透气硬性角膜接触镜矫治先天性小眼球屈光不正

The optical correction of microphthalmos with rigid gas-permeable contact lenses

目的 分析先天性小眼球的屈光参数特点,观察透气硬性角膜接触镜（rigid gas-permeable contactlens,RGP）矫治先天性小眼球的屈光不正的效果,并探讨验配注意事项.方法 对视光门诊确诊先天性小眼球的患者7例14只眼,测量眼轴长度、前房深度和角膜曲率,检影验光和主觉验光,并记录裸眼视力（uncorrected visual acuity,UCVA）和框架眼镜的最佳矫正视力（best spectacle corrected visual acuity,SP-VA）,配戴特殊设计的试戴镜,荧光素染色评价配适状态,片上验光追加度数,订制RGP,检查戴RGP的最佳矫正视力（best RGP-corrected visual acuity,RGP-VA）、配适情况,并随访观察.结果 14只先天性小眼球的平均角膜曲率半径（6.93±0.27）mm,前房深度（2.46±0.23）mm,眼轴长度（15.67±0.59）mm,验光度数（＋17.29±3.52）D,RGP的平均基弧（6.92±0.19）mm,屈光度（＋21.91±4.66）D.全部患者的RGP-VA比UCVA都有显著提高.RGP-VA与SP-VA相当.平均随访时间为20个月（7～29月）,镜片配适良好,患者均能坚持全天配戴,未发生与角膜接触镜相关的并发症.结论 先天性小眼球的屈光参数显著不同于正常眼球,角膜异常弯曲、前房浅、眼轴短.屈光呈超高度远视,均伴有弱视.RGP是有效的光学矫正手段.为确保订制的RGP参数准确,需要专用的RGP试戴镜.

Objective To analyze the optical parameters of microphthalmos,to observe the effect of optical correction of microphthalmos with rigid gas-permeable contact lenses（RGP）,and to discuss the fitting method and cautions.Methods Fourteen eyes of 7 patients with microphthalmos from optometry clinic were fitted with RGP after ocular axis,anterior chamber depth （ACD）,corneal curvature,retinoscopy and subjective refraction examined.Uncorrected visual acuity （UCVA）,best spectacle-corrected visual acuity （SP-VA） was recorded.Specially designed trial lenses were used,followed by fluorescein pattern evaluation and over-refraction.Best RGP-corrected visual acuity （RGP-VA） was recorded and lens fitting states were evaluated at follow-up.Results The average corneal curvature of 14 eyes was （6.93±0.27）mm,ACD：（2.46：1：0.23）mm,axial length：（15.67±0.59）mm,refraction：（＋17.29±3.52）D,base curve of RGP：（6.92±0.19）mm,power of RGP lens：（＋21.91±4.66）D.RGP-VA of 14 eyes were much better than UCVA.RGP-VA was nearly the same as SP-VA.After followed up for average 20 months（7-29 months）,all patients could wear lenses the whole day,and no complications related to RGP happened.Conclusions The optical parameters of microphthalmos are significantly different from that of normal eyes with highly curved cornea,shallow ACD,short axial length and super hyperopia accompanied by amblyopia.RGP is a useful method of optical corrections.Specially designed trial lens set is necessary.