Steele Chris, Davidson John
Optometry Department, Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP, United Kingdom.
Cont Lens Anterior Eye. 2007 May;30(2):84-93. doi: 10.1016/j.clae.2006.12.005. Epub 2007 Feb 27.
Despite recent advances in refractive surgical procedures a small proportion of patients still achieve sub-optimal results for a variety of reasons. In such cases, contact lenses may provide the only option for visual rehabilitation and restoration of binocular vision post-refractive surgery. The indications for contact lenses post-LASIK may be one, or a combination of the following: *Initial bandage lens for corneal protection. *Residual ametropia--over and under correction. *Irregular astigmatism. * Anisometropia. * Decentred ablation zones. In low powered corrections conventional soft lenses can be fitted in the normal way, giving good levels of acuity. Where there is astigmatism (>0.75 DC) then toric soft contact lenses may appropriate. Rigid lenses may prove to be the only viable option in a number of cases where visual correction is required post-refractive surgery, or in the presence of high levels of astigmatism. Fitting can be more complex however, since a conventional rigid lens cannot follow the shape of both the flattened central cornea and the relatively steeper periphery in higher corrections, as the amount of laser ablation increases. Reverse geometry lenses are indicated where there is a significant difference between the flat central ablated zone and the relatively steeper peripheral cornea. On rare occasions scleral lenses may also be indicated.
尽管屈光手术程序最近取得了进展，但仍有一小部分患者由于各种原因未能获得最佳效果。在这种情况下，隐形眼镜可能是屈光手术后视力康复和双眼视觉恢复的唯一选择。LASIK术后使用隐形眼镜的适应证可能是以下一种或多种：*用于角膜保护的初始绷带镜。*残余屈光不正——矫正过度和矫正不足。*不规则散光。*屈光参差。*偏心消融区。在低度数矫正中，传统软性隐形眼镜可以按常规方式佩戴，视力水平良好。如果存在散光（>0.75DC），则可能适合使用散光软性隐形眼镜。在屈光手术后需要视力矫正或存在高度散光的许多情况下，硬性隐形眼镜可能是唯一可行的选择。然而，配镜可能会更复杂，因为随着激光消融量的增加，传统硬性隐形眼镜在较高度数矫正中无法同时贴合扁平的中央角膜和相对较陡的周边角膜形状。当扁平的中央消融区与相对较陡的周边角膜之间存在显著差异时，应使用反几何设计镜片。在极少数情况下，也可能需要巩膜镜。
