圆锥角膜学生患者长期配戴硬性角膜接触镜效果评价  

Long-term corneal changes with gas-permeable contact lens wear in keratoconus students

作　　者：张蕾[1,2] 周艳峰[3] 刘才远[4] 

机构地区：[1]安徽医科大学第一临床学院,合肥230601 [2]安徽医学高等专科学校 [3]安徽医科大学第一附属医院眼科 [4]中国科学技术大学医院眼科

出　　处：《中国学校卫生》2015年第6期878-881,共4页Chinese Journal of School Health

摘　　要：目的分析圆锥角膜学生患者长期配戴透气性硬性角膜接触镜（rigid gas permeable,RGP）对角膜散光和角膜曲率的影响,进而探讨RGP的安全性和有效性。方法选择确诊为圆锥角膜的学生患者46例（72只眼）,在RGP验配过程中同时进行框架眼镜的验配,比较两种手段对圆锥角膜患者视力矫正的效果。在患者长期持续配戴RGP1~3 a后,观察其视力、散光度数和角膜曲率的变化,从而分析长期配戴RGP对圆锥角膜患者视力、散光度数和角膜曲率的影响。结果配戴RGP矫正的患眼视力达到4.8以上的有68只,占94.44%;而利用框架眼镜矫正的患眼视力达到4.8以上的41只,占56.94%,RGP矫正视力效果优于框架眼镜（χ2=27.517,P〈0.05）。初始配戴RGP,配戴RGP至少1 a后,矫正视力由（0.88±0.80）变为（0.92±0.16）,两者差异无统计学意义（t=1.73,P〉0.05）,RGP对圆锥角膜学生患者视力的矫正效果是稳定持久的。散光度数大于3.00 D的患者由配戴前的（-5.59±1.87）D降至（-4.95±2.83）D,RGP可以有效的降低圆锥角膜学生的散光度数（t=5.64,P〈0.05）。圆锥角膜学生持续配戴RGP1,2,3 a后分别与初始配戴前比较,角膜前表面最平曲率（Min K）变化差异均无统计学意义（P值均〉0.05）,但最陡曲率（Max K）均有所减小（P值均〈0.05）。结论圆锥角膜患者长期配戴RGP可以获得理想、稳定的矫正视力,且效果优于框架眼镜;RGP能有效延缓或控制圆锥角膜的病情进展;配戴RGP患者长期随访未出现明显的并发症,具有一定的安全性。Objective To analysis of long-term effect of corneal astigmatism and corneal curvature changes with gas-per- meable contact lens wear in keratoconus students. Methods A total of 46 patients （ 72 eyes） with diagnosis of keratoconus, who have been wearing corneal RGP contact lens for 1-3 years. Comparison of central corneal astigmatism and corneal asphericity was analyzed. Results Sixty-eight eyes （ 94.44%） wearing RGP corrected visual acuity ≥4.8, while 41 eyes （56.94% ） wearing glas- ses corrected visual acuity ≥ 4.8. Eyes with corrected visual acuity ≥ 5.0 increased from 43 to 54 after 1 year RGP wearing. RGP corrected visual acuity in patients with keratoconus is stable and lasting. Patients with astigmatism greater than 3.00D worn de- creased from {-5.59±1.87） D to （-4.95±2.83 } D, RGP can effectively reduce the astigmatism of keratoconus students. Students with keratoconus continued to wear RGP for 1 year, 2 years, 3 years, most flat front surface of the cornea curvature （ MinK） chan- ges were not significantly different（ P〉0.05） , but the steepest curvature （MaxKI has been reduced significantly （P〈0.05）. RGP can effectively reduce the steepest curvature of the anterior surface of the cornea, effectively delaying or controlling disease progres- sion of keratoconus. Conclusion RGP can improve corrected visual acuity for patients with keratoconus in long-term. RGP can ef- fectively reduce the degree of astigmatism, and delay the progression of keratoconus or control. There are no obvious complications occurred when wearing RGP.

关 键 词：学生 圆锥角膜 散光 

分 类 号：R181.24[医药卫生—流行病学] R778[医药卫生—公共卫生与预防医学]