临床评估不同类型隐形眼镜在圆锥角膜管理中的应用。

Clinical evaluation of different types of contact lenses in keratoconus management.

机构信息

Yıldırım Beyazıt University, Ankara Atatürk Training and Research Hospital, Ophthalmology Department, Üniversiteler Mahallesi Bilkent Caddesi No: 1, Ankara, Turkey.

出版信息

Cont Lens Anterior Eye. 2019 Oct;42(5):482-486. doi: 10.1016/j.clae.2019.02.013. Epub 2019 Feb 23.

DOI:10.1016/j.clae.2019.02.013

PMID:30808595

Abstract

PURPOSE

To compare the clinical and topographical findings of the keratoconus patients according to the prescribed contact lens type and to investigate the effects of corneal collagen cross-linking (CXL) and cone location on lens selection.

METHODS

The records of 301 eyes of 195 keratoconus patients who were prescribed contact lenses were analyzed retrospectively. The eyes were grouped according to the lens type: Soft toric contact lens (STCL), rigid gas-permeable contact lens (RGPCL), hybrid contact lens (HCL) and mini-scleral contact lens (MSCL). The history of having CXL, ophthalmological examination findings, and the topographical findings were compared between the groups. Brown-Forsythe, Chi-square, and post-hoc tests were used to compare the groups. Mann-Whitney U test was used for subgroup analysis. Comparison of the lens-corrected visual acuity (LCVA) and spectacle-corrected visual acuity (SCVA) levels was made with Wilcoxon signed-ranks test.

RESULTS

There was no significant difference between the groups regarding topographical cone location, CXL history, spherical refraction, and LCVA. The difference between spectacle-corrected visual acuity and LCVA was higher in RGPCL and MSCL groups than STCL group (p=0.01). Keratometry of RGPCL and MSCL groups were higher than STCL and HCL groups (p=0.01, p<0.001). In RGPCL group, eyes with central cones had a higher increase in visual acuity with contact lenses compared to eyes with paracentral cones (p=0.043). STCL and MSCL were mostly prescribed in mild and severe keratoconic eyes, respectively. In RGPCL group, the increase in visual acuity with contact lens was higher in eyes treated with CXL (p= <0.01).

CONCLUSIONS

While STCL and HCL were mostly prescribed in mild keratoconus, RGPCL and MSCL were selected for moderate or advanced disease. If appropriately chosen, all types of contact lenses could result in a good visual acuity level. CXL history did not affect the prescribed lens type. Having central cone location and CXL history in RGPCL group improved visual acuity more efficiently.

摘要

目的

根据所开处方接触镜的类型比较圆锥角膜患者的临床和地形学发现，并研究角膜交联（CXL）和圆锥位置对镜片选择的影响。

方法

回顾性分析了 195 例圆锥角膜患者 301 只眼的接触镜处方记录。根据镜片类型将这些眼分为：软式透氧性角膜接触镜（STCL）、硬性透气性角膜接触镜（RGPCL）、混合式接触镜（HCL）和迷你巩膜接触镜（MSCL）。比较组间 CXL 史、眼科检查结果和地形学发现。使用 Brown-Forsythe、卡方和事后检验比较组间差异。Mann-Whitney U 检验用于亚组分析。采用 Wilcoxon 符号秩检验比较镜片矫正视力（LCVA）和眼镜矫正视力（SCVA）水平。

结果

各组间地形学圆锥位置、CXL 史、球镜屈光度和 LCVA 无显著差异。RGPCL 和 MSCL 组的 SCVA 和 LCVA 差值高于 STCL 组（p=0.01）。RGPCL 和 MSCL 组的角膜曲率计值高于 STCL 和 HCL 组（p=0.01，p<0.001）。在 RGPCL 组中，中央圆锥眼的接触镜视力提高幅度高于旁中央圆锥眼（p=0.043）。STCL 和 MSCL 分别主要用于轻、重度圆锥角膜眼。在 RGPCL 组中，接受 CXL 治疗的眼使用接触镜后的视力提高幅度更高（p<0.01）。