摘要
目的观察不同设计角膜塑形镜配戴后角膜散光的变化，以及对视觉质量的影响。方法病例对照研究。分3组观察戴镜前后的角膜散光、角膜地形图、角膜波前像差（Pentacam）、视力以及视觉干扰症状。A组30眼，低度角膜散光戴常规设计角膜塑形镜，获良好配适状态；B组30眼，低度角膜散光戴常规设计角膜塑形镜，配适状态不良，有明显偏位；C组31眼，中高度角膜散光戴toric设计角膜塑形镜，配适状态尚好。采用SPSS16．0进行统计学分析。结果戴镜后角膜散光B组增加，A组及C组有降低。角膜地形图傅立叶转换．3组非对称性散光增加3mm区分别为（-0．393±0．329）D，（-4．050±2．084）D和（-0．494±0．522）D，P均〈0．01；3组高阶性散光增加3mm区分别为（-0．011±0．055）D（P〉0．05），（-0．635±0．441）D（P〈0．01）和（-0．055±0．082）D（P〈0．01）。3组3mm区规则性散光、非对称性及高阶散光的差值比较有统计学意义（F=79．862、83．882、54．265，P均〈0．01）。3组总体像差和总高阶像差，戴镜后均有不同程度增高，以B组最明显。各像差的差值比较中，仅前球差有统计学意义（F=18．048，P〈0．01）。患者摘镜后裸眼视力，A组中36．7％为1．2，50．0％为1．O，13.3％为0．8，均无明显视觉症状；B组中36．7％为1．0．46．7％为0．9．0．8．13-3％为0．6-0．5，3．3％为0．4，47％有虚影、重影、眩光等视觉干扰症状；C组中9．7％为1．2，51．6％为1．0，16．1％为0．9。0．8，22．6％为0．6，16％有视觉干扰症状。3组视力比较差异有统计学意义（X^2=20．252，P〈0．01）。结论角膜塑形镜的设计和配适状态明显影响角膜散光与视觉质量，适宜的Toric设计镜片可有效改善中高度角膜散光眼的配适，提高降低近视与散光度的角膜塑形效果。
Objective To observe the changes in corneal astigmatism after patients are fitted with different ortho-k contact lens （CL） designs and the influence of these lenses on visual quality. Methods In a case-control study, corneal astigmatism, corneal topography, wavefront aberrations （Pentacam）, visual acuity and visual disturbance symptoms were observed in three groups （groups A, B, C） before and after CL wear. Group A （30 eyes） had lower corneal astigmatism and wore a general ortho-k contact lens design that fit quite well; group B （30 eyes） had lower corneal astigmatism and wore a general ortho-k contact lens design that did not fit well and was obviously decentered; group C （31 eyes） had higher corneal astigmatism and wore toric ortho-k contact lenses with an acceptable fit. SPSS 16.0 statistical software was used to analyze the data. Results Changes in corneal astigmatism after fitting with the ortho-k CL： astigmatism increased in group B but was lower in groups A and C. Fourier analysis from corneal topography： increases in asymmetry for all three groups at 3 mm were （-0.393-_~0.329）D, （--4.050±2.084）D, and （-0.494±0.522）D, respectively, all at P〈0.001. Higher order aberrations in the three groups increased at 3 mm and were （-0.011± 0.055）D （/9〉0.05）, （-0.635±0.441）D （P〈0.001） and （-0.055±0.082）D （P〈0.01）. The three groups at 3 mm regular：differences in the comparison of astigmatism, asymmetry and higher order aberrations were statistically significant, F=79.862, F=83.882, F=54.265, respectively, all at P〈0.01. After fitting with ortho-k CLs, the total aberrations and total higher order aberrations for the three groups increased in varying degrees, with group B as the most significant. A comparison of the difference in aberrations： only the anterior surface of the spherical aberration had a statistically significantdifference （F=18.048, P〈0.01）. After the CLs were removed： in group A 36.7 % achieved a UVA of 1.2, 50.0% achieved 1.0 and 13.3% achieved 0.8; in group B 36.7% achieved 1.0, 46.7% achieved 0.9-0.8, 13.3% achieved 0.6-0.5, and 3.3% achieved 0.4; in group C 9.7% achieved 1.2, 51.6% achieved 1.0, 16.1% achieved 0.9-0.8 and 22.6% achieved 0.6. There were statistically significant differences in UVA between the three groups （X^2=20.252, P〈0.01）. Patients reported a variety of visual disturbance symptoms such as ghost, fringe, glare, etc. In group A, 0% reported visual disturbance symptoms, with 16% in group C and 47% in group B. Conclusion Ortho-k contact lens design and fitting significantly impact corneal astigmatism and visual quality. Appropriate ortho-k CL toric designs can be highly effective for improving the CL fitting and enhancing the corneal reshaping effect for some higher order corneal astigmatisms.
出处
《中华眼视光学与视觉科学杂志》
CAS
2013年第2期79-83,共5页
Chinese Journal Of Optometry Ophthalmology And Visual Science
