角膜塑型镜配戴不适269例临床分析

An analysis of the reasons for the sensation of discomfort during ortho-k lens fitting in 296 cases

目的 :探讨角膜塑型镜配戴不适的原因及其对策。方法 :对 2 6 9例 5 34眼角膜塑型镜配戴不适者的病史及眼科检查资料进行回顾性分析。结果 :总配戴不适率为 2 4.3% ( 5 34/ 2 191)。其中 :镜片松 16 4眼( 30 .7% ) ,因验光度或 K值测定数偏低或 e值低 ;镜片紧 79眼 ( 14.8% ) ,因验光度或 K值测定数偏高或 e值高 ;视力上升不佳 87眼 ( 16 .3% ) ,因镜片松、上睑紧或屈光度高 ;重影 189眼 ( 35 .4% ) ,因镜片偏位或戴片初期角膜塑型所致 ;角膜损伤 93眼 ( 17.4% ) ,因镜片过紧或取戴镜片时操作不规范 ;镜片破损 15片 ( 2 .8% ) ,因未按正确操作程序戴片、取片及护理镜片 ;镜片污染 36片 ( 6 .7% ) ,为眼脂分泌旺盛所致 ;过敏性眼炎 12眼( 1.1% ) ,主要发生在过敏性体质者。结论 :详细地询问病史 ,认真地做眼科检查、验光和准确地测定 K值及严格按正确的操作程序戴片、取片及护理镜片是预防配戴不适的主要措施 。

Objective:To discuss the causes of and treatments for discomfort induced by Ortho-k contact lenses.Methods:Retrospective analysis of the medical records and ophthalmic check-up data from patients experiencing discomfort (269 cases, 534 eyes) from a population of 1140 patients (2191 eyes) who wear the Ortho-k lens. Results:24.4% of the Ortho-k lens wearers experienced discomfort (534/2191). The following lists each condition and its main cause(s): 1) 164 contact lenses were too loose (30.71%); the final Rx was too low. 2) 79 contact lenses were too tight (14.79%); the final Rx was too high. 3) 87 eyes (16.29%) had lower-than-average vision improvement; the lens was too loose, the upper-eyelid too tight or the patient did not wear the transitional lens. 4) 189 eyes (35.39%) had a double shadow; the lens was too tight during the initial stages of corneal shaping. 5) 93 eyes (17.41%) had corneal staining; the lens was too tight or it was not removed skillfully. 6) 15 lenses (2.8%) had breakage; incorrect procedure for fitting and removing the lens. 7) 36 lenses were contaminated and 12 eyes suffered allergy problems. Conclusion:Patient history, complete examination procedures and fitting, lens care and handling are all important for the prevention of discomfort induced by the Ortho-k lens fitting. A retrospective approach should be used to find a solution for the discomfort.