巩膜镜对 LASIK 后扩张、圆锥角膜和边缘性角膜变性患者视力、屈光度和像差的影响。
The effect of scleral lenses on vision, refraction and aberrations in post-LASIK ectasia, keratoconus and pellucid marginal degeneration.
机构信息
Narayana Nethralaya, Bangalore, India.
Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.
出版信息
Ophthalmic Physiol Opt. 2021 Jul;41(4):664-672. doi: 10.1111/opo.12802. Epub 2021 Mar 26.
PURPOSE
To quantify the effect of a single scleral lens design on visual acuity and ocular higher-order aberrations in eyes with post-LASIK ectasia, keratoconus and pellucid marginal degeneration (PMD) that could not achieve satisfactory vision with spectacles or soft contact lenses.
METHODS
Forty-six eyes of 28 participants fitted with diagnostic scleral lenses (KeraCare) were analysed, including 19, 15 and 12 eyes with post-LASIK ectasia, keratoconus and PMD, respectively. Corrected distance visual acuity (CDVA) and ocular aberrations were measured prior to lens wear and during lens wear after 60 min of settling. An i-Trace aberrometer was used to determine aberrations over a 4.5 mm diameter pupil.
RESULTS
Before lens wear, the median (95% confidence interval) values across all groups were: CDVA 0.30 (0.30, 0.40) logMAR, spherical equivalent refraction -2.75 (-5.25, -2.12) D, cylindrical refraction 3.75 (2.50, 5.00) D, higher-order-root-mean-square error (HO-RMS) 0.90 (0.64, 1.03) μm and vertical coma co-efficient C(3,-1) -0.32 (-0.42, -0.12) μm. RMS coma of 0.52 (0.40, 0.74) μm was higher for the keratoconus group than for the other groups (p < 0.05). During lens wear, values improved considerably across all groups: CDVA 0.0 (0.0, 0.00) logMAR, spherical equivalent refraction -0.50 (-0.75, +0.50) D, cylindrical refraction 0.50 (0.00, 0.50) D, HO-RMS 0.32 (0.26, 0.42) μm and C(3,-1) +0.12 (+0.02, +0.19) μm (all p < 0.001 compared to pre-lens wear). While reduced significantly, RMS coma remained higher in the keratoconus group at 0.35 (0.31, 0.52) μm than in the post-LASIK ectasia and PMD groups at 0.17 (0.12, 0.21) μm and 0.07 (0.02, 0.46) μm, respectively (p < 0.05).
CONCLUSIONS
The KeraCare scleral contact lens reduced ocular aberrations and improved visual acuity in patients with post-LASIK ectasia, keratoconus and PMD. The sign of vertical coma changed in keratoconus and PMD.
目的
定量评估单一巩膜镜片设计对 LASIK 后扩张、圆锥角膜和边缘性角膜营养不良（PMD）患者的视力和眼高阶像差的影响，这些患者使用眼镜或软性隐形眼镜无法获得满意的视力。
方法
分析了 28 名参与者的 46 只眼睛，包括 19 只、15 只和 12 只 LASIK 后扩张、圆锥角膜和 PMD 眼。在佩戴镜片前和佩戴镜片 60 分钟后稳定时测量矫正远视力（CDVA）和眼像差。使用 i-Trace 像差仪测量 4.5mm 瞳孔直径的像差。
结果
在所有组中，佩戴镜片前的中位数（95%置信区间）值分别为：CDVA 0.30（0.30，0.40）logMAR，等效球镜屈光度-2.75（-5.25，-2.12）D，柱镜屈光度 3.75（2.50，5.00）D，高阶均方根误差（HO-RMS）0.90（0.64，1.03）μm 和垂直彗差系数 C（3，-1）-0.32（-0.42，-0.12）μm。与其他组相比，圆锥角膜组的 RMS 彗差（0.52（0.40，0.74）μm）更高（p<0.05）。在佩戴镜片期间，所有组的数值均显著改善：CDVA 0.0（0.0，0.00）logMAR，等效球镜屈光度-0.50（-0.75，+0.50）D，柱镜屈光度 0.50（0.00，0.50）D，HO-RMS 0.32（0.26，0.42）μm 和 C（3，-1）+0.12（+0.02，+0.19）μm（与佩戴镜片前相比，均为 p<0.001）。虽然 RMS 彗差显著降低，但圆锥角膜组仍高于 LASIK 后扩张组和 PMD 组，分别为 0.35（0.31，0.52）μm、0.17（0.12，0.21）μm 和 0.07（0.02，0.46）μm（p<0.05）。
结论
KeraCare 巩膜接触镜可降低 LASIK 后扩张、圆锥角膜和 PMD 患者的眼像差并提高视力。圆锥角膜和 PMD 的垂直彗差方向发生改变。
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