儿童配戴角膜塑形镜后早期角膜生物力学变化特征

目的：探讨近视儿童配戴角膜塑形镜后早期角膜生物力学变化特征及相关因素。方法：前瞻性临床 研究。收集山东第一医科大学附属眼科医院2018年6月至2019年12月配戴角膜塑形镜的中低度近 视患者55例（109眼）,男28例,女27例,年龄（12.1±3.7）岁,等效球镜度（SE）为（-2.97±1.56）D。 在配戴前及戴镜后1 d、1周、1个月,采用可视化角膜生物力学分析仪（Corvis ST）检查患者角膜生 物力学相关参数,如变形幅度比（DAR）、综合半径（IR）、水平方向Ambrosio相关厚度（ARTh）、硬 度参数（SP-A1）以及Corvis生物力学指数（CBI）;Pentacam检查角膜曲率;角膜光学相干断层扫描 （OCT）检查中央角膜厚度（CCT）和中央角膜上皮厚度（CET）。采用单因素方差分析比较不同时间 点角膜生物力学指标、屈光度和角膜形态的变化;采用Pearson检验进行各生物力学指标间的相关分 析。结果：所有患者在配戴角膜塑形镜后裸眼视力（UCVA）明显提高,1个月时均达到0 LogMAR。 CBI在配戴后1个月内逐渐上升,1个月时最高,配戴后1 d、1周、1个月较配戴前差异有统计学意义 （F=11.52, P<0.001）。IR在配戴后上升,1周时处于最高值,配戴前后比较差异有统计学意义（F=3.11, P=0.027）。ARTh在配戴后下降,1周时最低,配戴前后差异有统计学意义（F=29.82, P<0.001）。CBI 与SE呈正相关（r=0.21, P=0.003）,与CET呈负相关（r=-0.16,P=0.041）;与CCT无明显相关性。结论： 儿童配戴角膜塑形镜后1个月内,角膜生物力学特性有下降趋势,主要的变化指标为CBI。SE越低, CET越厚;CBI改变越小,角膜的安全性越高。     

巩膜镜的临床研究进展

巩膜镜是一种拱形覆盖角膜及角巩膜缘的大直径硬性透气性接触镜,用于日间配戴。随着对巩膜镜相关的研究逐步加深,巩膜镜治疗眼科疾病被更多的应用到临床。与常规硬性透氧性角膜接触镜相比,巩膜镜着落在巩膜上,在镜片后表面与角膜前表面之间形成一个液态穹窿,能够创造理想的眼表环境,并且具有不接触角膜表面及角巩膜缘,保护角膜组织,矫正角膜不规则散光,减少高阶相差,延缓或避免相关眼部疾病采用手术治疗,应用范围广,稳定性好及配戴舒适等优点。镜片材料、设计工艺、专业人员配镜技术及眼科成像技术的提高等推动了巩膜镜的临床应用。目前巩膜镜主要用于解决不规则角膜、眼表疾病及屈光不正等眼科疾病。本文旨在对巩膜镜的发展历史、适应证、验配及相关并发症等方面进行简要的综述。     

Pentacam眼前节分析系统在巩膜镜验配初始矢高选择中的应用.

目的：评估Pentacam眼前节分析系统测量的眼前节生物学参数在巩膜镜（SL）验配初始镜片矢高（LSD）选择中的应用价值。方法：回顾性系列病例研究。选取2020 年10 月至2021 年6 月于南京医科大学附属眼科医院验配SL的角膜不规则散光或干眼患者32 例（53 眼）。所有患者均行SL验配前一般眼科检查,采用Pentacam采集角膜前表面平坦曲率（Kf）、陡峭曲率（Ks）、散光量、非球面参数Q值、中央角膜厚度（CCT）、角膜直径、前房深度（ACD）等数据。此外,采用Pentacam自带软件测量受检眼于13.50 mm弦长下的角膜矢高（CSH）。采用Pearson或Spearman相关以及线性回归分析各眼前节生物学参数与最终试戴评估修正后LSD的关系。结果：患者均完成初次SL试戴验配。Pentacam眼前节分析系统Scheimpflug images模式下所测量的13.50 mm弦长下CSH为（3 746±187）μm,试戴修正后LSD为（3 622±206）μm。相关分析结果显示：角膜前表面Kf、Ks、散光量、ACD及Pentacam测量的CSH与试戴修正后的LSD均呈正相关（r=0.36～0.84,均P<0.05）;CCT与试戴修正后LSD呈负相关（r=-0.35,P=0.011）;非球面参数Q值、角膜直径与试戴修正后LSD无相关性。将试戴修正后LSD作为因变量,校正相关因素后的线性回归方程显示Pentacam测量的CSH与试戴修正后LSD高度相关,即试戴修正后LSD=416.996+0.854×CSH（调整R2=0.63,F=89.17,P<0.001）。结论：Pentacam测量的部分眼前节生物学参数与SL试戴修正后的LSD相关,其中CSH可作为LSD选择的重要参考依据。     

Ocular biomechanical measurements on post-keratoplasty corneas using a Scheimpflug-based noncontact device

AIM: To analyse ocular biomechanical properties, central corneal thickness (CCT) and intraocular pressure (IOP) in post-keratoplasty eyes, as compared to normal subjects, with a new Scheimpflug-based technology. Moreover, biomechanical data were correlated with the size and age of the donor and recipient corneas. METHODS: Measurements were conducted on 46 eyes of 46 healthy patients without any corneal pathology (age: 53.83±20.8y) and 30 eyes of 28 patients after penetrating keratoplasty (age: 49.43±21.34y). Ten biomechanical parameters, the CCT and IOP were recorded by corneal visualization scheimpflug technology (CorVis ST) using high-speed Scheimpflug imaging. Keratometry values were also recorded using Pentacam HR system. Scheimpflug measurements were performed after 43.41±40.17mo (range: 11-128mo) after the keratoplasty and after 7.64±2.34mo (range: 5-14mo) of suture removal. RESULTS: Regarding the device-specific biomechanical parameters, the highest concavity time and radius values showed a significant decrease between these two groups (P=0.01 and P<0.001). None of other biomechanical parameters disclosed a significant difference. The CCT showed a significant difference between post-keratoplasty eyes as compared to normal subjects (P=0.003) using the CorVis ST device. The IOP was within the normal range in both groups (P=0.84). There were no significant relationships between the keratometric data, the size of the donor and recipient, age of the donor and recipient and biomechanical properties obtained by CorVis ST. CONCLUSION: The ocular biomechanics remain stable after penetrating keratoplasty according to the CorVis ST measurements. Only two from the ten device-specific parameters have importance in the follow-up period after penetrating keratoplasty.     

Pentacam系统测量正常人眼表面麻醉前后中央角膜厚度的对比研究

目的 比较Pentacam三维眼前节分析系统与A超角膜测厚仪测量正常人中央角膜厚度的差异,并研究Pentacam系统与A超测量正常人眼表面麻醉前后中央角膜厚度的变化,为临床角膜屈光手术方式的选择提供参考.方法 对25例(50眼)正常人分别应用Pentacam系统及A超角膜测厚仪测量中央角膜厚度,Pentacam系统的测...     

The Boston Ocular Surface Prosthesis as a Novel Drug Delivery System for Bevacizumab

Corneal neovascularization causes deterioration of visual acuity and increases surface irregularities. Various techniques have been employed to help control the progression of corneal neovascularization; bevacizumab is a medication that targets the specific pathway of corneal neovascularization. The Boston Ocular Surface Prosthesis (BOSP) is a large diameter contact lens that aids in maintaining corneal surface integrity and may serve as a delivery system for topical bevacizumab. This paper reviews five patients who were treated with topical bevacizumab in their BOSP. All patients demonstrated improvement in their visual acuity and clinical exam. No adverse reactions were noted.     

短期配戴角膜接触镜对角膜形态和厚度的影响

目的探讨短期配戴软性角膜接触镜对角膜形态和厚度的影响。方法对25名青壮年近视志愿者(50眼)(等值球镜:-0.50~-7.25 D)统一配戴软性角膜接触镜1个月,测定摘镜后1个月内不同时间的角膜形态和厚度变化,并与戴镜前比较。结果戴镜前和摘镜后不同时间,角膜地形图形态构成、角膜地形图散光轴向的变化构成及一些角膜前表面形态相关指数无显著性差异(P>0.05)。戴镜前与摘镜后角膜地形图形态完全一致者占62.5%,且均以不对称领结形为著;在摘镜后1 d、1周、2周,角膜地形图散光轴向变化在16°以上及31°以上均超过30%和20%,直到1个月后仍有24%的眼角膜地形图散光轴向的变化在16°以上;角膜厚度在摘镜后1 d、2周均明显高于戴镜前(P<0.05),直到1个月后才与戴镜前接近,且受日均戴镜时间的影响。结论短期配戴软性角膜接触镜对角膜形态和厚度的影响虽轻微但复杂,摘镜后1 d变化最显著,随着时间的延长逐渐恢复,直到1个月后才与戴镜前基本一致。日均戴镜时间对摘镜后角膜厚度变化有影响。     

两种不同切口人工晶状体植入术后角膜地形图对比分析

目的 研究两种不同切口人工晶状体植入后角膜形态和散光的变化。方法 通过３．２ｍｍ透明角膜切口植入折叠人工晶状体５０眼和６．０ｍｍ巩膜隧道切口植入ＰＭＭＡ人工晶状体４８眼,术后应用计算机辅助角膜地莆图仪对这些病人的角膜形态进行检查。结果 角膜组术后早期角膜地形图垂直于切口径线的角膜轻度变平,于术后１个月即可稳定。巩膜组有膜垂直轴上出殃蝴蝶结样改变,而后蝴蝶结逐渐变小,或向水平方向转变而减少,至３个月时基本稳定。两组在术后１天至１个月的角膜散光和手术性角膜散光巩膜组大于角膜组（Ｐ〈０．０５）。结论 ３．２ｍｍ透明角膜切口组术后角膜形态改变小,视力恢复快。     

长期戴用软性接触镜后角膜内皮细胞的改变

目的：观察软性接触镜长期戴用后对角膜内皮细胞的影响,探讨如何提高ＳＣＬ使用的安全度。方法;利用非接触式角膜内皮显微镜（ＳＰ－５００,ＳＥＥＤ Ｃｏ．Ｌｔｄ）,观察长期戴用ＳＣＬ的４８只眼角与角膜内皮细胞的改变。分为日间戴镜组和连续过夜戴镜组,并分别探讨戴镜期间的长短与角膜内皮变化的关系。同年龄组正常非戴镜眼的角膜内皮细胞参数作为对照观察。     

正常角膜伴近视散光眼角膜各形态参数分布特征及与全眼屈光参数的关系

目的 探讨正常角膜伴近视散光眼角膜各形态参数分布特征及与全眼屈光参数的关系.方法 收集102例(204眼)近视患者,分别应用非接触眼压计、检影仪、A超、角膜超声测厚仪、Pentacam三维眼前节分析仪进行眼压、屈光度、眼轴长度、角膜厚度、角膜前后表面形态参数等测量,应用SPSS 13.0统计学软件进行数据分析.结果 正常角膜伴近视散光眼角膜中央厚度(537.06±25.45)μm,角膜中央前表面高度(2.35±1.39)μm,中央后表面高度(3.60±2.73) μm,角膜Q值(8 mm范围)-0.30±0.10,角膜最薄点距角膜顶点距离(0.59±0.19)mm,角膜最薄点位置多位于角膜顶点颞下方,占91.67％.角膜最薄点至周边厚度增长变化指数为1.04±0.13.角膜中央前后表面高度、角膜Q值、角膜最薄点至周边厚度增长变化指数与等效球镜、眼压、眼轴长度无明显相关性(均为P＞0.05).结论 正常角膜伴近视散光眼角膜形态各项参数分布值各有特点,与全眼屈光参数无明显相关性.     

长眼轴患者白内障超声乳化术后角膜生物力学的变化

目的　观察长眼轴患者行白内障超声乳化术后角膜生物力学的变化。方法　收集拟接受白内障手术的患者58例68眼，将其分为长眼轴组（28例34眼）和正常眼轴组（30例34眼），应用可视化角膜生物力学分析仪（corneal visualization scheimpflug technology，Corvis ST）对患者术前及术后1周、1个月的角膜生物力学参数进行测量。结果　术前及术后1周、1个月两组峰距、中央角膜厚度、矫正眼压、眼压及长眼轴组第二压平时间和最大形变幅度的总体比较，差异均有统计学意义（均为P＜0.05）；术后1周与术前相比，两组峰距、中央角膜厚度、矫正眼压、眼压明显增大，长眼轴组最大形变幅度较术前减小，差异均有统计学意义（均为P＜0.05），但术后1个月正常眼轴组峰距、中央角膜厚度、矫正眼压、眼压均恢复到术前水平（均为P＞0.05），而长眼轴组最大形变幅度较术前减小，矫正眼压、眼压较术前均增高（均为P＜0.05）。术后1个月与术后1周比较，两组峰距、中央角膜厚度、矫正眼压、眼压均有减小趋势（均为P＜0.05）。长眼轴组术后1周中央角膜厚度、矫正眼压及最大形变幅度的变化量与眼轴长度均存在正相关性（r=0.493，P=0.003；r=0.575，P＜0.001；r=0.587，P＜0.001），而正常眼轴组的相关参数的变化量与眼轴长度均无相关性（均为P＞0.05）。结论　白内障超声乳化术能影响角膜生物力学，且长眼轴患者较正常眼轴者术后更易引起角膜生物力学改变，在白内障术后应注意其用药时间及激素类药物的使用，防止伤口愈合不良导致迁延感染及高眼压的发生。     

Corneal conjunctivalisation in long‐standing contact lens wearers

Background: There are many contact lens‐related ocular surface disorders. Some can damage the limbal region where stem cells are thought to be located in its basal cell layer. This damage can result in destruction and a deficiency of corneal stem cells. One important sign of this complication is corneal conjunctivalisation. The purpose of this study is to describe clinical characteristics of a series of long‐standing contact lens (CL) wearers with corneal conjunctivalisation (CC). Methods: In a one‐year (March 2004 to March 2005) retrospective unmasked study, 591 CL clinical histories (195 new patients and 396 review patients) were analysed. Results: There were 24 eyes of 14 myopic patients (93 per cent women) with CC without a specific disease entity known to cause limbal stem cell deficiency (LSCD). Conjunctivalisation occurred in the inferior limbus of three eyes (12 per cent). Only four patients (28.6 per cent) reported previous ocular symptoms. All were myopic with a mean spherical equivalent of ‐8.80 ± 5.00 (SD) dioptres (range from ‐1.75 to ‐21.50 D) and mean visual acuity 0.9 ± 0.2 (range from 0.4 to 1.2). The mean years of CL wear was 17.6 ± 8.5 (CI 95% 13.2 to 22; range six to 30). All were daily‐wear patients with a mean daily‐wear time of 12.5 ± 1.8 hours per day (CI 95% 11.6 to 13.4). Conclusion: Corneal conjunctivalisation is a contact lens‐related complication in asymptomatic patients. Optometrists can play an important role in early diagnosis, education and management of these patients.     

巩膜扣带术后角膜内皮细胞形态学的改变

目的:研究巩膜扣带术对角膜内皮细胞的影响。方法:原发性视网膜脱离患者72例(72眼)行巩膜外垫压联合环扎术,分别在术前、术后1,3,5,15d测量眼压、角膜内皮细胞密度、六角形细胞比例和变异系数。结果:与术前相比,术后1d和3d的眼压及角膜内皮细胞变异系数都显著性增加(P<0.05),之后降低,与术前无显著性差异(P>0.05),两者之间也无明显相关性(P>0.05)。角膜内皮细胞密度和六角形细胞比例在术前和术后各时间之间均无明显差异(P>0.05)。结论:巩膜扣带术对角膜内皮细胞影响较小,仅使变异系数发生一过性改变,可能与细胞代谢过程受影响有关,术后0.5mo左右恢复。     

An analysis of the astigmatic changes induced by accelerated orthokeratology

Purpose : The change in corneal astigmatism induced by reverse geometry lenses for orthokeratology has not been described previously. This study examines the efficacy of accelerated orthokeratology for reducing astigmatism and whether this varies with the degree of pre‐existing astigmatism. Method : Twenty‐three randomly chosen eyes exhibiting 0.50 D to 1.75 D pre‐fitting with‐the‐rule astigmatism were retrospectively analysed. Astigmatism was measured by simulated keratometry and corneal topography before and at the completion of a course of ordiokeratology. The change in astigmatism measured by keratometry was calculated by two vector analysis techniques: the Bailey‐Carney method, which was designed for contact lens‐induced corneal shape changes, and the Alpins method, which was designed for surgically‐induced corneal shape changes. The change in astigmatism measured by corneal topography was calculated by the EyeSys Version 3.2 software. Results : Most patients (20/23) had some reduction of astigmatism but orthokeratology is incapable of a total elimination of pre‐fit astigmatism. Alpins vector analysis showed that an increased efficacy of 60 to 80 per cent would be required to eliminate astigmatism. All three methods found a 50 per cent mean reduction in astigmatism from the pre‐fit level. Topographical analysis indicates that the reduction in astigmatism occurs mainly over the central 2.00 mm chord. There is a very poor correlation between the pre‐and post‐wear corneal astigmatism at the 2.00 mm chord (R²= 0.11, p = 0.04) and the predictability of the final astigmatic axis is also poor (angle of error = 1.22 $pL 27.35). Conclusions : Accelerated orthokeratology seems more successful than conventional orthokeratology at reducing with‐the‐rule astigmatism. However, it reduces pre‐existing astigmatism by an average of only 50 per cent and it does not do so reliably either for magnitude or direction. These results provide two useful patient selection criteria for orthokeratology. They are: assuming 0.50 D to 0.75 D of astigmatism is a satisfactory outcome, orthokeratology can be expected to be successful for pre‐fitting astigmatism of up to 1.00 D to 1.50 D; and the greater the pre‐existing astigmatism, the less likely orthokeratology is to be successful.