中重度圆锥角膜患者巩膜镜试戴效果评估  

Fitting effect of scleral lens for moderate and severe keratoconus

作　　者：范棋 杨凯丽 任胜卫 Fan Qi;Yang Kaili;Ren Shengwei(Department of Ophthalmology,Henan Provincial People's Hospital,Henan Eye Hospital,Zhengzhou University People's Hospital,Henan University People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院眼科、河南省立眼科医院、郑州大学人民医院、河南大学人民医院,郑州450003

出　　处：《中华实验眼科杂志》2023年第12期1179-1186,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金青年科学基金项目(81200664);河南省自然科学基金面上项目(222300420536);河南省医学科技攻关计划省部共建重点项目(SBGJ202002028);河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2020023);河南省立眼科医院基础研究重点专项(20JCZD003)。

摘　　要：目的比较硬性透气性接触镜(RGPCL)和巩膜镜在中重度圆锥角膜患者中的试戴效果。方法采用横断面研究方法,纳入2022年9月至2023年9月于河南省立眼科医院圆锥角膜门诊就诊的患者42例52眼。依据陡峭角膜曲率(Ks)值将圆锥角膜分为中度组(48 D≤Ks<55 D)28眼和重度组(Ks≥55 D)24眼。对所有眼分别规范试戴RGPCL和巩膜镜,在裂隙灯显微镜下进行荧光素染色观察及眼前节光学相干断层扫描检查,观察镜片中央和旁中央与角膜之间的距离、镜片中央定位、活动度及周边配适情况;记录最佳矫正视力(BCVA)(LogMAR视力)以及戴镜舒适度、湿润度及视觉清晰度评分。比较同一患者试戴RGPCL和巩膜镜后BCVA、舒适度、湿润度和视觉清晰度评分差异及中度和重度圆锥角膜组间患者BCVA、舒适度、湿润度、视觉清晰度评分和改善值差异。结果所有患者试戴RGPCL后平均BCVA为0.19(0.10,0.30),舒适度、湿润度和视觉清晰度评分分别为5.5(3.0,7.0)、7.0(5.0,8.0)和7.0(4.0,8.0)分。试戴巩膜镜后BCVA为0.10(0.00,0.10),其舒适度、湿润度和视觉清晰度评分分别为8.0(8.0,9.0)、8.0(8.0,9.0)和8.0(6.0,9.0)分。与试戴RGPCL比较,患者试戴巩膜镜后BCVA、舒适度、湿润度和视觉清晰度评分显著提高,差异均有统计学意义(Z=-5.887、-6.064、-5.705、-5.516,均P<0.001)。试戴巩膜镜后BCVA与Kmax呈中等强度正相关(r_(s)=0.519,P<0.001),与TCT呈中等强度负相关(r_(s)=-0.535,P<0.001)。试戴巩膜镜的清晰度评分与TCT呈中等强度正相关(r_(s)=0.303,P=0.029)。中度和重度亚组分析中,试戴巩膜镜后BCVA优于RGPCL配适,舒适度、湿润度和视觉清晰度评分高于RGPCL,差异均有统计学意义(均P<0.05)。与中度组比较,重度组清晰度评分改善更为明显,差异有统计学意义(Z=-3.100,P=0.002)。结论中重度圆锥角膜患者试戴RGPCL提高BCVA的水平有限,试戴巩膜镜在提高患者BCVA的同时,可以显著改Objective To compare the fitting effect between rig gas-permeable contact lens(RGPCL)and scleral lenses(SLs)in moderate and severe keratoconus eyes.Methods A cross-sectional study was performed.Fifty-two eyes of 42 keratoconus patients were recruited in Henan Eye Hospital from September 2022 to September 2023.Based on steep keratometry(Ks)value,patients were divided into moderate stage(48 D≤Ks<55 D,28 eyes)and severe stage(Ks≥55 D,24 eyes).RGPCL and SLs were fitted normatively in all eyes.Fluorescein staining and anterior segment optical coherence tomography were performed under a slit lamp.The distance between the central and lateral centers of the lenses and the cornea,the centering of the lenses,the mobility of the lenses and the peripheral fit of the lenses were observed.Best corrected visual acuity(BCVA)converted to logarithmic minimum angle of resolution,comfort score,wetness score and clarity score were recorded.Differences in the above parameters of each patient between RGPCL and SLs wear were compared.The improvement of the above parameters after RGPCL and SLs wear was compared in moderate and severe patients.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital(No.HNEECKY-2019[5]-04).Written informed consent was obtained from each patient before any medical examination.Results After RGPCL wear,the mean BCVA,comfort,wetness,and clarity score were 0.19(0.10,0.30),5.5(3.0,7.0)points,7.0(5.0,8.0)points and 7.0(4.0,8.0)points,respectively.After SLs wear,the mean BCVA,comfort score,wetness score and clarity score were 0.10(0.00,0.10),8.0(8.0,9.0)points,8.0(8.0,9.0)points and 8.0(6.0,9.0)points,respectively.Compared with RGPCL wear,the BCVA,comfort score,wetness score and clarity score of SLs were significantly improved(Z=-5.887,-6.064,-5.705,-5.516;all at P<0.001).There was a moderate positive correlation between BCVA and Kmax after SLs wearing(r_(s)=0.519,P<0.001),and had a moderate negative correlation with TCT(r_(s)=-0.535,P<0.00

关 键 词：圆锥角膜 治疗 视力 巩膜镜 硬性透气性接触镜 清晰度 

分 类 号：R778[医药卫生—眼科]