目的 观察RGPCL矫正角膜手术后圆锥角膜和不规则散光的临床疗效和安全性.方法 回顾性病例研究.选择因角膜手术后继发圆锥角膜和不规则散光而验配RGPCL的患者29例(38眼),其中LASIK术后继发圆锥角膜12例(14眼)、LASEK术后继发圆锥角膜1例(1眼)、角膜移植术后不规则散光8例(13眼)、放射状角膜切开术后不规则散光2例(4眼)、LASIK术后不规则散光6例(6眼).在裂隙灯下进行RGPCL试戴荧光素染色评估后确定处方.采用配对￡检验对框架眼镜和RGPCL的矫正视力进行比较.患者填写主观自评表评价配戴RGPCL的舒适度和取戴、清洗镜片的难易度.结果 配戴框架眼镜最佳矫正视力≤4.2、4.3～4.4、4.5 ～4.6、4.7 ～4.8、4.9 ～5.0、＞5.0分别为5眼(13％)、5眼(13％)、8眼(21％)、10眼(26％)、10眼(26％)、0眼(0％).戴RGPCL后拥有相应程度最佳矫正视力的眼数分别为0眼(0％)、0眼(0％)、0眼(0％)、3眼(8％)、15眼(39％)、20眼(53％).配戴RGPCL最佳矫正视力好于框架眼镜(t=-4.416,P＜0.01).配戴者觉得舒适及取戴、清洁容易的分别为48％、69％、59％.随访期间未发现明显眼部并发症.结论 RGPCL矫正角膜手术后继发圆锥角膜和不规则散光的视觉效果优于框架眼镜,且无明显的并发症发生.%Objective To evaluate the clinical efficacy of rigid gas-permeable contact lenses (RGPCLs) in the treatment of keratoconus and irregular astigmatism after corneal surgery.Methods This was a prospective study.Twenty-nine patients (38 eyes) were fitted with RGPCLs.The patients included 12 with secondary keratoconus after LASIK (14 eyes) and 1 after LASEK (1 eye),8 with irregular astigmatism after corneal transplants (13 eyes),2 after ridial keratotomy surgery (4 eyes)and 6 after LASIK surgery (6 eyes).A paired t-test was used to compare best corrected visual acuity (BCVA) with spectacles and RGPCLs.Patients filled out a subjective assessment questionnaire for evaluating RGPCLs for comfort and ease of cleaning.Results BCVA was ≤4.2 (5 eyes,13％),4.3～4.4 (5 eyes,13％),4.5～4.6 (8 eyes,21％),4.7～4.8 (10 eyes,26％),4.9～5.0 (10 eyes,26％) and 0 eye (0％) was ＞5.0 with spectacles.BCVA with RGPCLs was 0 eye (0％),0 eye (0％),0 eye (0％),3 eyes (8％),15 eyes (39％) and 20 eyes (53％).The average BCVA was better with RGPCLs than with spectacles (t=-4.416,P＜0.01).No serious complications occurred during the follow-up period.Patients reported wearing the lenses feeling comfortable (48％),easy to wear and pick out lenses (69％) and easy to clean (59％).Conclusion The RGPCL was significantly more effective than spectacles for secondary kerotoconus and irregular astigmatism after corneal surgery.And RGPCLs were safe to wear.
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