外伤性角膜瘢痕的部位和程度与RGP矫正视力效果的关系  

The relationship between the position and severity of traumatic corneal scar and the effect of RGP corrected visual acuity

作　　者：骆非 韦振宇 王辉 吕岚 梁庆丰 Luo Fei;Wei Zhenyu;Wang Hui;Lv Lan;Liang Qingfeng(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科研究所,眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2020年第5期350-354,共5页Ophthalmology in China

基　　金：北京市百千万人才工程培养基金(2017A10)。

摘　　要：目的评价硬性透气性角膜接触镜(RGP)矫正不同部位和程度角膜穿通伤后角膜瘢痕致不规则散光的效果。设计前瞻性病例系列。研究对象北京同仁医院外伤性角膜瘢痕患者框架眼镜矫正视力差、除外重要眼底病变者44例(44眼)。方法患者每日至少戴RGP 8小时。戴RGP前及戴6个月后进行视力、裂隙灯显微镜、眼底照相、角膜曲率计、角膜地形图检查。根据瘢痕部位分角膜中央(26眼)、周边(16眼)及角膜缘(2眼)三组;根据瘢痕程度分为云翳(11眼)、斑翳(24眼)和白斑(9眼)三组;根据晶状体状态分为有晶状体眼(17眼)、人工晶状体眼(8眼)和无晶状体眼(19眼)三组。各组角膜地形图显示的角膜散光值无统计学差异。采用配对t检验比较各组患者戴RGP前框架眼镜最佳矫正视力与戴RGP 6个月后的最佳矫正视力。主要指标LogMAR最佳矫正视力。结果戴RGP后6个月,角膜中央、周边及角膜缘三组最佳矫正视力分别为(0.40±0.34)、(0.21±0.28)、(0.18±0.04),与框架眼镜视力进行比较前两组具有统计学差异(t=2.907,P=0.003)、(t=2.213,P=0.011)、(t=0.772,P=0.052)。戴RGP后6个月云翳、斑翳和白斑三组最佳矫正视力分别为(0.18±0.22)、(0.36±0.33)、(0.37±0.36),与框架眼镜视力进行比较斑翳组具有统计学差异(t=1.232,P=0.261)、(t=2.251,P=0.025)、(t=0.663,P=0.507)。戴RGP后6个月有晶状体眼、人工晶状体眼和无晶状体眼三组最佳矫正视力分别为(0.28±0.36)、(0.39±0.31)、(0.23±0.25),与框架眼镜视力进行比较各组均具有统计学差异(t=2.021,P=0.022)、(t=2.718,P=0.009)、(t=2.059,P=0.017)。结论与框架眼镜矫正相比,非角膜缘部位的角膜瘢痕更适合RGP矫正,角膜斑翳比云翳、白斑更适合RGP矫正。Objective To evaluate the clinical effect of rigid gas permeable(RGP)contact lens in correcting irregular astigmatism caused by different position and severity of traumatic corneal scar formation.Design Prospective case series.Participants 44 cases(44 eyes)of patients with traumatic corneal scar in Beijing Tongren Hospital with poor visual acuity corrected with framed glasses and without important fundus damage.Methods Patients wore RGP for at least 8 hours a day.All patients were examined including visual acuity,slit-lamp biomicroscopy,fundus photography,keratometry,and corneal topography.According to the position of corneal scar,the patients were divided into central cornea scar(26 eyes),peripheral cornea scar(16 eyes)and limbal corneal scar(2 eyes)three groups.According to the severity,the patients were divided into corneal nebula(11 eyes),corneal macula(24 eyes)and corneal leucoma(9 eyes)three groups.According to the status of lens,the patients were divided into phakic eyes(17 eyes),intraocular lens eyes(8 eyes)and aphakic eyes(19 eyes)three groups.There was no statistical difference in the astigmatism value of corneal topography among each group.Paired t-test was used for comparing the best corrected vision acuity(BCVA)before and after 6-month RGP therapy.Main Outcome Measures LogMAR BCVA.Results After wearing RGP for 6 months,the BCVA in the central,peripheral and limbal groups was(0.40±0.34),(0.21±0.28)and(0.18±0.04),respectively.The BCVA wearing RGP was compared with that of frame glasses,and the difference in central and peripheral groups was statistically significant(t=2.907,P=0.003;t=2.213,P=0.011;t=0.772,P=0.052).After wearing RGP for 6 months,the BCVA in the corneal nebula,pannus and leucoma groups was(0.18±0.22),(0.36±0.33)and(0.37±0.36),respectively.The BCVA wearing RGP was compared with that of frame glasses,and the difference in corneal pannus group was statistically significant(t=1.232,P=0.261;t=2.251,P=0.025;t=0.663,P=0.507).After wearing RGP for 6 months,the BCVA in phakic,intraocular le

关 键 词：硬性透气性角膜接触镜 角膜瘢痕 视力 角膜 

分 类 号：R779.1[医药卫生—眼科]