角膜接触镜屈光度含水量在连续日戴中对眼表影响

Effects of contact lens with different diopters and water vontent on ocular surface in the process of consecutive daily wear

目的 研究不同含水量、不同屈光度的角膜接触镜对眼表的影响.方法 对2012年5～12月在天津医科大学眼科医院收集的屈光不正患者29例58只眼,按球镜屈光度分为低度组（14只眼）、中度组（15只眼）和高度组（29只眼）共3组.其中高度组按随机数字表法又分为两组,一组（15只眼）与低、中度组均配戴高含水（55％）角膜接触镜;另一组（14只眼）配戴低含水（38％）角膜接触镜.各组分别于配戴前、配戴后1、3、6个月检查其角膜中央厚度、泪液分泌量及泪膜破裂时间,观察角膜接触镜对眼表的影响.结果 低、中度组在配戴高含水量镜片后,角膜厚度、泪液分泌量及泪膜破裂时间在各时期差异比较均无统计学意义（P＞0.05）;高度组配戴高含水镜片后角膜明显变薄,差异比较具有统计学意义（P＜0.05）,泪液分泌量在1、3个月时较配戴前下降,具有统计学意义（P＜0.05）,泪膜破裂时间在3、6个月时较配戴前缩短,具有统计学意义（P＜0.05）;高度组配戴低含水量镜片后角膜变薄,且在1个月时配戴高含水镜片者变薄程度大,差异比较均具有统计学意义（P＜0.05）,泪液分泌量在各时期无明显变化,泪膜破裂时间在3、6个月时较配戴前缩短,且与配戴高含水镜片的变化在各时期差异比较无统计学意义（P＞0.05）.结论 低、中度屈光不正者在短期配戴角膜接触镜,其角膜生理状态变化不明显.高度屈光不正者在配戴过程中会出现角膜变薄、泪液分泌量减少、泪膜破裂时间缩短,且镜片含水量的增加会加重以上变化.高度屈光不正者在配戴角膜接触镜时要更加注重镜片参数和设计以及配戴方式和时间.

Objective To investigate the effect of contact lens with different water content and different diopters on ocular surface physiological state.Methods Twenty-nie patients （58 eyes） with ametropia enrolled in Tianjin medical university hospital from May 2012 to December 2012 were presented into three groups according to their diopters of refractive error （low：less than-3.00D; moderate：from-3.00D～-6.00D; high：more than-6.00D）.The high group was subdivided into two groups again randomly,one of them as well as the groups of low and moderate myopia were wearing contact lenses with high water content （55%）,the other was with low water content （38%）.The examinations of central corneal thickness （CCT）,schirmer test and tear film break-up time （TBUT） were performed before wearing and 1 month,3 and 6 months after wearing,the acquired indexes were statistic analyzed.Results CCT,schirmer test and TBUT of low,moderate groups were not significant difference in each period （P 〉0.05）; CCT of both high groups were significantly thinner than that of before wearing （P 〈0.05）,and the degree of corneal thinning in high water content lenses wear was greater than that of low water content lenses in one month after wearing （P 〈0.05）;TBUT of both high groups were significantly shorter than that of before wearing （P 〈0.05）; the schirmer test of wearing high water content lenses was significantly decreased in 3 and 6 months after wearing （P 〈0.05）,while low water content lenses had no significant change in each period （P 〉 0.05）.Conclusions For people of low and moderate myopia,corneal physiological state do not change significantly with short-term wearing contact lens.Whereas for people of high myopia,the corneal thinning,schirmer test decreasing and TBUT shortening appear,which are aggravated by increasing of wearers,especially for people with high myopia should consult their doctor during wearing and pay more attention to the lens selection and corneal health.