软性角膜接触镜与透气性硬性角膜接触镜对像差的影响

目的 分析配戴软性角膜接触镜、透气性硬性角膜接触镜（rigid gas-permeable contact lens,RGP）患者波前像差及角膜地形图在配戴前后的变化,探讨角膜接触镜对人眼屈光系统成像质量的影响.设计前瞻性随机对照临床研究.研究对象近视眼患者41例（80眼）.方法 软镜组20例（40眼）配戴软性角膜接触镜,RGP组21例（40眼）配戴RGP镜片,患者治疗前后作角膜地形图及波前像差检查,随访观察12个月.主要指标观察配戴接触镜治疗前后角膜地形图及波前像差的变化.结果 软镜组患者治疗后角膜表面规则指数（surface regularityindex,SRI）及角膜表面非对称指数（surface asymne-tryindex,SAI）有所增加,而RGP组SRI及SAI轻度下降;戴镜条件下,两组的整体波前像差（软镜组：0.58;RGP组：0.91）均低于治疗前裸眼的整体波前像差（软镜组：0.71;RGP组：1.21）;配戴后裸眼条件下,RGP组整体像差低于治疗前,且以低阶像差下降为主,而软镜组整体像差高于治疗前,各阶像差呈均匀上升趋势.结论 良好配适状态下的角膜接触镜均可使像差减小,使患者获得优质的光学矫正.     

硬性透气性接触镜停戴后角膜前表面像差变化分析

目的 通过对角膜前表面波阵面的测量,研究配戴RGPCL及停戴之后角膜前表面的形态变化.方法 临床观察.使用客观波阵面仪测量30人(60只眼)在配戴RGPCL之前及停戴之后的30 min及1、3、7、14 d后的角膜前表面像差,并进行各时间点的对照分析.对停戴后各时间点、各像差项及各组间进行方差分析、配对t检验.结果 配戴RGPCL前、停戴后30 min及1、3、7、14 d时配戴者双眼角膜前表面7阶32项Zernike像差均方根值分别为1.438±0.328,1.076±0.355、1.362±0.402、1.373±0.398、1.387±0.415及1.448±0.423.其中停戴30 min时,2阶、3阶像差几乎全部改变(Z3、Z4、Z5、Z6、Z7、Z8),4阶中的四叶草(quadrafoil Z10)和球差(spherical Z12)2项改变,这些改变中除Z8、Z9、Z10增大外,其余均为减少.停戴后1 d相比配戴前,Z5、Z6减少,Z12比戴前有所增加(F=2.869～5.549,P=0.001～0.042).停戴后3 d,Z5、Z6依然比配戴前减少,而Z9和Z10又再次出现增加,Z12恢复到配戴前水平.停戴7 d后,只有Z6和Z9略有改变,其余均恢复至配戴前.停戴14 d时各阶像差与配戴前已无变化(F=0.018～1.876,P=0.154～0.650).结论 配戴RGPCL能显著减少角膜前表面总像差,这种改变在停戴后30 min最为明显,随着停戴时间延长慢慢减少,低阶像差基本都在较短时间内恢复戴前水平,在恢复过程中可能会产生一过性的高阶像差,但所有改变均在停戴2周内停止.

Abstract：

Objective The present study used a corneal topographic device to record aberrations on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGPCL on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction. Methods The study objects were 60 eyes from 30 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry & corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses every day for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 min, 1 day, 3 days, 1 week, and 2 weeks following use. Results Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results are as follows; root mean square (RMS) (pre) = (1.438 ±0.328), RMS (30 min) = (1.076 ± 0.355), RMS (1 day) = (1.362 ± 0.402) , RMS (3 day) =(1.373 ± 0.398), RMS (7 day) = (1.387 ± 0.415), and RMS (14 day) = (1.448 ± 0.423) .Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2nd-and 3rd-order aberrations were altered. Quadrafoil Z10 and spherical Z12 of the 4th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant compared with the time period prior to RGP use: Z5 and Z6 decreased, and Z12 increased slightly( F =2. 869 ～5. 549 ,P =0. 001 ～0. 042). Z5 and Z6remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use ( P ＞ 0. 05 ). At 2 weeks after discontinued use, all aberrations were not significantly different from the values prior to use ( P ＞ 0. 05). Conclusions The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2nd- and 3rd-order aberrations ( including Z3, Z4, Z5, Z6, Z7, and Z8 ) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 2 weeks after discontinued use of RGP contact lenses.     

硬性透气性接触镜停戴后角膜前表面像差变化分析

Objective The present study used a corneal topographic device to record aberrations on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGPCL on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction. Methods The study objects were 60 eyes from 30 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry & corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses every day for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 min, 1 day, 3 days, 1 week, and 2 weeks following use. Results Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results are as follows; root mean square (RMS) (pre) = (1.438 ±0.328), RMS (30 min) = (1.076 ± 0.355), RMS (1 day) = (1.362 ± 0.402) , RMS (3 day) =(1.373 ± 0.398), RMS (7 day) = (1.387 ± 0.415), and RMS (14 day) = (1.448 ± 0.423) .Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2nd-and 3rd-order aberrations were altered. Quadrafoil Z10 and spherical Z12 of the 4th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant compared with the time period prior to RGP use: Z5 and Z6 decreased, and Z12 increased slightly( F =2. 869 ～5. 549 ,P =0. 001 ～0. 042). Z5 and Z6remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use ( P ＞ 0. 05 ). At 2 weeks after discontinued use, all aberrations were not significantly different from the values prior to use ( P ＞ 0. 05). Conclusions The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2nd- and 3rd-order aberrations ( including Z3, Z4, Z5, Z6, Z7, and Z8 ) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 2 weeks after discontinued use of RGP contact lenses.     

硬性透气性接触镜停戴后角膜前表面像差变化分析

Objective The present study used a corneal topographic device to record aberrations on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGPCL on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction. Methods The study objects were 60 eyes from 30 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry & corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses every day for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 min, 1 day, 3 days, 1 week, and 2 weeks following use. Results Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results are as follows; root mean square (RMS) (pre) = (1.438 ±0.328), RMS (30 min) = (1.076 ± 0.355), RMS (1 day) = (1.362 ± 0.402) , RMS (3 day) =(1.373 ± 0.398), RMS (7 day) = (1.387 ± 0.415), and RMS (14 day) = (1.448 ± 0.423) .Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2nd-and 3rd-order aberrations were altered. Quadrafoil Z10 and spherical Z12 of the 4th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant compared with the time period prior to RGP use: Z5 and Z6 decreased, and Z12 increased slightly( F =2. 869 ～5. 549 ,P =0. 001 ～0. 042). Z5 and Z6remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use ( P ＞ 0. 05 ). At 2 weeks after discontinued use, all aberrations were not significantly different from the values prior to use ( P ＞ 0. 05). Conclusions The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2nd- and 3rd-order aberrations ( including Z3, Z4, Z5, Z6, Z7, and Z8 ) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 2 weeks after discontinued use of RGP contact lenses.     

硬性透气性角膜接触镜与软性角膜接触镜对中低度近视患者角膜形态的影响

目的　探讨屈光不正患者长期配戴软性角膜接触镜（soft contact lens,SCL）和硬性透气性角膜接触镜（rigid gas permeable contact lense,RGPCL）对角膜形态参数的影响。方法　收集视光学中心验配角膜接触镜的屈光不正患者60例(120眼),按照患者配戴SCL或RGPCL分为SCL组和RGPCL组（两组均为30例60眼）,在戴镜前及戴镜后1 a、2 a测量2组患者中央角膜厚度、内皮细胞密度、六角形细胞比例及变异系数,并对2组数据进行对比。结果　SCL组:戴镜后2 a,中央角膜厚度(509±31)μm较戴镜前(549±26)μm明显下降（P<0.05）;角膜内皮细胞密度为(2819.3±169.2）个·mm^-2,较戴镜前密度(3182.6±162.3）个·mm^-2减少;六角形细胞比例（51.52±4.69）%较戴镜前（61.45±4.58）%降低（P<0.05）;内皮细胞变异系数（39.14±3.15）较戴镜前（33.47±2.83）增加（P<0.05）。RGPCL组戴镜前后中央角膜厚度、角膜内皮细胞密度、六角形细胞比例及内皮细胞变异系数比较,差异均无统计学意义（均为P>0.05）。结论　与配戴SCL相比,配戴RGPCL对屈光不正患者的角膜形态和功能影响不明显,更适合长期配戴。     

配戴球面与非球面设计硬性透气性角膜接触镜时全眼像差的比较

目的通过波前像差仪测量球面与非球面硬性透气性角膜接触镜（RGPCL）对全眼像差的影响。方法24例（48眼）近视患者,随机分成两组,每组12例,按照两阶段交叉设计：一组先配戴美康镜片（球面设计）,另一组先配戴美尼康镜片（非球面设计）,日戴1个月后测量戴镜时的全眼像差,之后停戴1个月,更换另一种镜片继续日戴1个月后再次测量戴镜时的像差。对配戴两种镜片时的像差值进行交叉设计的方差分析。结果配戴两种不同设计的镜片时,全眼总像差均方根（RMS）值分别为（0．439±0．183）μm和（0．42714）．190）μm,差异无统计学意义。配戴两种不同设计的镜片时,单项像差中离焦（F=56．175,P〈0．01）、垂直散光（F=4．263,P=0．029）和四叶草（F=3．410,P=0．037）的差异有统计学意义,其中配戴美尼康镜片的离焦数值高于美康,垂直散光、四叶草反之。其他各项像差值在两种镜片中差异无统计学意义。结论近视眼配戴球面及非球面设计的RGPCL时的像差值无显著差异,但非球面镜片形成的“偏负泪液镜”可造成更多的正性离焦,同时,非球面设计镜片相对球面镜片可更好地控制散光及某些高阶像差。     

不同角膜接触镜对人眼Zernike像差的影响

背景 以往研究分析了角膜接触镜配戴产生的像差变化,但这些变化发生的机制仍不明确.完整理解镜-眼系统引起的波前像差变化原因是进一步改良角膜接触镜的设计、提高视觉矫正质量的基础.目的 通过分析近视患者配戴角膜接触镜状态下的Zernike像差,研究角膜接触镜对人眼光学特性的影响.方法 纳入双眼为近视状态的26例志愿者52眼,等效球镜屈光力为-1.75～-8.50 D,使用WASCA波前像差分析仪分别测量受试眼在未矫正状态、硬性透氧性角膜接触镜(RGP-CL)状态及软性角膜接触镜(Soft-CL)状态的人眼像差.采用重复测量单因素方差分析法比较3种状态下人眼波前像差及Zernike系数间的差异性,采用Pearson相关分析法分析受试眼未矫正状态下各像差与RGP-CL矫正状态或Soft-CL矫正状态下像差变化的关系、未矫正状态下各像差与RGP-CL矫正状态或Soft-CL矫正状态下双眼像差的关系及3种状态下双眼间像差变化的关系. 结果 在未矫正状态、RGP-CL矫正状态下及Soft-CL矫正状态下整眼像差的均方根值(RMS)分别为(0.71±0.30)、(0.54±0.19)、(0.74±0.32) μm,总体比较差异有统计学意义(F=8.758,P＜0.001).RGP-CL矫正状态下的整眼像差RMS明显低于未矫正状态,差异有统计学意义(t=2.746,P=0.008),Soft-CL矫正状态下的整眼像差RMS与未矫正状态相比差异无统计学意义(t=0.631,P=0.531),RGP-CL矫正状态下的整眼像差RMS显著低于Soft-CL矫正状态,差异有统计学意义(t=3.428,P=0.001).未矫正状态、RGP-CL矫正状态及Soft-CL矫正状态下的3～7阶高阶像差RMS分别为(0.34±0.12)、(0.28±0.12)、(0.40±0.14)μm,差异有统计学意义(F=10.681,P＜0.001).与未矫正状态相比,RGP-CL矫正状态下的高阶像差RMS略下降,差异无统计学意义(t=1.987,P=0.053),Soft-CL矫正状态下的高阶像差RMS明显高于未矫正状态,差异有统计学意义(t=2.101,P=0.041);RGP-CL矫正状态下的高阶像差RMS显著低于Soft-CL矫正状态,差异有统计学意义(t=4.266,P＜0.001).与未矫正状态相比,RGP-CL矫正状态的主轴散光(C5)和球差(C12)、Soft-CL矫正状态的球差(C12)均明显降低,差异均有统计学意义(P＜0.05).与未矫正状态相比,RGP-CL矫正的三叶草像差(C6)、垂直彗差(C7)和四叶草像差(CL0)的平均绝对值显著降低,而Soft-CL矫正状态垂直彗差(C7)的平均绝对值显著增加,差异均有统计学意义(P＜0.05).未矫正状态与RGP-CL矫正状态下球差(C12)的正相关性最显著(r=0.763,P＜0.001),与Soft-CL矫正状态下二阶散光(C11)的相关性最低(r=0.469,P＜0.001). 结论 RGP-CL配戴和Soft-CL配戴与角膜产生的相互作用不同,因此对人眼像差结构的影响不同.RGP-CL矫正可能基于对角膜表面形态的影响而减弱了双眼像差的双侧对称性,因此对人眼像差的改变最大,而Soft-CL矫正改变了人眼的高阶像差.     

配戴单焦点与多焦点硬性角膜接触镜近视患者视觉质量对比分析

目的　探讨多焦点设计的硬性角膜接触镜对近视患者视觉质量的影响。方法　选取川北医学院近视学生15例（30眼）,分别定制单焦点硬性角膜接触镜（SVRGP）与多焦点硬性角膜接触镜（MFRGP）。受试者先配戴SVRGP,停戴一周后配戴MFRGP,每种镜片配戴两周后分别进行视力、对比敏感度、波前像差、光学函数和散射检查,并完成主观视觉质量调查问卷。采用配对t检验比较受试者配戴两种镜片两周后视觉质量的差异。结果　配戴两种镜片后受试者最佳矫正视力差异无统计学意义（P=0.268)。在3 cpd、6 cpd、12 cpd空间频率下,配戴两种镜片后受试者对比敏感度差异均无统计学意义（均为P>0.05);在18 cpd空间频率下,配戴MFRGP后对比敏感度较配戴SVRGP后下降,差异有统计学意义（P=0.015）。配戴MFRGP后受试者角膜总高阶像差、球差、彗差、三叶草像差均较配戴SVRGP后增加,差异均有统计学意义（均为P<0.05）。配戴MFRGP后受试者客观散射指数较配戴SVRGP后增大,差异有统计学意义（P<0.001）;4 mm和6 mm瞳孔直径下,配戴两种镜片后受试者调制传递函数截止频率、斯特列尔比和3种模拟对比度视力（OV100%、OV20%、OV9%）差异均无统计学意义（均为P>0.05)。主观视觉质量问卷调查中,配戴两种镜片后受试者视觉清晰度、白天视力波动、近视力、远视力、对矫正视力的满意度5个项目评分差异均无统计学意义（均为P>0.05);配戴MFRGP后受试者眩光、症状2个项目评分较配戴SVRGP后下降,差异均有统计学意义（均为P<0.05）。结论　MFRGP可以为近视患者提供良好的矫正视力、对比敏感度和光学函数,但患者的高阶像差、散射和眩光有所增加。     

硬性透气性接触镜对角膜曲率的影响

目的 研究配戴硬性透气性接触镜(RGPCL)患者角膜曲率的变化.方法 随机选取2004年6月至8月来我院视光门诊配戴RGPCL的患者23例(46只眼),并随访12个月,比较12个月前后角膜曲率的变化.采用SAS9.01 t检验进行统计学处理,P＜0.05为差异有显著性.结果 配戴RGPCL 12个月后使角膜垂直曲率减少(0.43±0.51)D(P＜0.0001),水平曲率减少(0.08±0.23)D(P＜0.05),平均曲率减少(0.26±0.43)D(P＜0.0001).结论 配戴RGPCL使角膜曲率变小.     

球面透气性硬性角膜接触镜矫正高度角膜散光

目的评价球面透气性硬性角膜接触镜（rigid gas permeable contact lens，RGP）矫正高度角膜散光（≥3．00 D）时的有效性、稳定性和患者耐受性。方法选择高度角膜散光患者41例55眼，经角膜曲率检查、电脑验光、检影验光、综合验光仪验光，确认为总散光与角膜散光基本一致者，进行试戴片配适评估、戴片验光，给予配戴球面RGP。定期回访，记录矫正视力、镜片配适及配戴情况。结果RGP最佳矫正视力：30眼（占54.5％）高于框架镜，22眼（占40.0％）等于框架镜，3眼（占5．5％）低于框架镜。患者均获得稳定配适。随访1—65个月（平均40．5个月），3例（4眼）患者因不能适应镜片的异物感而停戴。其余38例（51眼）仍坚持配戴，并对该矫正方法满意。结论应用球面RGP矫正高度角膜散光，可获得良好配适和满意的视力矫正效果。多数患者能够坚持长期配戴。     

外伤角膜瘢痕无晶状体眼戴角膜接触镜后的角膜地形图改变

目的 探讨外伤性角膜瘢痕无晶状体眼戴硬性透气性接触镜前,后角膜表面的改变。方法 对戴该镜者１７眼及对照组（不戴镜）１２眼,在戴镜前后进行角膜地形图检测。结果 戴镜后平均８．４月,角膜散光减少（Ｐ〈０．０１）,角膜表面变得比较规则（Ｐ〈０．０５）,角膜表面的屈光度有变得相对比较平均的趋势。结论 戴硬性透气性角膜接触镜能使角膜瘢痕所致角膜散光减少,角膜表面变得较为规则。     

复曲面硬性透气性角膜接触镜矫正高度角膜散光

目的观察后表面复曲面硬性透气性角膜接触镜（BSTRGPCL）矫正高度角膜散光的效果及其对角膜地形图的影响。方法选择高度角膜散光患者31例（54眼）,经自动验光仪验光、客观检影、综合验光仪验光和角膜地形图检查,记录综合验光仪所得最佳矫正视力（BCVA）,确认角膜散光与整体散光基本一致,根据2／3散光原则定制BSTRGPCL。戴镜1个月后复查,观察配适和眼表并发症情况,记录BCVA和角膜地形罔变化。采用SPSS13．0统计软件对所得数据进行x2检验和配对t检验分析。结果戴镜后1个月．所有患者配适良好,无严重眼表损伤和感染等并发症。配戴BSTRGPCL的视力较框架眼镜视力有明显提高,39眼（72122％）的BCVA≥1．0．例数显著多于框架眼镜矫正时（18眼,33．33％）,差异有统计学意义（x2=16．38,P=0．00）。戴镜1个月后,角膜表面规则性指数、表面不对称性指数分别为13．66±0．21和0．36±0．18,较戴镜前无明显变化（t=1．01,P=0．32;t=1．40,P=0．17）;最大角膜曲率为（47．72±2．12）D,较戴镜前明显变低（t=2．42,P=0．02）,最小角膜曲率为（42．70±2．04）D,无明显变化（t=0．05,P=0．97）。结论BSTRGPCL矫正高度角膜散光配适良好,可获得较理想的矫正视力,短期配戴可使最大角膜曲率降低．但角膜规则性变化不显著。     

Aberration changes of the corneal anterior surface following discontinued use of rigid gas permeable contact lenses

AIM: To record aberrations with a corneal topographic device on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGP on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction.METHODS: The study objects were 24 eyes from 24 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry and corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses everyday for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 minutes, 1 day, 3, 7 and 14 days following use.RESULTS: Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results were as follows:root mean square (RMS) (pre)=(1.438±0.328)μm, RMS (30 minutes)=(1.076±0.355)μm, RMS (1 day)=(1.362±0.402)μm, RMS (3 days)=(1.373±0.398)μm, RMS (7 days)=(1.387±0.415)μm, and RMS (14 days)=(1.430±0.423)μm. Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2^nd- and 3^rd-order aberrations change. Quadrafoil Z10 and spherical Z12 of the 4^th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant differences compared with the time period prior to RGP use:Z5 and Z6 decreased, and Z12 increased slightly. Z5 and Z6 remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use. At 14 days after discontinued use, all aberrations were not significantly different from the values prior to use.CONCLUSION: The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2^nd- and 3^rd-order aberrations (including Z3, Z4, Z5, Z6, Z7, and Z8) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 14 days after discontinued use of RGP contact lenses.     

逆几何形特殊设计RGPCL矫正角膜屈光手术后的屈光不正

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,近似角膜塑型镜设计）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—18．75D,散光度0．75～4．50D,裸眼视力3．0～4．8：1眼放射状角膜切开术后又受外伤致术后无晶状体眼,＋8．00D／＋6．00D×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TomeyⅣ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）DVS（39．27＋-1．23）D,（39．24＋-2．46）DVS（39．88＋-1．19）D,（40．34＋-2．48）DVS（41．39＋-1．43）D,（41．23＋-2．43）DUS（41．21±1．45）D．（41．02＋-2．36）DVS（40．50＋-0．79）D],两组之间各区参数的差异均无统计学意义（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．     

硬性透气性角膜接触镜控制青少年进展性近视的效果

目的 观察Menicon-Z硬性透气性角膜接触镜(RGPCL)控制青少年进展性近视的临床效果.方法 前瞻性自身对照研究.选取18岁以下近视患者76例(148眼),按近视度分为4组(-0.50～-3.00 D,-3.25～-6.00 D,-6.25～-9.00 D,9.25～-20.00 D),分析配戴RGPCL(15.2±5.2)个月后的矫正视力、屈光状态、角膜地形图参数、年近视增长幅度及眼轴长度等项目的变化.采用配对样本t检验、单因素方差分析评价RGPCL控制青少年进展性近视的效果.结果 配戴RGPCL后平曲率(FK)、陡曲率(SK)值均降低,差异均有统计学意义(t=4.80,P＜0.01;t=7.76,P＜0.01);而球镜度、散光度、眼轴长度变化不明显;同原近视增长幅度[(-1.10±0.53)D/年]比较,配戴RGPCL后近视增幅[(-0.00±0.47)D/年]显著降低(t=-13.9S,P＜0.01).不同近视程度组间比较,配戴RGPCL前后近视增长幅度差异有统计学意义(F=4.84,P＜0.01),较高近视度患者配戴RGPCL后近视增长幅度较小.结论 长期配戴Menicon-Z RGPCL安全性高,并能有效地延缓青少年不断增长的近视度、角膜曲率及眼轴长度,尤其是对较高近视度者控制的效果更为显著.     

硬性透气性角膜接触镜控制青少年进展性近视的效果

目的 观察Menicon-Z硬性透气性角膜接触镜(RGPCL)控制青少年进展性近视的临床效果.方法 前瞻性自身对照研究.选取18岁以下近视患者76例(148跟),按近视度分为4组(-0.50～-3.00 D,-3.25～-6.00 D,-6.25～-9.00 D,9.25～-20.00 D),分析配戴RGPCL(15.2±5.2)个月后的矫正视力、屈光状态、角膜地形图参数、年近视增长幅度及眼轴长度等项目的变化.采用配对样本t检验、单因素方差分析评价RGPCL控制青少年进展性近视的效果.结果 配戴RGPCL后平曲率(FK)、陡曲率(SK)值均降低,差异均有统计学意义(t=4.80,P＜0.01;t=7.76,P＜0.01);面球镜度、散光、眼轴长度变化不明显;同原近视增长幅度[(-1.10±0.53)D/年]比较,配戴RGPCL后近视增幅[(-0.00±0.47)D/年]显著降低(t=-13.95,P＜0.01).不同近视程度组间比较,配戴RGPCL前后近视增长幅度差异有统计学意义(F=4.84,P＜0.01),较高近视度患者配戴RGPCL近视增长幅度最小.结论 长期配戴Menicon-Z RGPCL安全性高,并能有效地延缓青少年不断增长的近视度、角膜曲率及眼轴长度,尤其是对较高近视度者控制的效果更为显著.     

小儿白内障术后无晶状体眼RGP矫正屈光不正临床观察

目的 观察小儿白内障术后因无晶状体而配戴RGP的临床应用效果.方法 为5例(10只眼)因小儿白内障术后无晶状体的患儿验配RGP,观察小儿所需RGP的参数,随访观察镜片配戴情况,并发症发生情况,镜片更换及矫正视力.结果 所有患者均能正常配戴RGP,所配戴RGP基弧平均7.6,屈光度平均+24.5D,直径8.6mm.戴镜前后眼球震颤振幅分别为(11.0±4.2)度和(6.5±3.4)度,差异有统计学意义(t＝9.0,P＜0.05),振频分别为29.0± 9.6和19.6±2.9,有显著统计学意义(t=23.1,P＜0.05).平均6个月更换一次镜片.随访期间无并发症发生.结论 先天性白内障术后无晶状体眼配戴RGP安全有效.

Abstract：

Objective To investigate the effect of the rigid gas permeable contact lenses (RGP)for pediatric aphakia. Methods Ten eyes of 5 patients with cataract aphakia who were fitted into RGP for aggressive visual rehabilitation. The RGP lenses parameters such as basic curve (BC), power,and diameter were evaluated. Complications, correct visual acuity, and the number of lenses during the period of follow-up were observed. Results All patients could wear RGP lenses normally. The average BC of lenses was 7.6, power was +24.S D, and diameter was 8.6. The nystagmus amplitude were 11.0±4.2 degree and 6.5±3.4 degree before and after wearing RGP lenses (t =9.0, P ＜0.05). The nystagmus frequency were 29.0±9.6 and 19.6±2.9 before and after wearing RGP lenses (r =23.5, P ＜0.05). The average changing lenses cycle was 6 months. No complications occurred during the follow-up periods. Conclusions The RGP lenses are safe and effective to pediatric aphakia.