Impact of multifocal gas-permeable lens designs on short-term choroidal response, axial length, and retinal defocus profile

AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.

Aberration changes of the corneal anterior surface following discontinued use of rigid gas permeable contact lenses

AIM: To record aberrations with a corneal topographic device on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGP on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction.METHODS: The study objects were 24 eyes from 24 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry and corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses everyday for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 minutes, 1 day, 3, 7 and 14 days following use.RESULTS: Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results were as follows: root mean square (RMS) (pre)=(1.438± 0.328)μm, RMS (30 minutes) =(1.076 ±0.355)μm, RMS (1 day) =(1.362 ±0.402)μm, RMS (3 days) =(1.373 ±0.398)μm, RMS (7 days) =(1.387 ±0.415)μm, and RMS (14 days) = (1.430±0.423)μm. Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2 ndand 3 rd-order aberrations change. Quadrafoil Z10 and spherical Z12 of the 4 th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant differences compared with the time period prior to RGP use: Z5 and Z6 decreased, and Z12 increased slightly. Z5 and Z6 remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use. At 14 days after discontinued use, all aberrations were notsignificantly different from the values prior to use.CONCLUSION: The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2 ndand 3 rd-order aberrations (including Z3, Z4, Z5, Z6, Z7, and Z8) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 14 days after discontinued use of RGP contact lenses.

Contact lens impact on quality of life in keratoconus patients: rigid gas permeable versus soft siliconehydrogel keratoconus lenses

AIMTo determine the impact of rigid gas permeable (RGP) and silicone-hydrogel keratoconus lenses on the quality of life (QoL) in keratoconus (KCN) patients using the self-reported results from the Contact Lens Impact on Quality of Life (CLIQ) Questionnaire.METHODSFrom January 2013 to April 2013, 27 consecutive KCN patients who wore RGP contact lenses (conflexair100 UV KE Zeiss-W&#x000f6;hlk) or soft silicone-hydrogel contact lenses (SHCLs) for KCN (KeraSoft IC- Bausch&#x00026;Lomb or Hydrocone Toris K-Swiss lens) completed the CLIQ questionnaire.RESULTSThe mean age of 27 patients was 29.6&#x000b1;8.0y. Fifteen patients were RGP user. The groups were comparable with respect to the mean patient age, sex, and mean K values (P=0.1, P=0.8 and P=0.1, respectively). The mean CLIQperson measure was 42.8&#x000b1;5.5 in RGP group and 39.6&#x000b1;5.5 in SHCLs for KCN group (P=0.06). CLIQperson measure was positively correlated with steep K value (r=0.301, P=0.04). When eyes were stratified by visual acuity with contact lenses, the mean CLIQperson measure was 42.01&#x000b1;5.6 in eyes with a visual acuity of 20/20-20/25 (n=44) and 38.4&#x000b1;5.26 in eyes with a visual acuity of 20/32 or less (n=10; P=0.097).CONCLUSIONRGP lenses and SHCLs for KCN have similar impact on QoL.

Effect of rigid gas permeable contact lens on keratoconus progression: a review

The prevalence of keratoconus is 1/2000 in the general population and is high in adolescents.Keratoconus is a progressive disease,which has a great impact on patients’quality of life and mental health.It can be managed by surgical and non-surgical means,rigid gas permeable(RGP)contact lens as its main non-surgical method is widely used in clinic.The efficacy of wearing RGP contact lens has been confirmed to some extent,but some studies have found that wearing RGP contact lens has adverse effects,which may promote disease progression.In this paper,the advantages and disadvantages of RGP contact lens in controlling keratoconus were reviewed to provide more suggestions and references for the clinical application of RGP contact lens.

Effects of rigid gas permeable contact lens on morphological parameters and vision-related quality of life in keratoconus patients

AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers(32 eyes) and 13 non-wearers(25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up.RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers(P=0.038). The morphological parameters, including symmetry index of front corneal curvature(P=0.004) and Baiocchi-Calossi-Versaci index front(P=0.047), were lower in RGP wearers than in nonwearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively(P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers(P=0.003). At the last followup, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups(all P>0.05).CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.

Evaluation of a Modified Scleral Contact Lens as a Riboflavin Delivery Device for Corneal Collagen Crosslinking

Introduction: Keratoconus is a complex corneal disease that reduces visual acuity by progressively modifying the corneal shape and thickness, usually producing myopia and irregular astigmatism. Corneal collagen crosslinking with riboflavin + ultraviolet-A radiation (CXL) has become a widely accepted treatment for progressive keratoconus. During CXL, riboflavin administration is performed by repeated manual instillation of solution drops on the cornea for 30 minutes, a procedure that is often uncomfortable for many patients and that consumes surgical facilities and staff resources. In this study, especially modified scleral contact lenses (MSCL) were employed for delivering riboflavin to the cornea during CXL. Objective: The study aimed at evaluating the safety and efficacy of MSCL as a drug delivery system, verifying if anterior chamber flare confirms riboflavin penetration and describes the impact on patient comfort and optimization of surgical staff and facility resources. Material and Method: This study included 8 eyes of 6 patients aged 16 - 25 years old with history of progressive keratoconus. After mechanical removal of corneal epithelium, the concave surface of the modified scleral contact lens was filled with riboflavin solution and the lens was placed on the patient’s eye during 30 minutes. The lens design allows the formation of a riboflavin layer between the lens and the exposed corneal stroma to facilitate riboflavin penetration. Patients with lens were allowed to stand up and wait for the second UVA phase outside the surgical room. Riboflavin diffusion was confirmed by biomicroscopic examination of the corneal stroma and anterior chamber with the lens in place. Patients returned and the lens was removed before UV-A irradiation at 3 mW/cm2 for 30 minutes. Statistical analysis was performed by comparing the following parameters of each patient pre- and post-CXL: Spherical equivalent (Sph.Eq.), Mean simulated keratometry (SimK-m) and corrected distance visual acuity (CDVA) using the Wilcoxon method for non-parametric data (p Results: The MSCL allowed patients to be transferred from the surgical room to wait for corneal impregnation with riboflavin. The MSCL was effective in delivering riboflavin to the cornea as confirmed by biomicroscopic examination of the cornea and anterior chamber. No intraoperative or postoperative complications were observed. MSCL use improved the patient comfort and reduced the burden on surgical staff and facilities. All analyzed parameters showed statistically significant differences pre- and post-CXL: Sph.Eq. p = 0. 018 (Median: -2.50;Average: -2.52);SimK-m p = 0. 006 (Median: 47.92;Average: 45.56). CDVA p = 0. 012 (Median: -0.45;Average: 0.42). Conclusion: The MSCL is a safe and efficacious device for riboflavin delivery during CXL. The present study permits slit lamp observation of anterior chamber flare to confirm riboflavin penetration, and provides added safety and comfort for the patient and convenience to healthcare providers by optimizing the use surgical facilities and staff. Keratometric, visual and refractive results were similar to those reported in the literature for CXL with manual riboflavin instillation. Additional studies with larger numbers of patients are needed to confirm the study findings.

圆锥角膜患者长期配戴硬性透气性角膜接触镜后眼表变化分析

目的:分析圆锥角膜患者长期配戴硬性透气性角膜接触镜(RGPCL)后眼表相关参数的变化。方法:采用前瞻性病例研究。纳入2018-01/2022-01在我院眼视光学中心门诊确诊并验配RGPCL的原发性圆锥角膜患者113例213眼,根据圆锥角膜严重程度分为轻度圆锥角膜组42例80眼,中度圆锥角膜组54例102眼,重度圆锥角膜组17例31眼。采用Keratograph眼表综合分析仪观察三组患者戴镜前,戴镜后1 wk,1、3、6、12 mo的非侵入性泪膜破裂时间(NIBUT)、非侵入性泪河高度(NITMH)、眼红指数、脂质层厚度、角膜荧光染色、睑板腺分泌功能,Schirmer I试验及眼表疾病指数量表(OSDI)评分变化。结果:三组患者戴镜前性别、年龄、NIBUT、NITMH、脂质层厚度、睑板腺分泌功能、SchirmerⅠ试验均无差异(P>0.05),而球镜、柱镜、等效球镜(SE)、BCVA、IOP NCT、角膜前、后表面Kmax、最薄点角膜厚度、眼红指数、角膜荧光染色、OSDI评分均有差异(P<0.05)。低度圆锥角膜组NIBUT戴镜3、6、12 mo较戴镜前有差异(P<0.05);NITMH戴镜6、12 mo较戴镜前有差异(P<0.05);眼红指数、角膜荧光染色、OSDI戴镜1 wk,1 mo较戴镜前有差异(P<0.05);脂质层厚度和睑板腺分泌功能戴镜12 mo较戴镜前有差异(P<0.05)。中度圆锥角膜组NIBUT戴镜6、12 mo较戴镜前有差异(P<0.05);NITMH、脂质层厚度、睑板腺分泌功能戴镜12 mo较戴镜前有差异(P<0.05);眼红指数戴镜1 wk,1、3 mo较戴镜前有差异(P<0.05);角膜荧光染色戴镜后1 wk较戴镜前有差异(P<0.05);OSDI评分戴镜1 wk,1 mo较戴镜前有差异(P<0.05)。高度圆锥角膜组NIBUT、NITMH、眼红指数戴镜1 wk,1、3、6、12 mo较戴镜前有差异(P<0.05);脂质层厚度戴镜6、12 mo较戴镜前有差异(P<0.05);角膜荧光染色和OSDI评分戴镜1 wk,6、12 mo较戴镜前有差异(P<0.05);睑板腺分泌功能戴镜6、12 mo较戴镜前有差异(P<0.05);SchirmerⅠ试验戴镜12 mo较戴镜前有差异(P<0.05)。结论:圆锥角膜患者长期配戴RGPCL会不同程度影响眼表微循环,从而影响患者的主观舒适度,但对患者的视觉质量无明显影响,长期规范配戴RGPCL控制圆锥角膜进展具有良好的安全性。

巩膜镜矫正屈光不正的安全性

目的 探讨硬性巩膜接触镜在矫正屈光不正方面的安全性。方法 前瞻性研究,选取96例(192眼)近视患者(度数-20.00~0 D,散光度数0~3.50 D)为研究对象,分为试验组(配戴硬性巩膜接触镜)和对照组[配戴硬性角膜接触镜(RGP)],每组48例,分别于戴镜前、戴镜当天、戴镜后1周、戴镜后1个月及戴镜后3个月时检测并比较两组患者眼部相关参数指标[最佳矫正视力、角膜内皮细胞密度、六角形细胞比率、泪膜破裂时间(BUT)、眼压、角膜荧光素染色评分、结膜充血及睫状充血评分],观察是否出现眼部异常改变。结果 戴镜前至戴镜3个月期间,两组患者最佳矫正视力均≥1.00;戴镜后3个月时,与戴镜前比较,试验组患者角膜内皮细胞密度轻微下降,六角形细胞比率轻微上升,但差异均无统计学意义(均为P>0.05);戴镜前及戴镜后3个月时,试验组角膜内皮细胞密度及六角形比率均较对照组稍高,但差异均无统计学意义(均为P>0.05)。戴镜前、戴镜当天、戴镜后1周、戴镜后1个月及戴镜后3个月时,试验组与对照组患者BUT比较,差异均无统计学意义(均为P>0.05)。戴镜前、戴镜当天、戴镜后1周、戴镜后1个月及戴镜后3个月试验组与对照组患者眼压比较,差异均无统计学意义(均为P>0.05)。戴镜前及戴镜后3个月时,两组患者角膜荧光染色评级、结膜充血及睫状充血评级比较,差异均无统计学意义(均为P>0.05)。戴镜后3个月时,试验组患者均未出现结膜及角膜水肿等异常改变。结论 硬性巩膜接触镜与RGP具有一致的安全性与矫正屈光不正的有效性,值得推广及应用。

圆锥角膜屈光重建

圆锥角膜是一种进行性、严重影响青少年视力的疾病。圆锥角膜常造成高度近视、不规则散光,部分患者晚期角膜出现明显瘢痕,视力明显下降。在圆锥角膜的诊疗过程中,圆锥角膜屈光重建是临床关注的重点。经过多年的研究与探索,多种治疗方法在不同病程阶段中(非进展期、进展期、晚期)为圆锥角膜患者进行屈光重建,使其获得良好的视功能。文章主要针对不同时期圆锥角膜屈光重建的方案进行综述,分析国内外各治疗方案的利弊,总结不同治疗方式的特点,以期为圆锥角膜诊疗工作提供理论参考及新的治疗思路。

硬性透气性角膜接触镜矫正高度近视和散光的疗效

目的：评价硬性透气性角膜接触镜（rigid gas permeable contact lens,RGP）矫正高度近视及散光的效果。方法：采用自身对照方法 ,对41例近视（平均屈光度-9.03±6.19DS,最大值-23.00DS）、散光（平均-1.41±1.32DC,最大值-5.50DC）患者,共计65眼,用RGP进行矫正,并与患者自身使用框架眼镜,在自然瞳孔下验光的最佳矫正视力进行对比。结果：近视、散光65眼配制了RGP,RGP基弧（BC）绝大多数位于7.20~8.25mm区间内,度数-9.92±5.96DS。RGP矫正视力达到1.0的占46.2%,0.6以上的占80.1%,框架眼镜矫正视力达到1.0的占28%,0.6以上的占60%。RGP最佳矫正视力为0.81±0.22,框架眼镜的最佳矫正视力为0.66±0.28。RGP的最佳矫正视力优于框架眼镜（P〈0.01）。RGP比较框架眼镜最佳矫正视力提高1行以上有40眼（62%）,视力不变有24眼（37%）,视力下降一行的1眼（2%）。结论：RGP在矫正高度近视、散光方面效果优于普通框架眼镜。

硬性透气性角膜接触镜矫正复杂性无晶状体眼疗效观察

目的:探讨硬性透气性角膜接触镜(rigidgasperme-ablecontactlens,RGP)矫正复杂的无晶状体眼的效果和安全性。方法:2002-07/2005-06合并眼部其他异常的复杂的无晶状体眼病例22例23眼在本院采用验配RGP作视力矫正。结果:所有患者均一次验配成功。配戴RGP的矫正视力明显好于框架眼镜矫正视力,视力稳定。除1例诉复视外,21例患者无双眼视障碍的症状,无严重并发症发生。结论:RGP矫正复杂的无晶状体眼是安全有效的。

RGP对青少年复杂性屈光不正的矫正效果

目的:研究硬性透氧性角膜接触镜(rigid gas permeable contact lens,RGP)对青少年复杂性屈光不正的矫正效果。方法:对51例90眼复杂屈光不正10～20岁的青少年患者给予验配RGP镜片,观察其矫正视力以及随访其并发症。结果:RGP镜片平均矫正视力为0.95±0.17,与框架眼镜平均矫正视力(0.39±0.11)相比,矫正视力有明显提高,差异有统计学意义(P<0.05)。所有病例均无严重并发症出现。结论:RGP镜片能有效提高复杂屈光不正患者的矫正视力,促进青少年视觉功能发育。

长期配戴硬性透气性角膜接触镜对不同程度圆锥角膜的矫正效果及安全性评价

目的观察不同程度原发性圆锥角膜患者配戴硬性透气性角膜接触镜（RGPCL）5年以上的矫正效果、角膜曲率进展以及长期配戴的安全性。 方法采用回顾性病例观察研究方法，对2000—2010年在北京同仁医院配戴RGPCL超过5年的原发性圆锥角膜患者126例217眼的病例资料进行分析，依据角膜曲率Ks将圆锥角膜患者分为轻度、中度和重度组，角膜曲率Ks≤45.0 D者为轻度圆锥角膜组，Ks≥52.0 D者为重度圆锥角膜组，Ks介于二者之间者为中度圆锥角膜组。患者在初次就诊（戴镜前）及每次复查时均行LogMAR视力、自动验光仪/角膜曲率仪、裂隙灯显微镜及角膜地形图检查。评估RGPCL镜片配适状态，比较各组患者配戴框架眼镜矫正视力（SCVA）及RGP矫正视力（RGPVA），以及RGPCL配戴前后角膜表面参数变化和并发症情况。 结果轻度圆锥角膜组、中度圆锥角膜组和重度圆锥角膜组患者戴镜后末次随访的RGPVA分别为0.09±0.17、0.05±0.07和0.07±0.07，差异有统计学意义（F＝0.522，P＝0.594）；3个组患眼戴镜后末次随访时ΔKs分别为（2.25±5.42）、（0.26±3.44）和（－4.52±3.44）D，ΔKf分别为（2.06±4.98）、（1.02±3.41）和（－2.03±5.05）D，角膜散光变化值分别为（0.19±2.87）、（－0.78±2.84）和（－2.44±3.77）D，重度圆锥角膜组患者戴镜后末次随访时角膜曲率和角膜散光值的进展最小，差异均有统计学意义（均P〈0.05）。轻度圆锥角膜组、中度圆锥角膜组和重度圆锥角膜组患眼不同区域指数变化值（ΔDSI）分别为－0.33±1.64、0.14±3.01和－2.11±4.28，中央/周围指数变化值（ΔCSI）分别为－0.41±1.07、0.03±2.22和－2.49±4.15，角膜屈折力标准偏差变化值（ΔSDP）分别为－0.43±0.64、－0.02±0.89和－1.67±1.68，圆锥角膜预测指数变化值（ΔKPI）分别为0.00±0.07、0.03±0.09和－0.05±0.11，重度圆锥角膜组患者戴镜后末次随访时角膜表面参数值降低幅度均大于轻度圆锥角膜组和中度圆锥角膜组，差异均有统计学意义（均P〈0.01）。随访期间12眼出现轻度的结膜炎症状和点状角膜上皮荧光素染色，占5.5%。 结论RGPCL长期配戴可改善圆锥角膜患者视力并延缓角膜曲率的增加，且不增加角膜感染的风险，对于不同程度圆锥角膜的矫正是安全有效的。

Comfort-Kone硬性角膜接触镜矫治圆锥角膜

目的观察comfort-kone硬性角膜接触镜(rigid gas-permeable contact lens,RGPCL)控制圆锥角膜发展的效果。方法 52例(94眼)患者采用"三点接触法"配戴comfort-kone RGPCL,分析对比配戴后屈光度、角膜地形图参数及泪液情况的变化,评价RGPCL控制圆锥角膜发展的临床效果。结果配戴RGPCL后最佳矫正视力0.83±0.24,与配戴前最佳矫正视力0.58±0.35比较,差异有显著统计学意义(t=-8.87,P=0.00);RGPCL矫正视力与配戴眼屈光度和角膜曲率半径呈显著相关(P=0.001、0.000),与角膜散光度无显著相关性(P=0.081)。随访期间RGPCL矫正视力稳定,角膜健康状况良好;患者主观适应时间为(11.13±9.10)d;长期配戴后基础泪液分泌量显著降低,差异有显著统计学意义(t=2.867,P=0.007)。结论 Comfort-Kone RGPCL能够显著提高圆锥角膜患者的视觉质量,长时间配戴安全、稳定,有效地控制了圆锥角膜的持续发展。

玻璃酸钠滴眼液治疗青少年近视患者配戴硬性透气性角膜接触镜相关性干眼

目的:观察1g/L玻璃酸钠滴眼液(不含防腐剂)对青少年近视患者配戴硬性透气性角膜接触镜(RGP)相关性干眼的疗效评价。方法:选择2015-01/05来我院门诊就诊的90例透气性角膜接触镜相关性干眼症近视患者,年龄12.75±4.15岁,屈光度-3.50±1.50D,患者均接受正规角膜塑形镜验配。将患者随机分为3组,每组30例60眼:A组使用RGP润滑液,4次/d,1滴/次;B组使用1g/L玻璃酸钠滴眼液(不含防腐剂),4次/d,1滴/次;C组在使用RGP润滑液(4次/d,1滴/次)后15min再用1g/L玻璃酸钠滴眼液(不含防腐剂)(4次/d,1滴/次)。观察各组患者用药前1d与用药后第1、2、4wk的眼部症状评分、Schirmer I试验(SⅠt)、泪膜破裂时间(BUT)、角膜荧光染色评分变化。结果:三组患者在用药1wk后的干眼症状、角膜荧光染色和BUT均较治疗前有明显的改善(P<O.05),三组患者的SⅠt值治疗前后差异均无统计学意义(P>0.05)。各组患者在治疗第2、4wk后和治疗1wk时测得的各项指标差异无统计学意义(P>0.05)。B组与A组对干眼症状、SⅠt和BUT的改善作用差异无统计学意义(P>0.05);B组较A组改善角膜荧光染色作用更明显,差异有统计学意义(P<0.05)。C组对改善干眼症状和角膜荧光染色作用优于A组(P<O.05)。C组对改善干眼症状上优于B组(P<0.05)。结论:1g/L玻璃酸钠滴眼液(不含防腐剂)能够稳定泪膜,促进角膜上皮损伤愈合,改善青少年近视患者配戴硬性透气性角膜接触镜所致干眼症状,具有一定的临床应用价值。

硬性透氧性角膜接触镜对单眼屈光参差性弱视儿童的矫治效果观察

目的研究硬性透氧性角膜接触镜(RGP)对单眼屈光参差性弱视儿童矫治效果。方法选取2014年2月至2015年8月西安市中心医院收治的单眼屈光参差性弱视患儿110例。根据治疗方式的不同分为观察组59例,对照组51例。观察组予以RGP矫正视力,对照组则佩戴框架眼镜矫正视力。分别对两组患儿进行为期1年的随访,比较视力矫正情况,临床疗效,并发症发生情况以及患儿满意度。结果观察组配镜后1个月、6个月及12个月后矫正视力分别为(4.33±0.31)、(4.52±0.47)、(4.76±0.29),均高于对照组的(4.19±0.30)、(4.33±0.40)、(4.41±0.44),差异有统计学意义(均P<0.05)。观察组治疗总有效率为67.80%(40/59),高于对照组的43.14%(22/51),差异有统计学意义(P<0.05)。两组并发症发生率对比不明显,差异无统计学意义(P>0.05)。观察组病人满意度为100.00%(59/59),高于对照组的90.20%(46/51),差异有统计学意义(P<0.05)。结论 RGP对单眼屈光参差性弱视患儿的矫治效果显著,且安全性较好,更容易为患儿所接受。

硬性透气性角膜接触镜对青少年近视发展的Meta分析

目的:探讨硬性透气性角膜接触镜(RGPCL)对青少年近视发展的影响。方法:检索中外数据库及网络相关资源,获得有关RGPCL和框架眼镜控制青少年近视发展的临床试验研究资料,进行Meta分析,得到合并的加权均数差及其95%CI。结果:共纳入文献9篇,RGPCL组的等效球镜增加值、眼轴增长值及角膜变平屈折力减少值分别是框架眼镜组的-0.68(95%CI=-1.14^-0.21)、-0.18(95%CI=-0.31^-0.06)和0.21(95%CI=0.14~0.28)倍标准差。结论:RGPCL是延缓青少年近视发展的有益因素。

高度近视儿童配戴硬性透气性角膜接触镜临床观察

目的探讨6岁以下高度近视儿童配戴硬性透气性角膜接触镜(rigid gas permeable contact lens,RGPCL)2a的临床应用效果。方法在角膜地形图指导下对16例(32眼)3～6岁高度近视儿童进行RGPCL配戴,观察患儿的RGPCL配戴和适应情况,比较最佳框架眼镜和RGPCL矫正视力。随访2a观察并发症的发生情况、屈光度发展及视力提高情况。结果配戴框架眼镜矫正视力与RGPCL比较差异有统计学意义(t=-4.558,P<0.05);配戴RGPCL2a前后矫正视力差异有统计学意义(t=6.027,P<0.05),2a后屈光度增长(-0.17±0.42)D、眼轴长度增长(0.07±0.02)mm。所有患儿均1次配戴成功,配戴试戴镜5min后患儿能正常视物、玩耍,1周内均能适应全天日戴。随访期间,1例患儿因家长没有时间为孩子配戴而弃戴,其余均能日戴,镜片需患儿家长清洗、为患儿配戴,5例患儿能独立摘镜片;所有病例均未发现角膜缘新生血管,无角膜擦伤或角膜溃疡等严重并发症。结论近视性屈光参差及高度近视儿童配戴RGPCL矫正屈光不正安全、有效。

不同角膜接触镜对人眼Zernike像差的影响

背景 以往研究分析了角膜接触镜配戴产生的像差变化,但这些变化发生的机制仍不明确.完整理解镜-眼系统引起的波前像差变化原因是进一步改良角膜接触镜的设计、提高视觉矫正质量的基础.目的 通过分析近视患者配戴角膜接触镜状态下的Zernike像差,研究角膜接触镜对人眼光学特性的影响.方法 纳入双眼为近视状态的26例志愿者52眼,等效球镜屈光力为-1.75～-8.50 D,使用WASCA波前像差分析仪分别测量受试眼在未矫正状态、硬性透氧性角膜接触镜（RGP-CL）状态及软性角膜接触镜（Soft-CL）状态的人眼像差.采用重复测量单因素方差分析法比较3种状态下人眼波前像差及Zernike系数间的差异性,采用Pearson相关分析法分析受试眼未矫正状态下各像差与RGP-CL矫正状态或Soft-CL矫正状态下像差变化的关系、未矫正状态下各像差与RGP-CL矫正状态或Soft-CL矫正状态下双眼像差的关系及3种状态下双眼间像差变化的关系. 结果 在未矫正状态、RGP-CL矫正状态下及Soft-CL矫正状态下整眼像差的均方根值（RMS）分别为（0.71±0.30）、（0.54±0.19）、（0.74±0.32） μm,总体比较差异有统计学意义（F=8.758,P＜0.001）.RGP-CL矫正状态下的整眼像差RMS明显低于未矫正状态,差异有统计学意义（t=2.746,P=0.008）,Soft-CL矫正状态下的整眼像差RMS与未矫正状态相比差异无统计学意义（t=0.631,P=0.531）,RGP-CL矫正状态下的整眼像差RMS显著低于Soft-CL矫正状态,差异有统计学意义（t=3.428,P=0.001）.未矫正状态、RGP-CL矫正状态及Soft-CL矫正状态下的3～7阶高阶像差RMS分别为（0.34±0.12）、（0.28±0.12）、（0.40±0.14）μm,差异有统计学意义（F=10.681,P＜0.001）.与未矫正状态相比,RGP-CL矫正状态下的高阶像差RMS略下降,差异无统计学意义（t=1.987,P=0.053）,Soft-CL矫正状态下的高阶像差RMS明显高于未矫正状态,差异有统计学意义（t=2.101,P=0.041）；RGP-CL矫正状态下的高阶像差RMS显著低于Soft-CL矫正状态,差异有统计学意义（t=4.266,P＜0.001）.与未矫正状态相比,RGP-CL矫正状态的主轴散光（C5）和球差（C12）、Soft-CL矫正状态的球差（C12）均明显降低,差异均有统计学意义（P＜0.05）.与未矫正状态相比,RGP-CL矫正的三叶草像差（C6）、垂直彗差（C7）和四叶草像差（CL0）的平均绝对值显著降低,而Soft-CL矫正状态垂直彗差（C7）的平均绝对值显著增加,差异均有统计学意义（P＜0.05）.未矫正状态与RGP-CL矫正状态下球差（C12）的正相关性最显著（r=0.763,P＜0.001）,与Soft-CL矫正状态下二阶散光（C11）的相关性最低（r=0.469,P＜0.001）. 结论 RGP-CL配戴和Soft-CL配戴与角膜产生的相互作用不同,因此对人眼像差结构的影响不同.RGP-CL矫正可能基于对角膜表面形态的影响而减弱了双眼像差的双侧对称性,因此对人眼像差的改变最大,而Soft-CL矫正改变了人眼的高阶像差.

硬性透氧性角膜接触镜矫正中低度近视对人眼单色光波前像差和对比度视力的影响

背景硬性透氧性（RGP）角膜接触镜作为一种新兴的矫正屈光不正的方法已广泛使用，但是否会引起眼球光学系统的改变从而对视觉质量产生影响尚不确定。目的评价和比较采用RGP角膜接触镜矫正与采用框架眼镜矫正后中低度近视眼视觉质量改善的效果。方法纳入35例68眼中低度近视患者，比较配戴框架眼镜和配戴RGP角膜接触镜3个月后受试眼的波阵面像差和明环境、暗环境中不同对比度（10％、30％、40％、52％、76％、92％）下视力的差异。结果受试眼配戴RGP角膜接触镜后平均最佳矫正视力（BCVA）为1．26＋_0．03，优于配戴框架眼镜的0．94±0．10，差异有统计学意义（t=-9．266，P=0．000）。受试眼配戴RGP角膜接触镜后的总高阶像差较配戴前明显下降，差异有统计学意义（t=4．683，P=0．000），其中以3～4阶像差下降为主（RMS3：t=4．656，P=0．000；RMS4：t=3．929，P=0．000），而RGP角膜接触镜配戴前后受试眼5～6阶像差的差异均无统计学意义（RMS5：t=1．766，P=0．083；RMS6：t=1．150，P=0．256）。在明环境、暗环境中，受试眼在不同对比度下配戴RGP角膜接触镜的视力均明显好于配戴框架眼镜，差异均有统计学意义（均P〈0．05）。在相同环境条件下，随着视标对比度的下降，视力随之下降，但在相同矫正方式和对比度下，受试眼在明环境下与暗环境下的视力值均非常接近。结论中低度近视患者配戴RGP角膜接触镜的视觉质量好于配戴框架眼镜。