巩膜镜矫正圆锥角膜的临床效果观察

目的：探讨临床上巩膜镜治疗圆锥角膜的有效性。方法：回顾性研究。选择2020 年10 月至2021 年3月于南京医科大学眼科医院验配巩膜镜的圆锥角膜患者18例（26眼）。根据圆锥角膜AmeslerKrumeich分级，I级9眼，II级3眼，III级4眼，IV级10眼。所有患者均经规范验配程序试戴硬性透气 性接触镜（RGPCL），因RGPCL不耐受、RGPCL适配不佳等原因选择验配巩膜镜。所有患者均进行 视力、屈光度、裂隙灯显微镜、眼底和Pentacam检查等。应用巩膜镜试戴片试戴，分别通过裂隙灯 显微镜观察、荧光素染色及眼前节光学相干断层扫描（OCT）进行适配评估。评估镜片与中央角膜和 周边间隙，以及周边着陆区匹配情况，并评估戴镜后的最佳矫正视力（BCVA）及主观舒适度。采用 Friedman检验进行统计学分析。结果：所有圆锥角膜患者初戴巩膜镜时，裂隙灯显微镜观察示巩膜 镜定位良好。通过前节OCT观察初始角膜中央间隙为（212±58）μm；配戴巩膜镜4 h后，角膜中央间隙为 （164±58）μm，鼻侧为（101±38）μm，下方为（224±135）μm，颞侧为（103±72）μm，上方为（89±45）μm， 镜片边缘结膜血管未见异常。裸眼视力（UCVA）、框架眼镜BCVA、RGPCL配戴后BCVA及巩膜镜 配戴后BCVA（LogMAR）分别为1.35（1.00, 2.00）、0.52（0.22, 0.79）、0.15（0, 0.30）、0.10（0, 0.22）， 各视力差异有统计学意义（χ2 =67.11, P<0.001）。巩膜镜配戴后BCVA较UCVA、框架眼镜BCVA明显 改善，差异有统计学意义（χ2 =59.90, P<0.001; χ2 =31.08, P=0.001）；巩膜镜配戴后BCVA与RGPCL配 戴后BCVA差异无统计学意义（P=1.000）。配戴巩膜镜4 h后，22眼（22/26）主诉戴镜后舒适或非常舒 适；24眼（24/26）主诉戴镜视物良好或非常良好。结论：圆锥角膜配戴巩膜镜定位良好，舒适度也良 好，通过配戴巩膜镜可有效提升矫正视力。巩膜镜是圆锥角膜患者一种有效的治疗方式。

Clinical Effect of the Scleral Lens in the Treatment of Keratoconus

Objective: To investigate the clinical efficacy of the scleral lens in the treatment of keratoconus. Methods: In this retrospective study, 18 (26 eyes) keratoconus patients fitted with a scleral lens in the Eye Hospital of Nanjing Medical University from October 2020 to March 2021 were included. According to the AmslerKrumeich grading of keratoconus, there were 9 eyes with grade I, 3 eyes with grade II, 4 eyes with grade III and 10 eyes with grade IV. All patients were fitted with rigid gas permeable contact lens (RGPCL) by the standard fitting procedure, and a scleral lens was selected due to RGPCL intolerance and poor RGPCL matching. All patients underwent visual acuity, refractive error, slit lamp microscopy, fundus and Pentacam examinations. Scleral trial-lens fitting was evaluated by slit lamp microscopy, fluorescein staining and anterior segment optical coherence tomography (OCT). The central and peripheral corneal clearances were assessed, as well as the peripheral landing area. Corrected visual acuity and subjective comfort were evaluated after wearing a scleral lens. The Friedman test was used for statistical analysis. Results: The scleral lenses were well positioned by a slit lamp microscope when keratoconus patients first wore them. The initial average central corneal clearance was 212±58 μm measured by OCT. After wearing the scleral lenses for 4 hours, the average central corneal clearance was 164±58 μm, the nasal side was 101±38 μm, the inferior side was 224±135 μm, the temporal side was 103±72 μm, and the superior side was 89±45 μm. No abnormalities were observed in conjunctival vessels at the lens edge. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) after wearing glasses, BCVA after wearing RGPCL and BCVA after wearing scleral lenses were 1.35 (1.00, 2.00), 0.52 (0.22, 0.79), 0.15 (0, 0.30), and 0.10 (0, 0.22) (LogMAR visual acuity), respectively. The visual acuity differences were statistically significant (χ2 = 67.11, P<0.001). Compared to UCVA and BCVA after wearing glasses, BCVA after wearing scleral lenses improved significantly, and the difference was statistically significant (χ2 =59.90, P<0.001; χ2 =31.08, P=0.001). There was no significant difference in BCVA between the scleral lenses and RGPCL (P=1.000). After wearing scleral lenses for 4 h, subjective comfort (comfortable or very comfortable) was reported in 22 eyes (22/26), as well as subjective visual acuity (favorable or very favorable) in 24 eyes (24/26). Conclusions: Due to good positioning and comfort, wearing a scleral lens can effectively improve the corrected visual acuity of keratoconus patients. The scleral lens is an effective treatment for keratoconus patients