Department of Ophthalmology, University Hospital Hassan II, BP: 1835 Atlas, avenue Hassan II, 30050 Fès, Morocco; Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaâdi University, Tangier, Morroco.
Department of Ophthalmology, University Hospital Hassan II, BP: 1835 Atlas, avenue Hassan II, 30050 Fès, Morocco; Faculty of Medicine and Pharmacy Fez, Sidi Mohammed Benabdellah University, Fez, Morocco.
J Fr Ophtalmol. 2021 Apr;44(4):549-558. doi: 10.1016/j.jfo.2020.08.016. Epub 2021 Feb 3.
To assess the improvement in visual acuity (VA), tolerance and quality of life of patients after scleral contact lens (SCL) fitting.
We carried out a prospective observational study conducted from April 2016 to August 2017. Patients fitted with SCL were included. For the purpose of this study, we analyzed VA and quality of life score (NEI-VFQ25) after 6 months of use.
We identified 98 eyes of 56 patients; the major indication for SCL fitting was keratoconus in 64.3%; the other indications were post-penetrating keratoplasty, other irregular astigmatism, severe ametropia and ocular surface disease. The mean follow-up was 10.71 months. The mean daily wearing time was 9.89±1.63 hours. Best corrected Visual acuity "BCVA" (baseline 1.11±0.37 in the right eye and 1.13±0.42 LogMar in the left eye) improved to 0.19±0.20 and 0.23±0.38 LogMar respectively in the right and left eyes after SCL wear (P=0.000). The scores on the various subscales of the NEI-VFQ 25 questionnaire were significantly higher 6 months after SCL fitting, with a mean score of 87.28±9.87 with SCL versus 39.94±11.33 without these lenses (P=0.000). In our group, no complications related to the SCL wear occurred, except for the occurrence of "loose conjunctival tissue" at the inferior limbus in one patient.
Our results complement those of several large series published on this subject. The best visual acuities were reported after correction of irregular astigmatism, in particular keratoconus. Therefore, SCL fitting has become an alternative or a precursor to penetrating keratoplasty in patients with advanced keratoconus. In the case of ocular surface disease, in addition to the improvement in VA, the comfort and recovery of the homeostasis of the ocular surface is greater, with fewer wearing complications. Hence, their inclusion in the therapeutic arsenal for severe ocular surface disease alongside the conventional treatment options.
SCL have proven their efficacy and safety in the optical correction of irregular corneas and in the management of ocular surface problems. Additional studies are needed to compare the many lenses currently available and assess optimal fitting strategies for each type of scleral lens for easier fitting procedures and better wearing comfort.
评估巩膜接触镜（SCL）适配后患者视力（VA）、耐受性和生活质量的改善情况。
我们进行了一项前瞻性观察研究，时间为 2016 年 4 月至 2017 年 8 月。纳入了适配 SCL 的患者。出于本研究的目的，我们分析了使用 6 个月后的 VA 和生活质量评分（NEI-VFQ25）。
我们共纳入了 56 名患者的 98 只眼；SCL 适配的主要适应证为圆锥角膜（64.3%）；其他适应证包括穿透性角膜移植术后、其他不规则散光、严重屈光不正和眼表疾病。平均随访时间为 10.71 个月。平均每日佩戴时间为 9.89±1.63 小时。右眼最佳矫正视力（BCVA）（基线时为 1.11±0.37 LogMAR）和左眼分别提高至 0.19±0.20 和 0.23±0.38 LogMAR（P=0.000）。在 SCL 佩戴 6 个月后，NEI-VFQ 25 问卷的各个子量表的评分显著提高，佩戴 SCL 的平均评分为 87.28±9.87，而不佩戴 SCL 的平均评分为 39.94±11.33（P=0.000）。在我们的研究组中，除了 1 例患者下睑缘出现“松弛的结膜组织”外，没有发生与 SCL 佩戴相关的并发症。
我们的结果补充了几篇关于这个主题的大型系列研究的结果。报道的最佳视力是在矫正不规则散光后，特别是圆锥角膜后获得的。因此，对于晚期圆锥角膜患者，SCL 适配已成为穿透性角膜移植术的替代或先驱。在眼表疾病的情况下，除了 VA 改善外，舒适性和眼表稳态的恢复更好，佩戴并发症更少。因此，在严重眼表疾病的治疗中，SCL 与传统治疗方案一起被纳入治疗武器库。
SCL 已被证明在不规则角膜的光学矫正和眼表问题的管理中具有疗效和安全性。需要进一步的研究来比较目前可用的多种镜片，并评估每种 SCL 的最佳适配策略，以简化适配程序并提高佩戴舒适性。
