圆锥角膜患者长期配戴硬性透气性角膜接触镜后眼表变化分析  

Ocular surface changes in keratoconus after long-term wearing of rigid gas permeable contact lens

作　　者：张娜娜[1] 钱美伶 杨丽媛 杨君[1] Zhang Nana;Qian Meiling;Yang Liyuan;Yang Jun(Department of Optometric Center,Gansu Provincial Hospital,Lanzhou 730000,Gansu Province,China)

机构地区：[1]甘肃省人民医院眼视光学中心,甘肃省兰州市730000

出　　处：《国际眼科杂志》2024年第7期1127-1131,共5页International Eye Science

基　　金：甘肃省自然科学基金项目(No.21JR7RA606)。

摘　　要：目的:分析圆锥角膜患者长期配戴硬性透气性角膜接触镜(RGPCL)后眼表相关参数的变化。方法:采用前瞻性病例研究。纳入2018-01/2022-01在我院眼视光学中心门诊确诊并验配RGPCL的原发性圆锥角膜患者113例213眼,根据圆锥角膜严重程度分为轻度圆锥角膜组42例80眼,中度圆锥角膜组54例102眼,重度圆锥角膜组17例31眼。采用Keratograph眼表综合分析仪观察三组患者戴镜前,戴镜后1 wk,1、3、6、12 mo的非侵入性泪膜破裂时间(NIBUT)、非侵入性泪河高度(NITMH)、眼红指数、脂质层厚度、角膜荧光染色、睑板腺分泌功能,Schirmer I试验及眼表疾病指数量表(OSDI)评分变化。结果:三组患者戴镜前性别、年龄、NIBUT、NITMH、脂质层厚度、睑板腺分泌功能、SchirmerⅠ试验均无差异(P>0.05),而球镜、柱镜、等效球镜(SE)、BCVA、IOP NCT、角膜前、后表面Kmax、最薄点角膜厚度、眼红指数、角膜荧光染色、OSDI评分均有差异(P<0.05)。低度圆锥角膜组NIBUT戴镜3、6、12 mo较戴镜前有差异(P<0.05);NITMH戴镜6、12 mo较戴镜前有差异(P<0.05);眼红指数、角膜荧光染色、OSDI戴镜1 wk,1 mo较戴镜前有差异(P<0.05);脂质层厚度和睑板腺分泌功能戴镜12 mo较戴镜前有差异(P<0.05)。中度圆锥角膜组NIBUT戴镜6、12 mo较戴镜前有差异(P<0.05);NITMH、脂质层厚度、睑板腺分泌功能戴镜12 mo较戴镜前有差异(P<0.05);眼红指数戴镜1 wk,1、3 mo较戴镜前有差异(P<0.05);角膜荧光染色戴镜后1 wk较戴镜前有差异(P<0.05);OSDI评分戴镜1 wk,1 mo较戴镜前有差异(P<0.05)。高度圆锥角膜组NIBUT、NITMH、眼红指数戴镜1 wk,1、3、6、12 mo较戴镜前有差异(P<0.05);脂质层厚度戴镜6、12 mo较戴镜前有差异(P<0.05);角膜荧光染色和OSDI评分戴镜1 wk,6、12 mo较戴镜前有差异(P<0.05);睑板腺分泌功能戴镜6、12 mo较戴镜前有差异(P<0.05);SchirmerⅠ试验戴镜12 mo较戴镜前有差异(P<0.05)。结论:�AIM:To analyze changes in the ocular surface parameters of keratoconus after long-term wearing of rigid gas permeable contact lens(RGPCL).METHODS:Prospective case study.A total of 113 keratoconus patients(213 eyes)fitted with RGPCL in the optometry center of Gansu Provincial Hospital from January 2018 to January 2022 were included.They were divided into three groups according to the severity of keratoconus,including 42 cases(80 eyes)in mild keratoconus group,54 cases(102 eyes)in moderate keratoconus group and 17 cases(31 eyes)in severe keratoconus group.Furthermore,the non-invasive tear break-up time(NIBUT),non-invasive tear meniscus height(NITMH),red eye index,lipid layer thickness,fluorescent corneal staining,meibomian gland secretory function,Schirmer I test and ocular surface disease index(OSDI)scores were observed by Keratograph analyzer before and after wearing RGPCL for 1 wk,1,3,6,12 mo,respectively.RESULTS:There were no statistical significance in the age,NIBUT,NITMH,lipid layer thickness,meibomian gland secretory function and Schirmer I test among the three groups(P>0.05),while there were statistical significance in the sphere,cylinder,spherical equivalent,best corrected visual acuity(BCVA),non-contact intraocular pressure(IOP NCT),anterior,posterior corneal surface Kmax,corneal surface thickness at the thinnest point,eye redness index,fluorescent corneal staining,and OSDI(P<0.05).In the mild keratoconus group,NIBUT had statistical differences at 3,6 and 12 mo after wearing RGPCL(P<0.05),NITMH had statistical differences in 6 and 12 mo(P<0.05),the eye redness index,fluorescent corneal staining and OSDI scores had statistical differences in 1 wk and 1 mo(P<0.05),and lipid layer thickness and meibomian gland secretory function had statistical differences in 12 mo(P<0.05).In the moderate keratoconus group,there were statistical differences in NIBUT at 6 and 12 mo after wearing lenses(P<0.05);there were statistical differences in the NITMH,lipid layer thickness and meibomian secretory function at 12 mo after

关 键 词：眼表 圆锥角膜 硬性透气性角膜接触镜 

分 类 号：R779.6[医药卫生—眼科]