圆锥角膜患者配戴RGPCL前后视觉相关生活质量的比较

目的：探讨配戴硬性透气性角膜接触镜（RGPCL）对原发性和继发性圆锥角膜患者生活质量的影响。方法：前瞻性研究。选取温州医科大学附属眼视光医院门诊部2014 年7月至2016 年10 月间验配RGPCL的患者，在验配前测得患者配戴框架眼镜的单眼最佳矫正视力，采用生活质量量表（VF-QOL）问卷自我打分，在配戴RGPCL 1个月后复查患者的戴镜视力，并且再次使用VF-QOL问卷自我打分。数据采用中位数（最小值～最大值）表示，配戴RGPCL前后各数据比较使用Wilcoxon秩和检验。结果：最终收集圆锥角患者70例（137眼），配戴RGPCL前双眼中视力较好眼的视力为4.8（4.0～5.0），配戴后为5.0（4.8～5.1）。配戴RGPCL前双眼中视力较差眼的视力为4.5（4.0～4.9），配戴后为4.9（4.0～5.1）；配戴RGPCL前后较好眼、较差眼视力比较差异均有统计学意义（Z=5.92、6.28，P < 0.001）。配戴RGPCL前视功能维度分值为27（ 12～48），配戴后为19（ 12～30），配戴前后差异具有统计学意义（Z=6.64，P < 0.001）。配戴RGPCL前自理、活动、社交、心理4个方面的分值中位数分别为4、4、4、5，配戴后分别为4、3、2、4，配戴前后比较差异均有统计学意义（Z=3.74、5.18、5.20、4.98，P < 0.001）。结论：VF-QOL问卷分析表明配戴RGPCL可以提高圆锥角膜患者的视功能同时也提升了患者的生活质量。

Comparison of Vison-Related Quality of Life before and after Fitting Keratoconic Patients with RGPCLs

Objective: To estimate the impact of rigid gas-permeable contact lenses (RGPCLs) on the vision-related quality of life (VR-QOL) of keratoconic patients as assessed by the visual function quality of life questionnaire (VF-QOL). Methods: This prospective study recruited 70 keratoconus patients from the Eye Hospital,Wenzhou Medical University who were fitted with RGPCLs between July 2014 and October 2016. Before fitting each patient for RGPCLs, the best spectacle corrected visual acuity (BSCVA) and self-reported results using VF-QOL questionnaire were determined. After wearing the lenses for 1 month, the visual acuity of each patient was measured while wearing the contact lenses (RGPCLVA) and the VR-QOL was again assessed. BSCVA and RGPCLVA were compared, and the VR-QOL, assessed by self-care,daily-activities, social function, and mental health, were compared by the Wilcoxon signed-ranked test. Results: The median BSCVA of the better eye of each patient before lens fitting was 4.8 (range, 4.0 to 5.0). After one month of lens wear, the RGPCLVA increased to 5.0 (range, 4.8 to 5.1). The median BSVCA of the worse eye of each patient before lens fitting was 4.5 (range, 4.0 to 4.9). After one month of lens wear, the RGPCLVA increased to 4.9 (range, 4.0 to 5.1). The differences in visual acuity before and after one month of RGPCLs wear in the better eyes and in the worse eyes were each significant (Z=5.92, 6.28, respectively, P<0.001 for each). The median of the 12 items in the visual function questionnaire befor fitting RGPCLs was 27 (range, 12 to 48). After one month of RGPCLs wear, the median decreased to 19(range, 12 to 30). There was a significant difference in visual function from before and after wearing the RGPCLs (Z=6.64, P<0.001). VF-QOL included self-care, daily activities, social function, and mental health. The median scores for abilities were 4, 4, 4, and 5 respectively. After wearing RGPCLs for one month, the median scores were 4, 3, 2, and 4 respectively. The differences of score for each ability from before and after wearing RGPCLs were statistically significant (Z=3.74, 5.18, 5.20, 4.98, P<0.001 for each). Conclusions: RGPCLs not only contribute to increased visual acuity for keratoconic patients, but also improve vision-related quality of life.