Richter Kathrin, Jullien Theresia, Klühspies Ulrike, Langenbucher Achim, Seitz Berthold, Eppig Timo
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar.
Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar.
Klin Monbl Augenheilkd. 2022 Sep;239(9):1155-1163. doi: 10.1055/a-1526-9861. Epub 2021 Nov 3.
Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes.
This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting.
The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting.
The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.
如今，圆锥角膜（KC）能够以分阶段的方式得到很好的治疗。有多种设计和材料的隐形眼镜（CL）可用于治疗圆锥角膜。本研究的目的是评估在圆锥角膜眼中进行镜片验配的可能性、可能面临的挑战以及视觉效果。
这项回顾性研究纳入了2006年至2016年间在我们的隐形眼镜服务中心接受镜片验配试验的200例患者的数据。我们记录了眼科参数、所开具的隐形眼镜类型、所需试验镜片的数量以及镜片验配失败的可能原因。
初次镜片验配时的平均年龄为33.9±12.5岁。在98.8%的病例中，验配使用的是硬性透气性镜片，90.1%使用的是四曲面镜片。在所开具的非球面镜片总数中，87.5%是在圆锥角膜“1”至“2”期（地形图圆锥角膜分类；Oculus Keratograph）验配的。后表面环曲面镜片或双环曲面镜片在圆锥角膜“2 - 3”至“4”期的验配中占61.7%。在患者获得最终的隐形眼镜之前，所需试验镜片的中位数为2片（最多16片）。初次验配时镜片矫正后的平均视力为0.8±0.2，眼镜矫正后的平均视力为0.5±0.3。在7.7%的眼中，由于圆锥角膜病情进展到晚期需要进行角膜移植而停止了圆锥角膜镜片验配。停止隐形眼镜验配的原因包括镜片不耐受（2.3%）、佩戴问题（0.3%）或急性角膜水肿（0.3%）。在镜片验配后的后续过程中，因不匹配或佩戴问题而停止佩戴隐形眼镜的情况仅发生了4例（1.1%）。
隐形眼镜的使用是圆锥角膜分阶段恰当治疗的一个组成部分。在圆锥角膜的各个阶段都能获得良好的视力，且退出率较低。在大多数情况下，调整是使用具有四曲面几何形状的硬性透气性镜片进行的。在初始阶段，非球面镜片可能就足够了。当旋转对称镜片无法获得满意的适配效果时，在晚期阶段可以验配环曲面镜片。如果隐形眼镜成功验配，只有少数患者会因不耐受而放弃佩戴隐形眼镜。
