稳定，尚有一些病例有一定提高。戴镜前患者散光度数、角膜表面规则性指数及角膜表面非对称Objective To investigate the clinical effects of special designed rigid gas permeable contact lens （RGPCL） in the treatment of secondary keratoconus. Methods Retrospective study. The results of correction of secondary keratoconus by the RGPCL in 89 cases （ 102 eyes ） at the Optometry ＆ Ophthalmology Center were analyzed, including history, slit lamp microscope, computer assisted corneal topography, phoropter, corneal endothelial cell examinations and A -scan corneal thickness measurements. We selected and designed the contact lens with different materials for refractive correction according to different corneal deformations. Visual stability and corneal changes were regularly observed. We compared corrected vision, corneal curvature and corneal topography before and after wearing spectacles and RGPCL by using a paired-t test. Result Secondary keratoeonus after keratorefractive operation in 56 cases （67 eyes） ,including post-LASIK in 53 eyes, post- PRK in g eyes and post- RK in 10 eyes were observed. The cornea thickness in the lesion region was less than 0.4 mm, with nebula or macula. Corneal topography showed different local protrusions, Steep K ranged 47.56 D to 69.72 D, corneal astigmatism ranged 4. 00 D to 14. 00 D, with irregular deformations, visible different degrees matrix strips pattern changes and Fleischer ring. Secondary keratoconus in 31 cases （31 eyes） was developed after corneal injury. The lesions included opaque scar, decrease of corneal endothelial density, multi-deformations and aphakia in 15 eyes. In addition, there were different degrees of damage in pupil, iris, vitreous and retina. Secondary keratoconus in one case （2 eyes） was developed after anti-glaucoma and pediatric cataract extraction operations （with intraocular lens implantation）. Another case was secondary to repeated bilateral keratitis episodes, with large macula, mild thinning of cornea, neovascularization and roughness of corneal surface. The uncorrected visual acuity in these eyes was poor. After wear

关 键 词：圆锥角膜 接触镜 屈光外科手术 假体设计 视敏度 治疗结果 回顾性研究 

分 类 号：R778[医药卫生—眼科]