Massin M, Denis-Morère A, Ninine G
Klin Monbl Augenheilkd. 1976 Jan;168(1):24-32.
This work is a survey of 82 cases of keratoconus which have been followed up for 1 to 12 years. Among them only 66 were fitted with contact lenses. The contra-indications for them are: 1. a better visual acuity with spectacles than with contact lenses, 2. advanced cases (4th degree of Amsler) whose fitting is impossible, 3. unilateral keratoconus, 4. associated diseases such as trachomatous pannus, allergic kerato-conjunctivitis. Hard corneal lenses are now in use in most of the cases. Scleral lenses are much less used than they were 10 years ago, owing probably to the great improvement of the corneal lenses during this time. These hard corneal lenses have a short Ro (4 to 7 mm), an overall diameter between 8 and 11 mm, and an optic diameter of 5 mm. They are fitted under fluorescein control. The mobility must be good too. One case was fitted with soft lenses. The visual acuity is good and so is the tolerance: 80% of the patients wear their lenses 10 hours a day or more. Contact lenses do not affect the progression of keratoconus thus finally a keratoplasty must be performed in many cases. After the operation a contact lens is very often necessary, but its daily wearing time must be divided by two, to avoid corneal neo-vascularisation. Soft corneal lenses may be used in some cases of keratoconus. They are indicated when the hard lenses are no longer tolerated and before a keratoplasty. The base curves of these soft lenses are not related to the radii of the conic cornea. In most of the cases they are between 7.50 and 8.60 mm. The diameter is large: 14 or 15 mm. The lenses must not move too much: 1 mm up or down when the patient blinks. The edge of the lens must not depress the bulbar conjunctiva and there must be no air bubble under the lens. In many cases a cylindrical spectacle lens is necessary to obtain a good visual acuity. Some authors prefer to fit a hard corneal lens over the soft one: this is the "piggy back" method. Sometimes keratoconus has appeared in patients already fitted during several years to correct a myopic astigmatism. It is not clear whether these keratoconus have been produced or not be the contact lenses.
这项研究对82例圆锥角膜患者进行了为期1至12年的随访。其中只有66例佩戴了隐形眼镜。其禁忌证包括：1. 戴框架眼镜视力优于戴隐形眼镜；2. 晚期病例（阿姆斯勒4级）无法佩戴；3. 单侧圆锥角膜；4. 伴有沙眼性血管翳、过敏性角结膜炎等相关疾病。目前大多数病例使用硬性角膜接触镜。巩膜接触镜的使用比10年前少得多，这可能是因为在此期间角膜接触镜有了很大改进。这些硬性角膜接触镜的Ro较短（4至7毫米），总直径在8至11毫米之间，光学直径为5毫米。它们在荧光素控制下佩戴。活动度也必须良好。有1例佩戴了软性接触镜。视力良好，耐受性也不错：80%的患者每天佩戴镜片10小时或更长时间。隐形眼镜不会影响圆锥角膜的进展，因此在许多情况下最终必须进行角膜移植术。手术后通常需要佩戴隐形眼镜，但每天佩戴时间必须减半，以避免角膜新生血管形成。软性角膜接触镜可用于某些圆锥角膜病例。当硬性接触镜不再耐受时以及在角膜移植术前可使用。这些软性接触镜的基弧与圆锥角膜的半径无关。在大多数情况下，它们在7.50至8.60毫米之间。直径较大：14或15毫米。镜片移动不能过多：患者眨眼时上下移动1毫米。镜片边缘不得压迫球结膜，镜片下不得有气泡。在许多情况下，需要佩戴柱面框架眼镜以获得良好视力。一些作者更喜欢在软性接触镜上佩戴硬性角膜接触镜：这就是“背驮式”方法。有时，在已经佩戴多年以矫正近视散光的患者中会出现圆锥角膜。尚不清楚这些圆锥角膜是否由隐形眼镜引起。
