圆锥角膜的早期诊断和透气性硬性角膜接触镜矫正治疗研究
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摘要
目的:圆锥角膜是青少年时期屈光疑难病,其矫正、治疗和控制疾病发展是眼科临床难题。本研究的目的是研究角膜地形图在圆锥角膜早期诊断的临床意义,并观察各种类型透气性硬性角膜接触镜(RGPCL)对圆锥角膜患者的矫正效果和视觉质量评估。
方法:
第一部分:对于角膜地形图的观察选取了门诊收治圆锥角膜患者共212例(340只眼)和年龄相匹配正常对照组200例(400只眼),采用TMS Ⅳ系统进行角膜地形图分析,获得最大、最小拟似角膜K值(SimK1、SimK2)、表面不对称指数(SAI)、表面规则指数(SRI)、离心率指数(CEI)、角膜中心下方3mm处屈光力与角膜中心上方3mm处屈光力的差值(I-S)、不同区域指数(DSI)、相对区域指数(OSI)、中央/周围指数(CSI)、圆锥角膜预测指数(KPI)、圆锥角膜指数(KCI)和圆锥角膜程度指数(KSI),以及同一个体双眼角膜中心屈光力差值(ΔK)进行多组方差分析和两组间两两比较SNK-q检验,并对多种角膜地形图参数进行多因素回归分析。
在第二部分:对于RGPCL疗效的观察选取了135例(259只眼)亚临床期和临床期圆锥角膜患者,亚临床期为68只眼,临床期
Objective:Keratoconus was a kind of rarely occur corneal ectasia disease in patients who were juveniles. It was a difficult problem on the optical correction, treatment and control for keratoconus patients. We studied the index of corneal topography to instruct the earlier diagnosis and to guide the RGPCL choice and fitting. All kinds of RGPCL were observed on both correction effect and visual quality.Meathod:In part one, 212(340 eyes) keratoconus patients and 200(400eyes) age-matched normal controls were detectedusing TMS Ⅳ topographer. The index contains SimK1, SimK2,SAI, SRI, CEI, I-S, ΔK, DSI, OSI, CSI, KPI, KCI and KSI.F test, SNK-q test and mutifactor regression were analysed.In part two, 135(259 eyes) keratoconus patients were fitted with 4 kind RGPCL according to the refractive states, corneal surface modality and fitting state. Patients were
examined periodically on fitting state, VA, K value, astigmatism, corneal topography within 2 years. Paired t test were analysed.In part three, 27(54 eyes) keratoconus patients were divided into three groups. Light 30eyes, moderate 13 eyes and severe 11 eyes were fitted with spherical and special designed Comfort kone lens. Corneal topography, subjective wavefront aberration and contrast sensitive were detected before and after RGPCL wearing within 30 days. Paired t test were analysed.Results:1. Corneal surface morphology in normal eyes was round, oval, symmetry tie and asymmetry tie. While upper corneal curve in sub-clincal patients similar to normal, there were nipple changed in the lower part, especially in lower temperal. 48.6% were asymmetry tie. Corneal steepen in local area as nipple, oval, global, unregular in clinical patients.2. 1 There were significant change between sub-clincal patients clinical patients and normal in corneal topography index except CEI (p<0.001) .2.2 The maximum steep points were not located on corneal center, sub-clincal patients 47% and clinical patients 47%. 104 eyes lower temperal, 35 eyes right down, 45 lower nasal. There were significant changes between all
groups on AK ( p <0. 001) .2.3 There were significant changes between sub-clincal patients, clinical patients and normal in corneal topography attached keratoconus screening index KPI,KCI and KSI (p <0.001) .3. Spherical, asphrical, ROSE-K and Piggyback lens were fitted for keratoconus patients. It showed the corrective VA was significant improved after RGPCL wearing in all groups, sepecial in moderate and severe patients. The corneal K value flattened with corneal astigmatism decrease. Corrective VA was stable with 2 years.4. There was no serious eyes reaction except 17 eyes with mild cornal staining.5. Wavefront aberration increased with disease processing in clinical patients (p<0.001) .6. Wavefront aberration decreased with RGPCL wearing (j?< 0.001) . The most decrease occured at 3 order RMS ( p< 0. 001 ) .7. With RGPCL wearing, Contrast sensitivity curve (light on and light off) were significantly higher than that with SP in whole range of frequency, especially in middle and high frequency (i><0.05, i?< 0.001) .Conclusion:1. Corneal topography index were valuable in
differentiate sub-clinical patients from normal control. The keratoconus screening software was more important. It was easy to make diagnosis union with other regular exams in sub-clinical patients diagnosis.2. For the light, moderate and severity keratoconus patients, wearing different design RGPCL could provide sufficient corrective effect. It was successful and safe for long period wearing.3. RGPCL showed some Orthokeratologic effect in keratoconus patients. The corneal curve flattened and astigmatism decreased. Piggyback lens could improve RGPCL stability and prevent corneal scar forming while acute corneal edema occured.4. The significant improvement on corneal topography, contrast sensitivity, Wavefront aberration results of keratoconus patients identified the corneal regularity and visual quality improvement.
方法:
第一部分:对于角膜地形图的观察选取了门诊收治圆锥角膜患者共212例(340只眼)和年龄相匹配正常对照组200例(400只眼),采用TMS Ⅳ系统进行角膜地形图分析,获得最大、最小拟似角膜K值(SimK1、SimK2)、表面不对称指数(SAI)、表面规则指数(SRI)、离心率指数(CEI)、角膜中心下方3mm处屈光力与角膜中心上方3mm处屈光力的差值(I-S)、不同区域指数(DSI)、相对区域指数(OSI)、中央/周围指数(CSI)、圆锥角膜预测指数(KPI)、圆锥角膜指数(KCI)和圆锥角膜程度指数(KSI),以及同一个体双眼角膜中心屈光力差值(ΔK)进行多组方差分析和两组间两两比较SNK-q检验,并对多种角膜地形图参数进行多因素回归分析。
在第二部分:对于RGPCL疗效的观察选取了135例(259只眼)亚临床期和临床期圆锥角膜患者,亚临床期为68只眼,临床期
Objective:Keratoconus was a kind of rarely occur corneal ectasia disease in patients who were juveniles. It was a difficult problem on the optical correction, treatment and control for keratoconus patients. We studied the index of corneal topography to instruct the earlier diagnosis and to guide the RGPCL choice and fitting. All kinds of RGPCL were observed on both correction effect and visual quality.Meathod:In part one, 212(340 eyes) keratoconus patients and 200(400eyes) age-matched normal controls were detectedusing TMS Ⅳ topographer. The index contains SimK1, SimK2,SAI, SRI, CEI, I-S, ΔK, DSI, OSI, CSI, KPI, KCI and KSI.F test, SNK-q test and mutifactor regression were analysed.In part two, 135(259 eyes) keratoconus patients were fitted with 4 kind RGPCL according to the refractive states, corneal surface modality and fitting state. Patients were
examined periodically on fitting state, VA, K value, astigmatism, corneal topography within 2 years. Paired t test were analysed.In part three, 27(54 eyes) keratoconus patients were divided into three groups. Light 30eyes, moderate 13 eyes and severe 11 eyes were fitted with spherical and special designed Comfort kone lens. Corneal topography, subjective wavefront aberration and contrast sensitive were detected before and after RGPCL wearing within 30 days. Paired t test were analysed.Results:1. Corneal surface morphology in normal eyes was round, oval, symmetry tie and asymmetry tie. While upper corneal curve in sub-clincal patients similar to normal, there were nipple changed in the lower part, especially in lower temperal. 48.6% were asymmetry tie. Corneal steepen in local area as nipple, oval, global, unregular in clinical patients.2. 1 There were significant change between sub-clincal patients clinical patients and normal in corneal topography index except CEI (p<0.001) .2.2 The maximum steep points were not located on corneal center, sub-clincal patients 47% and clinical patients 47%. 104 eyes lower temperal, 35 eyes right down, 45 lower nasal. There were significant changes between all
groups on AK ( p <0. 001) .2.3 There were significant changes between sub-clincal patients, clinical patients and normal in corneal topography attached keratoconus screening index KPI,KCI and KSI (p <0.001) .3. Spherical, asphrical, ROSE-K and Piggyback lens were fitted for keratoconus patients. It showed the corrective VA was significant improved after RGPCL wearing in all groups, sepecial in moderate and severe patients. The corneal K value flattened with corneal astigmatism decrease. Corrective VA was stable with 2 years.4. There was no serious eyes reaction except 17 eyes with mild cornal staining.5. Wavefront aberration increased with disease processing in clinical patients (p<0.001) .6. Wavefront aberration decreased with RGPCL wearing (j?< 0.001) . The most decrease occured at 3 order RMS ( p< 0. 001 ) .7. With RGPCL wearing, Contrast sensitivity curve (light on and light off) were significantly higher than that with SP in whole range of frequency, especially in middle and high frequency (i><0.05, i?< 0.001) .Conclusion:1. Corneal topography index were valuable in
differentiate sub-clinical patients from normal control. The keratoconus screening software was more important. It was easy to make diagnosis union with other regular exams in sub-clinical patients diagnosis.2. For the light, moderate and severity keratoconus patients, wearing different design RGPCL could provide sufficient corrective effect. It was successful and safe for long period wearing.3. RGPCL showed some Orthokeratologic effect in keratoconus patients. The corneal curve flattened and astigmatism decreased. Piggyback lens could improve RGPCL stability and prevent corneal scar forming while acute corneal edema occured.4. The significant improvement on corneal topography, contrast sensitivity, Wavefront aberration results of keratoconus patients identified the corneal regularity and visual quality improvement.
引文
1. Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol, 1984, 28: 293-302.
2. Kennedy RH, Bourne MW, Dyer JA. A 48-year clinical and epidemiologyic study of keratoconus. Am J Ophthalmol, 1986, 101: 267-273.
3. Rabinowitz YS. Keratoconus. Surv Ophthalmol, 1998, 42: 297-319.
4. Georgiou T, Funnell CL, Casse1-Brown A, et al. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye, 2004, 18: 379-383.
5. Soni PS, Gerstman DR, Iloner DG, et al. The management of keratoconus using the corneal modeling system and a piggyback system of contact lenses. J Am Optom Assoc, 1991, 62: 593-597.
6.谢培英,成颖,刘悦等.接触镜对101例圆锥角膜的矫正与治疗.眼视光学杂志,1999,1:19-23.
7. Israel K, et al. Histologic evidence of recurrent keratoconus seven years after keratoplasty. Am J Ophthalmol. 1995, 119(4): 511-512.
8. Rabinowitz YS, Garbus J, Mc Donnell PJ. Computer-assisted corneal topography in family members of patients keratoconus. Arch Ophthalmol, 1990, 108: 365-371.
9. Maeda N, Klyce SD, Smolek MK. Automated keratoconus screening with corneal topography analysis. Invest Ophthahnol Vis Sci, 1994, 35: 2749-2157.
10. Rabinowitz YS, Rasheed K. KISA% index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. J Cataract Refract Surg, 1999, 25: 1327-1335.
11. Yaron S. Rabinowitz: Keratoconus. Surv Ophthalmol 1998, 42(4): 297-319.
12. Wilson SE, Klyce SD. Screening for corneal topographic abnormalities before refractive surgery. Ophthalmology, 1994, 101: 147-152.
13.齐虹,陈跃国,朱秀安.角膜地形图对亚临床期圆锥角膜筛选的作用.眼科研究,1999,6:195-198.
14. Kalin NS, Maeda N, Klyce SD, et al. Antomated topographic screening for keratoconus in refractive surgery candidates. CLAO J, 1996, 22: 164-167.
15. Anffarth GU. Wang L. Volcker HE. Keratoconus evaluation using the Obscan topography sys. J Cataract Refract Surg, 2000, 26: 222-228.
16. Colin J, Velor S. Current surgical options for keratoconus. J Refract Surg, 2003, 29: 379-386.
17. Donshik PC, Reisner DS, Luistro AE. The use of computerized videokeratography as an aid in fitting rigid gas permeable contact lenses. Trans Am Ophthalmol Soc, 1996, 94: 135-143.
18. Colin J, Velor S. Current surgical options for keratoconus. J Refract Surg, 2003, 29: 379-386.
19. Betts AM. Mitchell GL. Zadnik K. Visual performance and comfort with the Rose K lens for keratoconus, Optom Vis Sci. 2002, 79: 493-501.
20. Soni PS, Gerstman DR, Iloner DG, et al. The management of keratoconus using the corneal modeling system and a piggyback system of contact lenses. J Am Optom Assoc, 1991, 62: 593-597.
21.谢培英,刘悦,张缨,等.圆锥角膜和软硬组合式接触镜眼视光学杂志,2000,2:138-141.
22. Wygledowska PD, Zawojska I. Procedure for keratoconus detection according to the Rabinowitz-Rasheed method-personal experience. Klin Oczna, 2000, 102: 241-244.
23. Stephen J. Tuft, et al: Prognostic Factors for the Progression of Keratoconus. Ophthalmology, 1994, 102(3): 439-44?.
24. Modeling Corneal Topography with a Subdivision System in Keratoconus. Ophthalmology, 2001, 98:(1) 54-59.
25. He JC, Marcos S, Webb RH, et al. Measurement of the wave-front aberration of the eye by a fast psychophysical procedure. J Opt Soc Am A Opt Image Sci Vis. 1998. 15: 2449-2456.
26.刘岚,唐罗生.波阵面像差及波阵面像差仪在眼科的应用及发展.中国实用眼科杂志,2001,19:883.
27. Applegate RA, Hilmantel G, et al. Corneal first surface optical aberration and visual performance. J Refract Surg, 2000, 16: 507-510.
28. Meade N. Wavefront technology in ophthalmology. Curr Opin Ophthalmol, 2001, 12: 294-298.
29. Mrochen M, Katemmerer P, et al. Principle of tscherning aberrometry. J Refract Surg, 2000, 16: 570-575.
30. Oshika T, Klyce SD, et al. Comparison of corneal wavefront aberration after photorefractive keratectomy. Arch Ophthalmol, 1998, 116: 1053-1058.
2. Kennedy RH, Bourne MW, Dyer JA. A 48-year clinical and epidemiologyic study of keratoconus. Am J Ophthalmol, 1986, 101: 267-273.
3. Rabinowitz YS. Keratoconus. Surv Ophthalmol, 1998, 42: 297-319.
4. Georgiou T, Funnell CL, Casse1-Brown A, et al. Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients. Eye, 2004, 18: 379-383.
5. Soni PS, Gerstman DR, Iloner DG, et al. The management of keratoconus using the corneal modeling system and a piggyback system of contact lenses. J Am Optom Assoc, 1991, 62: 593-597.
6.谢培英,成颖,刘悦等.接触镜对101例圆锥角膜的矫正与治疗.眼视光学杂志,1999,1:19-23.
7. Israel K, et al. Histologic evidence of recurrent keratoconus seven years after keratoplasty. Am J Ophthalmol. 1995, 119(4): 511-512.
8. Rabinowitz YS, Garbus J, Mc Donnell PJ. Computer-assisted corneal topography in family members of patients keratoconus. Arch Ophthalmol, 1990, 108: 365-371.
9. Maeda N, Klyce SD, Smolek MK. Automated keratoconus screening with corneal topography analysis. Invest Ophthahnol Vis Sci, 1994, 35: 2749-2157.
10. Rabinowitz YS, Rasheed K. KISA% index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. J Cataract Refract Surg, 1999, 25: 1327-1335.
11. Yaron S. Rabinowitz: Keratoconus. Surv Ophthalmol 1998, 42(4): 297-319.
12. Wilson SE, Klyce SD. Screening for corneal topographic abnormalities before refractive surgery. Ophthalmology, 1994, 101: 147-152.
13.齐虹,陈跃国,朱秀安.角膜地形图对亚临床期圆锥角膜筛选的作用.眼科研究,1999,6:195-198.
14. Kalin NS, Maeda N, Klyce SD, et al. Antomated topographic screening for keratoconus in refractive surgery candidates. CLAO J, 1996, 22: 164-167.
15. Anffarth GU. Wang L. Volcker HE. Keratoconus evaluation using the Obscan topography sys. J Cataract Refract Surg, 2000, 26: 222-228.
16. Colin J, Velor S. Current surgical options for keratoconus. J Refract Surg, 2003, 29: 379-386.
17. Donshik PC, Reisner DS, Luistro AE. The use of computerized videokeratography as an aid in fitting rigid gas permeable contact lenses. Trans Am Ophthalmol Soc, 1996, 94: 135-143.
18. Colin J, Velor S. Current surgical options for keratoconus. J Refract Surg, 2003, 29: 379-386.
19. Betts AM. Mitchell GL. Zadnik K. Visual performance and comfort with the Rose K lens for keratoconus, Optom Vis Sci. 2002, 79: 493-501.
20. Soni PS, Gerstman DR, Iloner DG, et al. The management of keratoconus using the corneal modeling system and a piggyback system of contact lenses. J Am Optom Assoc, 1991, 62: 593-597.
21.谢培英,刘悦,张缨,等.圆锥角膜和软硬组合式接触镜眼视光学杂志,2000,2:138-141.
22. Wygledowska PD, Zawojska I. Procedure for keratoconus detection according to the Rabinowitz-Rasheed method-personal experience. Klin Oczna, 2000, 102: 241-244.
23. Stephen J. Tuft, et al: Prognostic Factors for the Progression of Keratoconus. Ophthalmology, 1994, 102(3): 439-44?.
24. Modeling Corneal Topography with a Subdivision System in Keratoconus. Ophthalmology, 2001, 98:(1) 54-59.
25. He JC, Marcos S, Webb RH, et al. Measurement of the wave-front aberration of the eye by a fast psychophysical procedure. J Opt Soc Am A Opt Image Sci Vis. 1998. 15: 2449-2456.
26.刘岚,唐罗生.波阵面像差及波阵面像差仪在眼科的应用及发展.中国实用眼科杂志,2001,19:883.
27. Applegate RA, Hilmantel G, et al. Corneal first surface optical aberration and visual performance. J Refract Surg, 2000, 16: 507-510.
28. Meade N. Wavefront technology in ophthalmology. Curr Opin Ophthalmol, 2001, 12: 294-298.
29. Mrochen M, Katemmerer P, et al. Principle of tscherning aberrometry. J Refract Surg, 2000, 16: 570-575.
30. Oshika T, Klyce SD, et al. Comparison of corneal wavefront aberration after photorefractive keratectomy. Arch Ophthalmol, 1998, 116: 1053-1058.