透气性半硬性角膜接触镜矫正高度近视合并高度散光的短期视力结果

The visual acuity efficacy of half-rigid gas permeable contact lenses on high myopia combined with high astigmatism:six-month follow-up

目的通过与框架眼镜的矫正视力进行比较,评价透气半硬性角膜接触镜(RGPCL)对高度近视合并高度散光的矫治效果。设计回顾性病例系列。研究对象通过屈光检查确诊为高度近视合并高度散光患者271例(492眼)。方法在验光检查的屈光不正患者中连续选取高度近视(球镜>-8.00 D)合并高度散光(柱镜>-2.50 D)患者271例(492眼)。每一被检者分别采用框架眼镜和RGPCL两种矫正方法进行屈光矫治,要求被检者坚持框架眼镜和RGPCL每日交替配戴,逐步适应两种矫正方式。并在戴镜后1周,1个月,3个月,6个月定期复查矫正视力。戴镜6个月后,对被检者用两种不同的矫正方法所得的矫正视力进行对照比较,并观察配戴RGPCL后的角膜曲率半径、眼压及角膜内皮计数。主要指标框架眼镜矫正视力,RGPCL矫正视力,角膜曲率半径,眼压,角膜内皮细胞计数及配戴并发症。结果戴镜6个月时,患者配戴框架眼镜和RGPCL的矫正视力≥1.0者分别为75眼(15%)和311眼(63%),两者比较差异有统计学意义(χ2=250.33,P=0.001);两种矫正方式平均矫正视力分别为(0.6±0.3)和(0.9±0.2),两者比较差异有统计学意义(t=4.051,P=0.002)。被检者在配戴RGPCL 6个月后角膜曲率半径平均变化(0.03±0.02)mm,眼压平均变化(2±1)mm Hg,角膜内皮细胞计数平均变化(164±60)个/mm2。配戴RGPCL期间有16例(27眼)发生角膜上皮浅层划伤,4例因镜片污染主诉异物感,治疗后痊愈,未影响RGPCL的矫正视力。结论对于高度近视合并高度散光的屈光不正,配戴RGPCL能够获得较框架眼镜更为清晰的矫正视力,是一种安全、有效的矫正方法。

Objective To evaluate the corrected effect of half-rigid gas permeable contact lenses（RGPCL） for high myopia combined with high astigmatism.Design Retrospective case series.Participants 271 patients（492 eyes） with high myopia combined with high astigmatism.Methods 271（492 eyes） consecutive high myopia combined with high astigmatism（sphere diopter was higher than-8.00 D,cylinder diopter was higher than-2.50 D） patients wore spectacles were fitted with RGPCL,and were followed up for one week to six months.The corrected visual acuity by RGPCL was compared with that of corrected by spectacles.Main Outcome Measures Corrected visual acuity with spectacles,corrected visual acuity with RGPCL,corneal curvature,intraocular pressure,the number of endothelial cells.Results At six months,after fitted with RGPCL,311 eyes（63%） corrected visual acuity was over 1.0,compared with 75 eyes（15%） with spectacles,the difference was significant（χ2=250.33,P=0.001）.The mean corrected visual acuity with spectacles and with RGPCL was（0.6±0.3） and（0.9±0.2）,respectively.The difference was significant（t=4.051,P=0.002）.The mean change of corneal curvature was（0.03±0.02） mm.The mean change of intraocular pressure was（2±1） mm Hg,and the mean change of the number of endothelium cells was（164±60）/mm2.There were 16 patients（27 eyes） suffered from corneal abrasions and 4 patients felt foreign body at the cornea during wearing the RGPCL.All these patients were cured after treatment.Conclusion For those with high myopia and high astigmatism,the corrected visual acuity is better wearing RGPCL than spectacles.RGPCL is safe and effective for those with high myopia and high astigmatism.