HL-K硬性透气性角膜接触镜在圆锥角膜矫治中的应用

摘要

Objective To observe the clinical efficacy of rigid gaspermeable contact lens (RGPCL) for correcting keratoconus and analyze the predictors for the base curve of RGPCL.Methods Data of 86 patients (143 eyes) with keratoconus fitted with RGPCL were retrospectively analyzed.All eyes were divided into the mild (n =18 eyes),moderate (n =73 eyes),advanced (n =34 eyes) and severe group (n =18 eyes).After evaluating the lens fitting,best corrected visual acuity of eyes wearing spectacle lenses and RGPCL among the 4 groups was statistically compared.And the correlation between the fitting guidance index and HL-K RGPCL base curve in each group was analyzed according to keratometry.Results All patients wearing RGPCL gained significantly better corrected vision in the mild (t =-3.336,P =0.004),moderate (t =-11.213,P ＜0.001),advanced (t =-13.959,P ＜0.001) and severe groups(t =-11.047,P ＜0.001) than those with spectacles.Equivalent spherical degree of spectacle lenses was lower than the diopter of HL-K RGPCL in the moderate (P =0.043) and severe group (P =0.006).The mean base curve of RGPCL was (50.52 ±5.64) diopter,and it was correlated with corneal curvature parameters.In mild group,the RGPCL base curve was correlated with the steep keratometry (P ＜ 0.001).The average K and relative steep K of 0.2 mm (Rm-0.2) were highly correlated with RGPCL base curve in moderate group (r =0.798,P ＜ 0.001;r =0.798,P ＜ 0.001),in advanced group (r =0.745,P ＜ 0.001;r =0.745,P ＜ 0.001) and in severe group (r =0.616,P =0.007;r =0.617,P =0.006).Conclusion Patients with keratoconus wearing HL-K RGPCL can obtain ideal corrected vision.Determination of RGPCL base curve by adjusting the corresponding indicators is conducive to improving the long-term wearing safety of the lens and enhancing the efficiency of lens fitting.%目的 探讨HL-K硬性透气性角膜接触镜(rigid gas permeable contact lens,RGPCL)在圆锥角膜矫治中的有效性并分析其原因.方法 回顾性分析圆锥角膜患者验配HL-K RGPCL 86例(143眼),按相关标准分为轻度组(18眼)、中度组(73眼)、重度组(34眼)和极重度组(18眼).评估镜片配适状态,比较各组内框架眼镜和HL-K RGPCL最佳矫正视力,并根据角膜曲率等因素分析各组内验配指导性指标与HL-K RGPCL基弧的关联.结果 各组患者最佳矫正视力比较,轻度组(P=0.004)、中度组(P＜0.001)、重度组(P＜0.001)和极重度组(P＜0.001) HL-K RGPCL最佳矫正视力均高于框架眼镜.框架眼镜等效球镜度低于中度组(P=0.043)和重度组(P=0.006) HL-K RGPCL屈光度.HL-K RGPCL基弧K值为(50.52±5.64)D,HL-K RGPCL基弧与角膜曲率的多项参数具有相关性,其中轻度组HL-K RGPCL基弧与角膜曲率陡K值具有正相关性(P＜0.001),中、重和极重度组HL-KRGPCL基弧与角膜曲率平均K值及起始试戴基弧Rm-0.2 mm相对应K值正相关性最强:中度组(r=0.798,P＜0.001;r=0.798,P＜0.001),重度组(r=0.745,P＜0.001;r=0.745,P＜0.001),极重度组(r=0.616,P=0.007;r =0.617,P=0.006).结论 圆锥角膜患者配戴HL-K RGPCL可以获得满意的矫正视力,依据病变程度通过配适评估对相应指标动态调整以确定HL-K RGPCL基弧的过程,有利于提高长期配戴镜片安全性,提高验配效率.