角膜地形图相关参数引导的圆锥角膜镜片验配研究

A study on keratoconus' contact lens fitting guided by topography

目的:探讨在角膜地形图相关参数引导下快速、准确地验配硬性透气性(RGP)圆锥角膜接触镜的方法。方法:根据角膜地形图的中央角膜曲率值及A值(中央与旁中央3 mm区角膜曲率值之差),为14例(23眼)圆锥角膜患者选择诊断片并在裂隙灯下进行荧光素染色配戴评估,确定处方,定期复查最好矫正视力、角膜地形、眼部健康和主觉症状。结果:18眼(18/23,78.3％)通过1～2片诊断片试戴成功。配戴圆锥角膜镜后,矫正视力≥1.0的眼数为18眼,平均视力增加3行,眩光现象明显改善8人(8/14,57.1％),视物变形症状明显改善10人(10/14,71.4％)。随访4～64m,未发现角膜曲率和角膜散光明显改变,未发现明显眼部并发症。结论:利用角膜地形图相关参数可明显提高圆锥角膜验配的效率。国锥角膜镜片明显改善轻度、中度及部分重度圆锥角膜眼的矫正视力、舒适性和镜片稳定性,正确的验配对角膜生理功能无明显影响。

Objective:To investigate efficiency and accuracy of rigid gas permeable(RGP) contact lens for keratoconus guided by topography. Methods: According to topographical central keratometry reading(K-reading) and A value(the difference of K-reading between centre and 3 mm apart), a diagnostic RGP contact lens was determined and fluorescein patterns were evaluated. Best corrected visual acuity ( BCVA) , topography, ocular physiology and subjective symptoms were assessed by follow-up 6 - 64 months. Results: 14 keratoconus patienls(23 eyes) fitted RGP contact lens, 18 eyes(18/23,78.3% ) were fitted successfully by used 1-2 diagnostic lenses. 18 eyes have BCVA ≥1. 0.8 patients'(8/14,57.1%) glare senses were improved. No significant complications happened during the follow up visits. Conclusion:The efficiency of contact lens fitting for keratoconus is increased when guided by topography. RGP contact lens improve the BCVA, comfort and lens stability for most of the keratoconus.