Mushtaq Adeel, Alvi Isaamuddin
Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, GBR.
Trauma and Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR.
Cureus. 2025 Jan 7;17(1):e77102. doi: 10.7759/cureus.77102. eCollection 2025 Jan.
This systematic review evaluates the long-term effectiveness of scleral lenses in improving visual outcomes, patient satisfaction, and safety in patients with keratoconus. A systematic search of six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and MEDLINE) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria included studies with more than or equal to three months of follow-up, included a minimum of 20 keratoconus patients, published after year 2020 and outcomes reporting visual acuity, comfort or quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Murad et al. case series tool. Five studies (463 eyes) met the inclusion criteria. Scleral lenses consistently improved best-corrected visual acuity (BCVA) across studies, with visual gains from baseline logMAR 0.50-0.53 to post-treatment logMAR 0.08-0.09. Significant improvements in vision-related quality of life (National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores) were observed in validated assessments. Complications were infrequently reported but included lens handling issues (10.4%-63%), fogging (58%), and physiological events (e.g., corneal epitheliopathy). Long-term follow-up indicated that 14.6% of the patients experienced worsening visual acuity due to keratoconus progression. Methodological quality was variable, with limitations including variable outcome reporting and limited follow-up duration. Scleral lenses provide substantial and sustained improvements in visual acuity and quality of life for keratoconus patients, particularly those with advanced disease. However, the evidence is limited by methodological shortcomings and a lack of long-term controlled studies. Future research should prioritise randomised trials with standardised reporting and longer follow-up to better assess complications and durability of outcomes.
本系统评价评估了巩膜镜在改善圆锥角膜患者视觉效果、患者满意度及安全性方面的长期有效性。按照系统评价与Meta分析的首选报告项目（PRISMA）指南，对六个数据库（PubMed、Embase、Web of Science、Scopus、Cochrane图书馆和MEDLINE）进行了系统检索。纳入标准包括随访时间不少于三个月、至少纳入20例圆锥角膜患者、2020年后发表且报告视力、舒适度或生活质量结果的研究。采用纽卡斯尔-渥太华量表和穆拉德等人的病例系列工具评估方法学质量。五项研究（463只眼）符合纳入标准。在各项研究中，巩膜镜均持续改善了最佳矫正视力（BCVA），视力从基线的logMAR 0.50 - 0.53提高至治疗后的logMAR 0.08 - 0.09。在经过验证的评估中，观察到与视力相关的生活质量（美国国立眼科研究所视觉功能问卷（NEI-VFQ）评分）有显著改善。并发症报告较少，但包括镜片操作问题（10.4% - 63%）、起雾（58%）和生理事件（如角膜上皮病变）。长期随访表明，14.6%的患者因圆锥角膜进展而视力恶化。方法学质量参差不齐，局限性包括结果报告不一致和随访时间有限。巩膜镜为圆锥角膜患者，尤其是晚期患者的视力和生活质量提供了显著且持续的改善。然而，证据受到方法学缺陷和缺乏长期对照研究的限制。未来的研究应优先进行标准化报告和更长随访时间的随机试验，以更好地评估并发症和结果的持久性。
