【摘要】 目的 探讨穿透性角膜移植术后配戴硬性透气性接触镜（rigid gas permeable contact lens, RGPCL）的安全性、有效性及配适特点。方法 19例（23眼）穿透性角膜移植术后患者验配RGPCL，其中后表面球面设计2眼，前后表面非球面设计17眼，特殊圆锥角膜设计4眼，配适状态为近似平行配适和三点接触配适。随访时间6 37个月，平均（14.63±3.92）个月。结果 戴镜视力达到或超过0.8者14眼(60.87%)，0.5以上23眼（100%），显著优于框架眼镜视力（P＜0.01），角膜顶点K值和角膜散光值配戴前分别为（47.18±4.92）D和（6.53±2.26）D，配戴后分别为（45.69±3.04）D及（3.95±1.87）D，均有统计学意义（P＜0.05）；角膜内皮细胞密度配戴前为（773±145）个/mm2，配戴后为（742±205）个/ mm2，差异无统计学意义，未见有明显角结膜并发症发生。 结论 穿透性角膜移植术后应用高DK值RGPCL进行屈光重建效果理想、弹性配戴或连续配戴安全，采用非球面设计、特殊后表面设计的RGPCL更易获得理想配适。
【关键词】 角膜移植 硬性透气性接触镜 屈光 重建
TAO Xiangchen, LI Xin, WANG Zhen, MU Guoying
(Department of Ophthalmology, Jinan Central Hospital, School of Clinical Medicine, Shandong University,
Jinan 250013, Shandong, China)
Abstract: Objective To investigate the safety, efficacy and characteristics of rigid gas permeable contact lens (RGPCL) for correction of ammetropia after penetrating keratoplasty. Methods 23 eyes of 19 patients after penetrating keratoplasties were fitted with RGPCL. Among them, 2 had spherical posterior surface designs, 17 had aspherical designs and 4 had special keratoconus designs. The status was in a flat and three points fitting. All were followed up for six to thirtyseven months. Results All patients achieved visual acuity over 0.5 and 14 even equal or over 0.8, which was significantly different from the best corrected visual acuity with glasses. After wearing RGP, the K value decreased from 47.18±4.92D to 45.69±3.04D and corneal astigmatism from 6.53±2.26D to 3.95±1.87D（P＜0.05）. There were no significant changes in corneal endotheliu. No significant epithelial or corneal complications were observed during the follow up period. Conclusions RGPCL is ideal for refraction reconstruction of ammetropia after penetrating keratoplasty. Both flexible and continuous wearing are safe. It is easier to achieve an ideal fitting state with the aspherical design and special posterior surface design.
Key words: Keratoplasty; Rigid gas permeable contact lens; Refraction; Reconstruction
穿透性角膜移植术（penetrating keratoplasty, PKP）是治疗角膜病盲的有效手段，随着显微技术的不断提高、抗排斥药物的不断研发及角膜特有的“免疫赦免”状态，角膜移植术是所有器官移植成功率最高的手术。但由于术后角膜植床和植片的屈光异常，尤其是角膜高度散光和不规则散光，许多患者术后视力欠佳，有研究［1］表明PKP术后80％患者的视力低于0.5，且难以用框架眼镜矫正，严重影响患者的视觉和生活质量。我们近年来应用硬性透气性角膜接触镜（rigid gas permeable contact lens, RGPCL），用于解决19例（23眼）患者PKP术后屈光不正、视觉差的问题，在矫正角膜高度散光和不规则性散光等方面获得了良好效果，报告如下。
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