圆锥角膜患者验配RGP便捷方法探讨
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摘要
目的通过了解硬性高透气性角膜接触镜(rigid gas permeable corneal contact lens,RGP)度数(degree of rigid gas permeable corneal contact lens,RGPD)与主觉验光等效球镜度(spherical equivalent degree,SSED)之间关系,RGP最佳矫正视力(best corrected visual acuity of rigid gas permeable corneal contact lens,RGPVA)与裸眼视力(uncorrected visual acuity,UCVA)、主觉验光最佳矫正视力(best corrected visual acuity of subjective refraction,SBCVA)之间关系,探讨圆锥角膜患者验配RGP便捷方法,观察RGP矫治圆锥角膜患者的疗效、安全性、舒适度及并发症。方法收集2011年7月至2015年5月我院圆锥角膜患者64例(102眼),记录UCVA、主觉验光结果及其SSED、RGPVA、RGPD及定期复查情况。为探讨RGPD、RGPVA与SSED、SBCVA间大小及关系,分别把圆锥角膜102眼作为一组(A)及以散光度数2.0 CD、3.0 CD、4.0 CD、5.0 CD、6.0 CD为界分别把102眼分为两组,即(B1、B2)、(C1、C2)、(D1、D2)、(E1、E2)、(F1、F2)来研究。结果相关性分析:除F2组外,其他各组RGPD与SSED均呈正相关(均为P<0.01);除E2、F2组外,其他各组RGPVA与SBCVA均呈正相关(均为P<0.01);所有组RGPVA与UCVA间均无相关性(均为P>0.01)。差异分析:除D2、E2、F2组外,其他各组RGPD与SSED度数差异均无统计学意义(均为P>0.05)。所有组RGPVA较UCVA、SBCVA均有明显提高(均为P<0.05)。随访期间RGP配戴者无明显不适及严重并发症发生。结论圆锥角膜患者其主觉验光度数和视力可为RGP验配提供重要参考,使RGP验配更快捷,但随着散光度数的增加,此参考价值减小。圆锥角膜患者配戴RGP后能达到更好的矫正视力,并有较高的舒适度和安全性。
Objective By understanding the relationship between rigid gas permeable corneal contact lens( R GP) degree( R GPD) and the spherical equivalent degree of subjective refraction( SSED),and the relationship among R GP visual acuity( R GPVA) and the best corrected visual acuity of subjective refraction( SBC VA),uncorrected visual acuity( U C VA),to investigate a convenient method of fitting keratoconus patients for R GP,and also observe the safety,effectiveness,comfort and complications of keratoconus patients w earing R GP. Methods A total of 64 keratoconus patients( 102 eyes) in our hospital from July 2011 to M ay 2015 w ere collected. U C VA,results of subjective refraction and SSED,R GPVA,R GPD,and periodic follow-up w ere recorded. In order to accurately explore the relationship betw een R GPD and SSED,relationship betw een R GPVA and SBC VA,the data of the 102 eyes w ere analyzed as a unified group and also divided the 102 eyes into tw o groups,( B1,B2),( C 1,C 2),( D1,D2),( E1,E2) and( F1,F2),on the basis of astigmatism 2. 0 CD,3. 0 CD,4. 0 CD,5. 0 CD,6. 0CD,respectively.Results Correlation analysis: Except for F2 group,RGPD and SSED in other groups were positively correlated( all P < 0. 01); Except for E2 and F2 group,R GPVA and SBC VA in other groups w ere positively correlated( all P < 0. 01). N o correlation w as found betw een R GPVA and U C VA in all groups( all P > 0. 01). D ifference analysis: Except for D2,E2 and F2 group,there w as no significant differences in SSED and R GPD among other groups( all P > 0. 05). R GPVA in all groups w as significantly increased in comparison w ith U C VA and SBC VA( all P < 0. 05).N o obvious discomfort and serious complication occurred during the follow-up period of the patients of R GP. Conclusion For keratoconus patients,the degree and vision of subjective refraction can provide important reference for R GP fitting and making R GP fitting more quickly,but w ith the increase of astigmatism,the reference value is reduced. Patients w ith keratoconus can achieve better visual acuity after w earing R GP,and have a good comfort and security.
Objective By understanding the relationship between rigid gas permeable corneal contact lens( R GP) degree( R GPD) and the spherical equivalent degree of subjective refraction( SSED),and the relationship among R GP visual acuity( R GPVA) and the best corrected visual acuity of subjective refraction( SBC VA),uncorrected visual acuity( U C VA),to investigate a convenient method of fitting keratoconus patients for R GP,and also observe the safety,effectiveness,comfort and complications of keratoconus patients w earing R GP. Methods A total of 64 keratoconus patients( 102 eyes) in our hospital from July 2011 to M ay 2015 w ere collected. U C VA,results of subjective refraction and SSED,R GPVA,R GPD,and periodic follow-up w ere recorded. In order to accurately explore the relationship betw een R GPD and SSED,relationship betw een R GPVA and SBC VA,the data of the 102 eyes w ere analyzed as a unified group and also divided the 102 eyes into tw o groups,( B1,B2),( C 1,C 2),( D1,D2),( E1,E2) and( F1,F2),on the basis of astigmatism 2. 0 CD,3. 0 CD,4. 0 CD,5. 0 CD,6. 0CD,respectively.Results Correlation analysis: Except for F2 group,RGPD and SSED in other groups were positively correlated( all P < 0. 01); Except for E2 and F2 group,R GPVA and SBC VA in other groups w ere positively correlated( all P < 0. 01). N o correlation w as found betw een R GPVA and U C VA in all groups( all P > 0. 01). D ifference analysis: Except for D2,E2 and F2 group,there w as no significant differences in SSED and R GPD among other groups( all P > 0. 05). R GPVA in all groups w as significantly increased in comparison w ith U C VA and SBC VA( all P < 0. 05).N o obvious discomfort and serious complication occurred during the follow-up period of the patients of R GP. Conclusion For keratoconus patients,the degree and vision of subjective refraction can provide important reference for R GP fitting and making R GP fitting more quickly,but w ith the increase of astigmatism,the reference value is reduced. Patients w ith keratoconus can achieve better visual acuity after w earing R GP,and have a good comfort and security.
引文
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[7]KYMIONIS GD,GRENTZELOS MA,LIAKUPOULOS DA,PAR ASKEVO PO U LO S T A,KLAD O S N E,T SO U LN AR AS KI,et al.Long-term follow-up of corneal collagen cross-linking for keratoconus-the C retan study[J].C ornea,2014,33(1):1071-1079.
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[9]杨积文,卜立敏,谢姝,杨小飞,纪惠芳.RGP矫治圆锥角膜长期临床观察[J].中华眼视光学与视觉科学杂志,2014,16(2):100-102.
[10]孙荔,张琰,吕川,徐漫,徐艳春.RGP对早期圆锥角膜患者屈光状态改变的分析[J],国际眼科杂志,2012,12(10):1964-1965.
[11]YANAI R,UEDA K,SONODA KH.Bevel tonic multicurve rigid gas-permeable lens for keratoconus[J].Jpn J O phthalmol,2013,57(2):199-205.
[12]姜珺,吕帆,金婉卿,余阿勇.角膜地形图相关参数引导的圆锥角膜镜片验配研究[J].眼视光学杂志,2003,5(3):160-162.
[13]常枫,沈政伟,陈云辉,何灿,周和政.OCULUS角膜地形图引导下的硬性透氧性角膜接触镜矫治圆锥角膜的验配[J].眼科新进展,2011,31(7):667-669.
[14]ZHANG Q,XIE PY.RGP fitting techniques for keratoconus[J].Int J O phthalmol,2005,5(2):313-315.
[15]MOHAMMAD TR,ZAHRA MF,SEYEDE KN,FAHIMEH J,ASKAR D,PAR VIZ Z,et al.R igid contact lens fitting based on keratometry readings in keratonocuspatients:predicting formula[J].Int J Ophthalmol,2011,11(11):1869-1872.
[16]高彦,林潇,刘明娜,王殊婷,王海莹,陈百秋,等.硬性透气性角膜接触镜矫正圆锥角膜不规则散光后对比度视力的提高[J].眼科,2010,19(3):183-186.
[2]谢培英.图释圆锥角膜[M].北京:北京大学医学出版社,2009:86.
[3]HUANG T,HU Y,GUI M,ZHANG H,WANG Y,HOU C.Large-diameter deep anterior lamellar keratoplasty for keratoconus:visual and refractive outcomes[J].Br J O phthalmol,2015,99(9):1196-1200.
[4]MRAZOVAC D,BARISI KUTIJA M,VIDAS S,VIDAS S,KU Z M AN T,PET R IC EK I,et al.C ontact lenses as the best conservative treatment of new ly diagnosed keratoconus-epidemiological retrospective study[J].C oll A ntropol,2014,38(4):1115-1118.
[5]XIE PY.Visual quality needs to be improved in non-surgical optical correction[J].Zhong H ua Yan K e Za Zhi,2016,52(1):5-9.
[6]CHANG CY,HERSH PS.Corneal collagen cross-linking:a review of 1-year outcomes[J].Eye C ontact Lens,2014,40(6):345-352.
[7]KYMIONIS GD,GRENTZELOS MA,LIAKUPOULOS DA,PAR ASKEVO PO U LO S T A,KLAD O S N E,T SO U LN AR AS KI,et al.Long-term follow-up of corneal collagen cross-linking for keratoconus-the C retan study[J].C ornea,2014,33(1):1071-1079.
[8]谢培英.图释圆锥角膜[M].北京:北京大学医学出版社,2009:95.
[9]杨积文,卜立敏,谢姝,杨小飞,纪惠芳.RGP矫治圆锥角膜长期临床观察[J].中华眼视光学与视觉科学杂志,2014,16(2):100-102.
[10]孙荔,张琰,吕川,徐漫,徐艳春.RGP对早期圆锥角膜患者屈光状态改变的分析[J],国际眼科杂志,2012,12(10):1964-1965.
[11]YANAI R,UEDA K,SONODA KH.Bevel tonic multicurve rigid gas-permeable lens for keratoconus[J].Jpn J O phthalmol,2013,57(2):199-205.
[12]姜珺,吕帆,金婉卿,余阿勇.角膜地形图相关参数引导的圆锥角膜镜片验配研究[J].眼视光学杂志,2003,5(3):160-162.
[13]常枫,沈政伟,陈云辉,何灿,周和政.OCULUS角膜地形图引导下的硬性透氧性角膜接触镜矫治圆锥角膜的验配[J].眼科新进展,2011,31(7):667-669.
[14]ZHANG Q,XIE PY.RGP fitting techniques for keratoconus[J].Int J O phthalmol,2005,5(2):313-315.
[15]MOHAMMAD TR,ZAHRA MF,SEYEDE KN,FAHIMEH J,ASKAR D,PAR VIZ Z,et al.R igid contact lens fitting based on keratometry readings in keratonocuspatients:predicting formula[J].Int J Ophthalmol,2011,11(11):1869-1872.
[16]高彦,林潇,刘明娜,王殊婷,王海莹,陈百秋,等.硬性透气性角膜接触镜矫正圆锥角膜不规则散光后对比度视力的提高[J].眼科,2010,19(3):183-186.