屈光参数对动态稳定法设计的环曲面软镜定位的影响

Effects of refractive parameters on the orientation of dynamically stabilized toric soft contact lenses

目的 观察动态稳定法设计环曲面软性角膜接触镜（环曲面软镜）在国人眼中的配适定位,并探讨近视度、散光度及轴向对其的影响.方法 前瞻性临床研究.为191例散光志愿者验配动态稳定法设计环曲面软镜,根据患者的近视度、散光度及轴向进行分组.记录右眼的镜片旋转量、稳定性,分析患者的近视屈光度,散光轴向和散光量与两者之间的关系.数据分析采用方差分析、Fisher精确检验和Wilcoxon秩和检验.结果 动态稳定法设计型环曲面软镜的矫正视力与框架眼镜所达到的最佳矫正视力差异无统计学意义（Z=-1.061,P＞0.05）,镜片的中心定位和活动度良好.较高的和非斜轴散光眼的镜片能更迅速地达到相对稳定.高度近视组的镜片稳定性较中度近视组好（x2=5.371,R＜0.05）,斜轴散光组中镜片旋转量大的比例明显高于顺规和逆规散光组（x2=7.046,P＜0.05;x2=6.462,P＜0.05）,散光度越高,镜片的稳定性越好,旋转量相对越小.结论 球镜量、散光轴向和度数对动态稳定设计的环曲面软镜的定位有不同程度的影响,高度近视的逆规散光患者是配戴该设计镜片的理想人群.

Objective To observe the orientation of dynamically stabilized toric soft contact lenses （TCL） in Chinese subjects and discuss the effect of myopic refractive error,the amount of astigmatism and its axis.Methods This was a prospective clinical study.One hundred and ninety one subjects were fitted with dynamically stabilized TCLs.Subjects were classified into different groups based on the amount of sphere,cylinder and cylinder axis.The amount of rotation and stability of the lenses in the right eye was recorded and their relationship with myopic refractive error,astigmatic amount and axis were analyzed.Data were analyzed with ANOVA,Fisher＆#39;s exact test and Wilcoxon signed-rank test.Results There was no difference between corrected visual acuity of the dynamically stabilized TCLs and that of spectacles （Z=-1.061,P〉0.05）.The lenses had good centralized positioning and mobility.Lenses on eyes with non-oblique and greater amounts of astigmatism became relatively stable within a shorter time.Lenses in the high myopia group had better stability compared with the moderate myopia group （x2=5.371,P〈0.05）.The amount of rotation was higher in the oblique astigmatism group than in with-the-rule and against-the-rule astigmatism groups （x2=7.046,P〈0.05; x2=6.462,P〈0.05）.The higher the astigmatism,the better the stability and the less amount of lens rotation.Conclusion Spherical refractive error,amount of astigmatism and axis affect the orientation of dynamically stabilized TCLs to some extent.People with high myopia and against-the-rule astigmatism were the ideal subjects for fitting dynamically stabilized TCLs.