目的 探讨后表面逆几何形特殊设计透气性硬性角膜接触镜(RGDRGPCL,近似角膜塑型镜没计)矫正准分子激光原位角膜磨镶术、准分子激光屈光性角膜切削术和放射状角膜切开术术后屈光不正的可行性和有效性.方法 有针对性地选择角膜屈光手术后视力不良,残留明显屈光不正的29例患者(51眼)配戴RGDRGPCL,观察其配适状态、矫正视力、患者满意度、角膜形态变化、波前像差改变以及眼表健康状况.术后50眼球镜度-1.00～-18.75 D,散光度0.75～4.50 D.裸眼视力3.0～4.8;1眼放射状角膜切开术后义受外伤致术后无晶状体眼,+8.00 D/+6.00 D×10°,视力3.0.所有病例戴框架镜矫正视力不满意,或存在屈光参差.同时选择30只配戴角膜塑型镜的中低度近视眼作为对照组.采用Tomey Ⅳ角膜地形图,显示角膜表面30个投照环,计算每6环的平均曲率,共5区,将角膜屈光手术后和角膜塑型术后两组角膜地形图中各区的平均曲率进行比较.评价戴镜3个月后的适配状态、患者满意度以及视力和波前像差的变化.对所得数据进行独立样本t检验.结果 屈光手术后与近视眼配戴角膜塑型镜后,角膜地形图中各区参数相近[(39.24±2.09)D vs (39.27±1.23)D,(39.24±2.46)D vs(39.88±1.19)D,(40.34±2.48)D vs (41.39±1.43)D,(41.23±2.43)D vs (41.21±1.45)D,(41.02±2.36)D vs(40.50±0.79)D,两组之间各区参数的差异均尤统计学意义(P>0.05).配戴RGDRGPCL后,35眼视力可达5.0或更高.配适状态基本良好,患者自觉清晰、舒适的满意度均较高,部分显示波前像差明显降低.戴镜期间末出现明显角、结膜并发症,部分长期戴镜后可出现角膜规则塑型效果.结论 针对角膜屈光手术后视力低下,角膜中央区平坦而旁周边区陡峭的显著形变,而且利用普通框架眼镜和球面或非球面设计的RGPCL矫正困难的病例,配戴设计适宜的RGDRGPCL进行视力再矫正是一个合理、良好的选择.%Objective To determine the feasibility and efficacy of rigid gas permeable contact lenses (RGPCL) with reverse geometry design (RGDRGPCL) for correction of ametropia after laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK) and radial keratectomy (RK) surgery. Methods The changes in corneal topography were compared between patients after corneal refractive surgery and after being fitted with Ortho-K CLs for myopia. Twenty-nine patients (51 eyes) who had poor visual acuity and significant residual ametropia after corneal refractive surgery were selected to wear RGDRGPCL. The CL fitting, corrected visual acuity, patient satisfaction, changes in corneal shape, wavefront aberrations and ocular surface health were evaluated. The refractive status of 50 eyes after surgery were as follows: -1.00 to -18.75 DS and 0.75 to 4.50 DC. Unaided visual acuity was 3.0 to 4.8. One aphakic eye with post-RK and post-traumatic surgery was +8.00 D/+6.00 D×10°, Unaided visual acuity was 3.0. All patients whose visual acuity was corrected with spectacles were not satisfied or were anisometropic. Results Tomey Ⅳ corneal topography showed 30 placido rings, and the mean curvature of 6 rings (5 zones) was calculated. It showed that the parameters of each zone after surgery and Ortho-K CL wear had comparatively close values [(39.24±2.09)D vs (39.27±1.23)D;(39.24±2.46)D vs (39.88±1.19)D;(40.34±2.48)D vs (41.39±1.43)D;(41.23±2.43)vs (41.21±1.45)D;(41.02±2.36) vs (40.50±0.79)D], and the differences in each zone between the two groups were not statistically significant (P>0.05). When wearing RGDRGPCL, visual acuity achieved 5.0 or better in 35 eyes, and the fitting was good. All patients were satisfied with the clarity and comfort. Wavefront aberrations decreased significantly in some patients. There were no remarkable complications on the ocular surface. Some patients showed regular corneal reshaping after long-term RGDRGPCL wear. Conclusion In cases of lower visual acuity after corneal refractive surgery, which is difficult to correct with common spectacles and RGPCL with a spherical or aspherical design, the reverse ge-ometry design RGPCL is a reasonable selection for refractive correction because the corneal shape in these cases is flattened in the central cornea and there is steepening in the paraperipheral cornea.
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