与接触镜相关的角膜疾病及其防治

角膜接触镜的增视，美容和方便的特点使其在世界各地被广泛使用。但在其配戴过程中，可引起一系列的眼部生理变化，如：角膜厚度增加，角膜电位改变，葡萄糖代谢改变，角膜缺氧，二氧化碳分压增加，ＰＨ值下降，角膜表面温度下降等，对某些长期配戴，还可能发生各种较严重的并发症，如：微生物性角膜炎，代谢性，毒性和变应性角膜病变。本就此及其防治作简要综述。     

抛弃型角膜接触镜研究进展

角膜接触镜 (contact lens,CL )材料科学与生产工艺特别是全自动铸模工艺的发展使抛弃型 CL (disposable CL ,DCL)得到迅速发 [1～ 3] 。目前的 DCL 均属于以聚甲基丙烯酸羟乙酯 (polyhydroxyethyl m ethacrylate,H EMA)等亲水性材料为主要原料生产的软性 CL(SCL) ,因此亦称抛弃型 SCL(disposable SCL ,DSCL )。近年的临床实践表明 ,DCL虽然方便了护理 ,使一些并发症的发生率显著降低 [4～ 1 3] ,然而 ,包括日抛镜片 (Daily DCL,DDCL)在内均未能完全杜绝 CL 并发症的发生 ,一些并发症的发生率甚至有所增加 [1 4～ 2 0 ]。…     

角膜接触镜研究进展

角膜接触镜 (conact lens,CL)作为矫正屈光不正的一种特殊医疗器具 ,其优良的材料性能、科学的配戴方式对角膜与结膜健康的维持是非常重要的。本文就接触镜材料、配戴方式、特殊用途镜片等方面的进展进行了简要综述。　　一、接触镜材料研究进展1.硬镜材料 :硬镜由高模量 (>10 0 MPa)、含水量 <1%的透明交联聚合物材料制成。硬镜材料仅能吸收很少量的水分 ,这是由于在其结构中存在有疏水基团。通常 ,疏水性聚合物的属名都用后缀 - focon。常用硬镜材料的基本特点如下〔1〕:(1)聚甲基丙烯酸甲酯 [poly (methylmethacrylate) ,PMMA]PMMA…     

角膜接触镜的并发症及其对策

随着角膜接触镜的广泛应用,眼部并发症也日益增多.为了减少或避免此并发症,作者根据多年的临床实践及有关文献,就此问题综述于后,以引起同道及角膜接触镜配戴者的重视.(一)眼部并发症1.角膜溃疡:角膜溃疡是戴角膜接触镜引起的最严重的眼部并发症,如不及时治疗,有失明危险.角膜溃疡可由细菌、真菌、病毒、原虫等引起,其中以绿脓杆菌感染最常见.国外报道戴接触镜引起的角膜溃疡中,绿脓杆菌性者占75%,国内报道75例,其次为葡萄球菌、肺炎球菌及溶血性链球菌引起者,真菌所致者少见,同外报道仅占4%,病毒、棘阿米巴性者国内尚未见报道.     

软性角膜接触镜的不良反应及并发症

随着软性角膜接触镜（ＳＣＬ）广泛应用，所引起的眼部不良反应及并发症日益增多，引起眼科界及眼镜行业的高度重视。近年来的研究结果表明：①ＳＣＬ导致角膜微环境改变，包括低氧状态，二氧化碳潴留，ｐＨ值上降，渗透压及温度变化。②ＳＣＬ引起角膜功能及结构异常，包括上皮微囊形成，角膜敏感度下降及上皮变薄，基质水肿、变薄及新生血管形成，内皮细胞多相性改变及细胞数目减少。③ＳＣＬ并发眼部炎症及感染，包括滤泡性结膜炎     

角膜接触镜材料研究进展

本文对从本世纪４０年代末聚甲基丙烯酸甲酯硬镜材料的问世,到６０年代初聚甲基丙烯酸羟乙酯水凝胶软镜材料的出现,７０年代中期硅氧烷丙烯酸酯透气性硬镜材料的研制成功,８０年代末期氟硅氧烷丙烯酸酯材料的发展以及９０年代新一代（氟）硅氧烷水凝胶材料的研究进是行了简要综述。     

戴角膜接触镜引起的眼部并发症

近年来,角膜接触镜已广泛用于矫正屈光不正和美容等方面,山此而引起的眼部损害时有发生.1988年9月～1993年9月共治疗7例戴角膜接触镜引起的眼部损害,报告如下.一般资料:本组共7例(7眼),男性4例,女3例;右眼3例,左眼4例;年龄15～38岁(平均20.8岁);学生5例,职工2例.发病至就诊时间最短1天,最长11天(平均4.8天).全部为亲水性软接触镜日戴片.     

大气污染对配戴角膜接触镜影响的初步分析

报告７３例１４５眼配戴角膜接触镜后的随访观察结果，首次结合本地区大气污染资料对配戴角膜接触镜的影响，发现二者之间有较为密切的关系，并建议进一步加强大气污染对角膜接触镜影响的观察和研究。     

角膜接触镜长戴研究进展

自1981年长戴型角膜接触镜（EWCL）问世以来,人们逐渐认识到各种EWCL,包括普通型、勤换型与抛弃型软性接触镜（SCL）,以及透气性硬镜（RGP）与硅胶CL,长戴并发症包括接触镜相关性感染性角膜炎（CLAMK）的发病率明显高于日戴。新近推出的高透氧SCL透氧性较普通SCL大大提高。高透氧SCL过夜配戴是否安全？就近年来关于长戴对角膜前泪液膜、角膜与结膜囊微生物丛的影响等方面的研究进展进行了综述。     

Contact lens compliance amongst soft contact lens users

目的:从卫生和镜片、镜片盒及镜片护理液的更换来调查隐形眼镜配戴者的依从性.方法:以每天配戴镜片至少8h、持续配戴≥6mo的隐形眼镜配戴者为研究对象.采用半结构化、经过预先测试和验证的问卷调查表,在接受口头知情同意后评估软性隐形眼镜配戴者的依从性.每位受试者都接受访问,收集有关戴隐形眼镜使用历史的信息.年龄、性别、使用的镜片类型、配戴经验(a)、配戴时间和习惯、一天中持续使用镜片的时间和护理方法的细节都进行了记录.结果:共73名参与者的平均年龄为23.63±5.23y.观察到:依从性最高的项目为镜片清洁和消毒程序(98%);依从性最低的是隐形眼镜配件护理(81%).依从性较差的是:更换镜片盒(41%),检查并丢弃过期的护理液(22%)和未能进行后续随访(22%).镜片配戴的性别、配戴方式、配戴类型以及隐形眼镜使用年限依从性间无统计学差异.结论:这项研究结果证明总体上配戴者依从性良好.然而,在隐形眼镜盒和护理液等镜片配件的护理中,存在一定程度的不遵嘱执行.我们认为有必要考虑改善镜片护理操作依从性的方法.     

接触镜在圆锥角膜中的临床应用及并发症研究进展

圆锥角膜是一种不断进展的致盲性眼病，其特征是角膜变薄和突起，伴有不规则散光和视力下降。早期圆锥角膜的不规则散光可通过框架眼镜矫正，对于中重度圆锥角膜的不规则散光，框架眼镜不再适用，接触镜成为患者矫正视力的最佳选择。接触镜种类繁多，在接触镜的选择上难以抉择，如长时间试戴镜片会增加患者的不适，影响整体感受，也大大增加了医生的工作量。因此，本文对接触镜的分类、接触镜在不同圆锥角膜类型中的应用、接触镜配戴中的并发症及其未来展望等方面予以汇总和讨论，以期了解接触镜在圆锥角膜中的临床应用与管理，有助于进一步发挥接触镜在圆锥角膜中的应用价值。     

Non-compliance with lens care and maintenance in diabetic contact lens wearers

We hypothesize that diabetic contact lens wearers may represent a special group displaying higher levels of compliance with their lens care regimens as a result of learned behaviour relating to maintenance of their diabetic condition. To test this hypothesis, a prospective, single centre, controlled, masked study was performed whereby 29 diabetic contact lens patients and 29 non-diabetic control subjects were issued with disposable hydrogel contact lenses and a multipurpose lens care regimen. All participants were given identical instruction on lens care and maintenance. Compliance levels were assessed at a 12-month aftercare appointment by demonstration and questionnaire. Twenty-four different aspects of compliance were scored, 12 by observation and 12 by questionnaire report, of which only two showed a significant difference between the diabetic and control groups. Although the combined population of contact lens wearers was generally compliant, there were examples of non-compliance in both groups. Neither the duration of diabetes nor the degree of metabolic control appeared to have a significant effect on compliance. The results suggest that eye care practitioners cannot assume that diabetic patients will be more compliant with contact lens care and maintenance than non-diabetic patients.     

Microbial contamination of contact lenses and lens care accessories of soft contact lens wearers (university students) in Hong Kong

PURPOSE: This study aimed to examine the rates of microbial contamination, and identify contaminants associated with contact lenses and lens care accessories used by a group of young contact lens wearers. METHODS: Collected contact lenses, lens cases, and lens care solutions were studied by bacterial culture. Contamination rates of these samples were recorded and compared with those reported in previous studies. RESULTS: Of the samples tested, 9% of lens extracts, 34% of case extracts and 11% of solution samples were contaminated with ocular pathogenic microorganisms. Serratia spp., Staphylococcus aureus and coagulase-negative staphylococci were the most common microorganisms isolated. Lens cases were the most frequently contaminated item. Lens cases also yielded the widest range of bacterial isolates. Contact lenses used by occasional wearers were associated with a higher contamination rate. Using either saline or multipurpose solution to rinse lenses before use appeared to be effective in reducing incidence of contamination. CONCLUSION: Our findings demonstrate that contact lenses and lens care accessories are not well maintained by contact lens wearers. Regular reviews and reinforcement of lens care procedures for the usage and care of contact lenses and lens care accessories is therefore important and essential.     

美容性角膜接触镜的验配探讨

目的：为各种角膜白斑、虹膜异常的病人寻求医学美容及保留有用视力。方法Ｚ：对各种角膜白斑、虹膜异常的病人按有用视力和无用视力。分别进行有孔和无孔美容性角膜接触镜（俗称美容镜）的配戴。与健眼的虹膜色泽、瞳孔大小、舍适程度、配戴前后有用视力的评估。进一步统计分析探讨。结果：共收集４３０眼美容镜配戴者,有用视力的角膜旁中央白斑戴有孔美容镜４３眼,视力范围在眼前指数至０．６之间,戴镜前后的有用视力基本保持不变;无用视力的各种角膜白斑戴无孔美容镜３８７眼,能有效遮盖白斑,起到角膜美容的作用。结论：（１）各种角膜白斑的医学美容应首选配戴美容性隐形眼镜,既可逆性,又经济、安全、有效。（２）有孔美容镜既能有效遮盖角膜旁中央白斑,又能保留有用视力,两全其美。     

中和肉汤在隐形眼镜护理液中适用性试验研究

目的研究ISO14729[1]和ISO14730[2]中用到的中和剂———D/E中和肉汤(D-E neutralizer broth)的适用性。方法采用悬液定量法。结果选择国内市场上几种品牌的隐形眼镜护理液,用中和肉汤作为中和剂进行中和剂鉴定试验,结果符合中和剂鉴定试验的要求。结论用D/E中和肉汤作为中和剂对试验中所用的产品是适用的。     

亲水性软性角膜接触镜所致角膜新生血管临床观察

本文观察了因配戴软性亲水性角膜接触镜而产生角膜新生血管的３３例５９眼，对角膜新生血管的发病机制进行了探讨，指出角膜新生血管的发生与戴镜年限、连续戴镜时间、角膜与镜片的匹配有密切关系，对于此并发症的治疗采用停戴接触镜取得较好效果。     

接触镜及其护理产品国际标准体系现状与发展趋势

笔者对接触镜和接触镜护理产品的国际标准现状、体系、演变过程和发展趋势进行了研究。通过梳理、比对分析,总结了该领域国际标准体系结构特性和发展规律,并对未来的工作重点和发展趋势给出了判断,同时给出了我国标准体系建设的借鉴建议。     

The effect of a compliance enhancement strategy (self‐review) on the level of lens care compliance and contamination of contact lenses and lens care accessories

Purpose: The aims were to determine the level of compliance of contact lens wearers, to identify which procedures have highest levels of non‐compliance and to study the effectiveness of a compliance enhancement strategy on the level of compliance. Methods: The level of compliance for each subject was evaluated with a self‐administered questionnaire together with microbiological examination of their contact lenses, lens cases and lens care solutions. The effect of an intervention to improve the level of compliance was determined by a controlled trial. A regular self‐review exercise on proper lens handling was given to the test group once every three months for 12 months. The levels of compliance and contamination of contact lenses and lens care accessories between test and control groups were compared at the end of the 12‐month period to evaluate the effect of the intervention. Results: Sixty‐five subjects who were experienced contact lens wearers were recruited and 60 completed the study. All showed some degree of non‐compliance in the care of their contact lenses and lens accessories. Most (about 60 per cent) were non‐compliant with at least six of a total of 15 lens care procedures. The most common non‐compliant behaviour among contact lens wearers was associated with the care of the lens case. By the end of the study period, our compliance enhancement strategy did not appear to have had a significant effect on the behaviour of our subjects, except for improvement in the care of lens cases. Compliance for other procedures improved in both test and control groups. Conclusion: All subjects showed some degree of non‐compliance and the spectrum of non‐compliance was wide. The poorest levels of compliance were associated with care of the lens case, which was also the most frequently contaminated item. Our compliance enhancement strategy showed a significant difference in improvement in compliance between the intervention and control groups only in the care of lens cases.