巩膜镜治疗圆锥角膜的安全性和疗效。

Safety and Efficacy of Scleral Lenses for Keratoconus.

机构信息

Southern College of Optometry, Memphis, Tennessee.

出版信息

Optom Vis Sci. 2020 Sep;97(9):741-748. doi: 10.1097/OPX.0000000000001578.

DOI:10.1097/OPX.0000000000001578

PMID:32932400

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7547898/

Abstract

SIGNIFICANCE

This study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus.

PURPOSE

This study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population.

METHODS

A retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for ≥1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma.

RESULTS

A total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 ± 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 ± 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens-induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses (P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression.

CONCLUSIONS

Consistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.

摘要

意义

本研究证实了巩膜接触镜在圆锥角膜患者中的长期安全性和有效性。

目的

本研究旨在评估当代巩膜接触镜在圆锥角膜人群视力康复中的安全性和有效性。

方法

对 2013 年至 2018 年期间检查的圆锥角膜患者进行回顾性研究。无论年龄、性别、既往疾病或巩膜镜设计如何，均纳入研究对象。仅纳入成功佩戴巩膜接触镜≥1 年的眼。排除标准为既往角膜手术、营养不良、变性和外伤。

结果

共有 86 例患者的 157 只眼符合研究标准。初次配镜时平均角膜圆锥严重程度评分（Keratoconus Severity Score）为 3.6±1.0。镜片为透气性非开窗型，平均总直径为 15.8±0.6mm，70.1%为有散光的巩膜周边。9.6%的眼出现生理性不良反应，包括微生物性角膜炎（0.6%）、疱疹性结膜炎（0.6%）、角膜擦伤（1.3%）、接触镜诱导性急性红眼（1.3%）、角膜浸润性病变（1.3%）、翼状胬肉（1.3%）和水肿（3.2%）。55.4%的眼记录到与镜片相关的不良反应。与表面问题相关的不良反应包括：低湿润度 1.9%，处理不当 3.8%，储液雾 7.0%，镜片不耐受 7.6%，沉淀物 8.9%，镜片破裂 26.1%。最常见的管理策略包括重新配镜（54.0%的干预措施）、患者再教育（29.5%）、药物治疗（5.5%）、手术转诊（6.8%）、调整佩戴时间（2.5%）、表面处理（1.2%）和镜片更换（0.6%）。最佳矫正距离 logMAR 视力从戴眼镜时的平均 0.50 显著提高到戴巩膜镜时的平均 0.08（P<0.0001）。在研究期间，14.6%的眼失去最佳矫正巩膜镜视力，均因圆锥角膜进展所致。