Porcar Esteban, Montalt Juan Carlos, España-Gregori Enrique, Peris-Martínez Cristina
Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain.
Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain.
Cont Lens Anterior Eye. 2017 Jun;40(3):190-194. doi: 10.1016/j.clae.2016.12.007. Epub 2017 Jan 7.
We describe a case of fitting a corneo-scleral contact lens with a multi-aspheric geometry design (MAGD CScL) on top of a daily silicone hydrogel lens (piggyback system) for keratoconus management.
A 48-year-old man using soft toric contact lenses required an improvement in the unsatisfactory quality of his vision. He presented with bilateral asymmetric keratoconus with high myopia in the right eye (RE) and severe myopia in the left eye (LE). In addition, he had low vision in his LE because of a maculopathy. He was fitted with MAGD CScL to correct his irregular astigmatism. A diagnostic trial set was used in the fitting process and the patient was assessed according to a standardised fitting methodology. Visual acuity, corneal topography and contrast sensitivity were evaluated. The follow-up period was 1year.
The best spectacle-corrected visual acuity was 0.5 logMAR for the RE with -10 D/-5 D×60° and 2 logMAR for the LE with -20 D/-3 D×105°. After fitting MAGD CScL, visual acuity improved significantly to 0.1 logMAR for the RE and 1.3 logMAR for the LE, as well as contrast sensitivity. The fitting parameters of the base curve, diameter, and power were 7.05mm, 12.60mm, -18.50 D and 7.15mm, 12.60mm, -19 D for the RE and LE, respectively. Optimal fitting characteristics were found in terms of lens position and lens movement. To increase the time of MAGD CScL wear, they piggybacked on daily silicone hydrogel lenses of low power (-0.5 D). The patient reported being comfortable with this piggyback system for approximately 15h a day. After 1year of using the piggyback system, visual quality and wearing time were maintained. In addition, no adverse ocular effects were found during this period.
This case report shows that in this patient a MAGD CScL could be fitted successfully on a daily silicone hydrogel lens in a piggyback system for keratoconus management, providing good visual quality along with prolonged use times and without adverse effects on the cornea.
我们描述了一例在日抛型硅水凝胶镜片（背负式系统）上佩戴多非球面几何设计的角膜巩膜接触镜（MAGD CScL）以治疗圆锥角膜的病例。
一名48岁使用软性散光接触镜的男性，其视力质量不尽人意，需要改善。他患有双眼不对称圆锥角膜，右眼（RE）高度近视，左眼（LE）重度近视。此外，由于黄斑病变，他的左眼视力低下。给他佩戴MAGD CScL以矫正其不规则散光。在配镜过程中使用了诊断性试戴镜片组，并根据标准化的配镜方法对患者进行评估。评估了视力、角膜地形图和对比敏感度。随访期为1年。
最佳矫正视力，右眼为0.5 logMAR（-10 D/-5 D×60°），左眼为2 logMAR（-20 D/-3 D×105°）。佩戴MAGD CScL后，右眼视力显著提高至0.1 logMAR，左眼提高至1.3 logMAR，对比敏感度也有所提高。右眼和左眼的基弧、直径和屈光度的配镜参数分别为7.05mm、12.60mm、-18.50 D和7.15mm、12.60mm、-19 D。在镜片位置和镜片移动方面发现了最佳的配镜特征。为了增加MAGD CScL的佩戴时间，他们在低度数（-0.5 D）的日抛型硅水凝胶镜片上采用了背负式佩戴方式。患者报告称，这种背负式系统每天佩戴约15小时感觉舒适。使用背负式系统1年后，视力质量和佩戴时间得以维持。此外，在此期间未发现眼部不良反应。
本病例报告表明，在该患者中，MAGD CScL可以成功地佩戴在日抛型硅水凝胶镜片上，采用背负式系统用于圆锥角膜的治疗，可提供良好的视觉质量，延长使用时间，且对角膜无不良影响。
