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目的探讨各类接触镜在矫正不同儿童屈光异常眼病中的临床有效性和安全性。方法具体分析几种疑难性屈光性儿童眼病的接触镜选择、验配、使用方法,对比框架眼镜的矫正效果并观察戴镜后屈光度改变和眼部反应。结果(1)35例(62眼)圆锥角膜(包括穿透性角膜移植术后)患儿全部选择配戴了透气性硬性接触镜(RGPCL)。RGPCL 矫正视力(RGPVA)≥0.8者占70%,按轻、中、重度分组,各组RGPVA 均显著高于框架镜矫正视力(SPVA)。戴镜1.5年左右复查,可见部分病例近视度和散光度降低,部分视力尚有提高。(2)眼外伤术后51例(52眼),59.6%使用了软性接触镜(SCL),矫正视力>0.6的比例,框架镜25.8%,SCL 29.1%。40.4% 使用了RGPCL,RGPVA0.7～0.9占23.8%,1.0～1.2占23.8%,SPVA0.7～0.9占14.3%,1.0～1.2占4.8%,并使多数病例恢复了双眼单视。(3)RGPCL 对96只高度散光及高度近视眼,30只近视、散光眼,28例屈光参差矫正效果良好,RGPVA 均高于SPVA,高度散光眼最为显著。21例有复诊记录,近视度平均降低1.16D±0.97D,散光度平均降低1.22D±0.56D,5只眼视力提升1～2行。(4)SCL 用于7例屈光参差,8只高度近视眼和22只近视、散光眼,矫正视力与SPVA 相近,但明显消除了不等像视,扩大了视野。(5)低视力儿童8例(先天性虹膜、脉络膜缺损,先天性白内障术后无晶体,白化病,马凡综合征,眼球震颤,角膜白斑,高度近视,高度散光)选择配戴了加虹膜色彩的SCL 和RGPCL,并配合光学助视器有效提高了功能视力,使患儿能维持正常学习和生活。全部病例均对接触镜矫正满意,未发现明显角、结膜并发症而停用接触镜者。结论充分发挥接触镜的光学矫正优势,可有效提高矫正视力,促进儿童双眼视觉功能发育,并有可能不同程度控制近视和散光发展。儿童对接触镜的接受程度与成人无异,医师与患儿及其家长密切配合下的科学使用基本可保证戴镜安全。
Objective To investigate the clinical efficacy and safety of various types of contact lenses in the correction of refractive abnormalities in children. Methods The contact lens selection, fitting and using method of several kinds of difficult refractive eye diseases were analyzed in detail. The corrective effects of the spectacle lenses were compared and the refraction changes and the eye reactions were observed. Results (1) All of the 35 children (62 eyes) with keratoconus (including penetrating keratoplasty) chose to wear rigid gas permeable lens (RGPCL). RGPVA ≥0.8 accounted for 70% of patients with RGPCL. The RGPVA of each group was significantly higher than that of frame-corrected vision (SPVA) by light, medium and severe grouping. Wearing glasses 1.5 years review, shows some cases of myopia and astigmatism decreased, some still have improved vision. (2) In 51 eyes (52 eyes) after trauma, 59.6% used soft contact lens (SCL), corrected visual acuity> 0.6, 25.8% in frame mirror and 29.1% in SCL. 40.4% used RGPCL, RGPVA 0.7 ~ 0.9 accounted for 23.8%, 1.0 ~ 1.2 accounted for 23.8%, SPVA 0.7 ~ 0.9 accounted for 14.3%, 1.0 ~ 1.2 accounted for 4.8%, and most cases recovered binocular vision. (3) RGPCL had good effect on 96 patients with high astigmatism and high myopia, 30 myopia and astigmatism, and 28 patients with anisometropia correction. RGPVA was higher than SPVA, and the most significant was astigmatism. 21 cases had referral records, myopia decreased by an average of 1.16D ± 0.97D, astigmatism decreased by 1.22D ± 0.56D, 5 eyes improved visual acuity of 1 to 2 lines. (4) SCL was used for 7 cases of anisometropia, 8 high myopia and 22 myopia, astigmatism, corrected visual acuity and SPVA similar, but obviously eliminated the unequal image, expanding the field of vision. (5) 8 cases of low vision children (congenital iris, choroid defect, congenital cataract after surgery without lens, albinism, Marfan syndrome, nystagmus, corneal leukoplakia, high myopia, high astigmatism) choose to wear plus iris color The SCL and RGPCL, and with the help of optical visual aids effectively improve functional vision so that children can maintain normal learning and life. All patients were satisfied with the contact lens correction, no significant angle, conjunctival complications and disable the contact lens. Conclusion Give full play to the optical correction of contact lenses, can effectively improve the corrected visual acuity, promote visual development of children’s binocular vision, and may have varying degrees of control of myopia and astigmatism. Children’s acceptance of contact lenses and adults is no different, physicians and their children and their parents in close cooperation with the basic scientific use of glasses to ensure safety.