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目的分析硬性透气性角膜接触镜(RGPCL)矫正圆锥角膜的视觉质量。方法采用回顾性病例对照研究。18例(36眼)圆锥角膜患者配戴RGPCL后,通过视力、对比敏感度检查评价视功能;通过角膜地形图、波前像差检查分析影响视觉质量的原因。将同期配戴RGPCL、最佳矫正视力达1.0的近视患者9例(18眼)作为对照组。结果所有圆锥角膜患者配戴RGPCL后最佳矫正视力均大于或等于0.6,22眼(61.11%)最佳矫正视力达1.0。与近视组比较,RGPCL矫正圆锥角膜后的对比敏感度在低频段差异无统计学意义(P>0.05),中频段的暗视对比度和高频段的明视、暗视对比度均明显降低(P<0.05)。角膜地形图显示RGPCL使圆锥角膜组角膜散光由(8.25±3.61)D减少至(1.25±0.13)D,近视组角膜散光由(1.28±0.34)D减少至(0.42±0.06)D。经RGPCL矫正后,圆锥角膜组的总高阶像差、慧差、球差的均方根值明显高于近视组(P<0.05)。结论 RGPCL能将圆锥角膜的视力矫正至正常或接近正常,残余散光和高阶像差的存在可能是影响视觉质量的原因。
Objective To analyze the visual quality of keratoconus by rigid gas permeable contact lens (RGPCL). Methods Retrospective case-control study. Eighteen patients (36 eyes) with keratoconus after wearing RGPCL were evaluated by visual acuity and contrast sensitivity. The corneal topography and wavefront aberration were used to analyze the causes of visual quality. Nine patients (18 eyes) with RGPCL and best corrected visual acuity of 1.0 were selected as the control group. Results All patients with keratoconus had the best corrected visual acuity of 0.6 or more (61.11%) and best corrected visual acuity of 1.0 after wearing RGPCL. Compared with the myopia group, the contrast sensitivity of the RGPCL correction keratoconus had no significant difference in the low frequency range (P> 0.05). The contrast in the middle frequency range and the bright and dark contrast in the high frequency range were significantly decreased (P < 0.05). Corneal topography showed that corneal astigmatism decreased from (8.25 ± 3.61) D to (1.25 ± 0.13) D in RGC group and from (1.28 ± 0.34) D to (0.42 ± 0.06) D in RG group. After RGPCL correction, the total high order aberrations, coma and spherical aberration of the keratoconus group were significantly higher than those of the myopic group (P <0.05). Conclusion RGPCL can correct the visual acuity of keratoconus to normal or nearly normal, and the existence of residual astigmatism and higher-order aberrations may be the reason of affecting visual quality.