RGPCL矫治圆锥角膜长期临床观察

目的观察RGPCL矫治圆锥角膜的长期临床应用效果。方法回顾性研究。以2005-2009年间在沈阳爱尔眼科医院视光中心因圆锥角膜验配RGPCL患者为研究对象，共260例（496眼）。男212例，女48例。所有患者随访观察时间至少4年。评估RGPCL镜片配适状态，对配戴框架眼镜和RGPCL的矫正视力，配戴RGPCL前后圆锥锥顶K值及角膜厚度进行比较，观察角膜曲率的变化及并发症的发生情况。数据采用配对t检验进行分析。结果所有病例配戴RGPCL初期获得满意的矫正视力，框架眼镜矫正视力与RGPCL比较差异有统计学意义（t=-25.55，P<0.05）。4年后，框架眼镜矫正视力与RGPCL矫正视力差异有统计学意义（t=-30.02，P<0.05）。配戴RGPCL前及4年后圆锥锥顶K值比较差异有统计学意义（t=3.02，P＜0.05），圆锥锥顶厚度比较差异无统计学意义（t=1.46，P＞0.05）。432眼（87.1％）的配适状态为三点接触，46眼（9.3％）为顶点充盈，18眼（3.6％）为可接受的顶点接触。角膜曲率变化情况为，仅3眼（0.6%）陡峭角膜曲率值增加，64眼（12.9%）扁平角膜曲率值增加。随访期间，所有病例均未弃戴，33眼（6.6％）出现角膜上皮点状着染，未发现角膜缘新生血管，无角膜溃疡等严重并发症。结论圆锥角膜患者配戴RGPCL能获得满意的矫正视力，能延缓圆锥角膜发展，且无严重并发症发生。

Effect of rigid gas-permeable contact lenses on keratoconus

Objective To investigate the effect of the rigid gas permeable contact lens （RGPCL） on keratoconus in clinical practice. Methods In this retrospective study, 496 eyes of 260 patients with keratoconus were fitted with RGPCLs at the optometry center of Shenyang Aier Eye Hospital between 2005 and 2009. The patients included 212 males and 48 females. Evaluations were performed on all patients. The follow-up period lasted at least 4 years to assess visual acuity, pattern matching, changes in keratometry, the apex K value, the apex thickness of the cornea and complications. Data were analyzed using a paired t test. Results All patients wearing RGPCLs obtained acceptable vision. There was a statistically significant improvement in corrected visual acuity with RGPCLs compared to spectacles （t=-30.02, P〈0.05） before and after 4 yea~. There was also an apex K value improvement with RGPCLs （t=3.02, P〈0.05） before and after 4 years, but not in the apex thickness of the cornea （t=1.46, P〉0.05）. Four hundred thirty-two eyes （87.1%） had a three-point-touch relationship and 46 eyes （9.3%） had an apical clearance relationship. Eighteen eyes （3.6%） had an apical contact relationship. Keratometry steepness increased in only 3 eyes （0.6%） and 64 eyes （12.90%） had a flat keratometry value that was steeper than before. All patients could wear RGPCLs all day with the exception of 33 patients （6.6%） whose corneas were stained. There were no severe complications like corneal neovascularization, corneal abrasion, or keratohelcosis. Conclusion The successful fit rate of RGPCLs for keratoconus is higher. The RGPCL is safe and effective for keratoconus.