光学相干断层扫描在角膜塑形镜验配中的应用

Application of optical coherence tomography in orthokeratology fitting

摘要:

目的：通过光学相干断层扫描(OCT)测量角膜塑形镜下泪液间隙厚度，探讨泪液间隙厚度与角膜塑形镜配适度之间的关系，为角膜塑形镜的验配提供一种更直观、量化的临床评估手段。

方法：收集2023-01/12在我院验配角膜塑形镜的近视患者。在进行配镜之前，对所有患者都实施了全面的眼科诊断，涵盖了视力检测、裂隙灯检查、非接触眼压测量、眼底检查、双眼眼位检查、测量角膜直径、角膜地形图检查、泪膜破裂时间评估以及综合验光检查等项目。根据个人的检查结果选择试戴片的参数，待患者戴镜适应后进行荧光素染色配适度评估。将被检眼分为镜片过松组、镜片适配组、镜片过紧组。使用OCT测量三组被检眼泪液间隙厚度，评估三组数据之间差异性。

结果：本研究共纳入近视患者49例77眼。验配前测得平均球镜度为-3.10±1.25 D，平均柱镜度为-0.43(-0.75，0)D，平均水平子午线角膜曲率(HK)为42.48±0.81 D，平均垂直子午线角膜曲率(VK)为42.98(42.25，43.50)D。镜片适配组21例34眼(13例双眼，8例单眼)、镜片过松组14例22眼(8例双眼，6例单眼)、镜片过紧组14例21眼(7例双眼，7例单眼)。三组受检者的主要基础资料比较无差异(均P>0.05)。使用OCT测量得出，镜片适配组、镜片过松组、镜片过紧组泪液间隙厚度分别为231.18(219.0，243.0)、220.41(214.0，224.3)、249.00(241.5，258.0)μm，三组厚度数值比较有差异(P<0.05)。

结论：OCT技术提供了一种安全可靠的测量泪液间隙厚度的方法，它可以帮助评估角膜塑形镜的适配情况，为角膜塑形镜的验配评估提供了一种无创的、更直观和定量的评估手段。

Abstract:

AIM: To assess the gap between the peak of the base curve to the surface of the cornea, as well as examines the correlation between the thickness of the tear film and the fitting of the orthokeratology lens through optical coherence tomography(OCT), providing an intuitive and quantitative clinical evaluation method for the fitting of the orthokeratology lens.

METHODS: Myopia patients who fitted orthokeratology at our hospital from January to December 2023 were included. Examinations, including naked vision, slit lamp, non-contact intraocular pressure, ocular fundus, eye position, corneal diameter, corneal topography, tear film rupture time, optometry, etc., were performed on all patients before fitting. The trial lens parameter was selected according to the examination results, and fluorescein staining was performed to evaluate lens fitting state after patients adapted to wearing glasses. According to the performance of fluorescein staining, the inspected eyes are divided into three groups: lens loose group, lens fitting group, and lens tight group. In addition, the tear film thickness of three groups of subjects was measured by OCT, and the differences between the three groups of data were evaluated.

RESULTS: A total of 49 myopic patients(77 eyes)were included. The average sphere degree was -3.10±1.25 D, the average cylinder degree was -0.43(-0.75, 0)D, the average horizontal keratometry(HK)was 42.48±0.81 D, and vertical keratometry(VK)was 42.98(42.25, 43.50)D. There were 21 cases(34 eyes)in the lens fitting group, with 13 cases of bilateral eyes, 8 cases of one eye, 14 cases(22 eyes)in the lens loose group, with 8 cases of bilateral eyes, 6 cases of one eye, and 14 cases(21 eyes)in the lens tight group, with 7 cases of bilateral eyes, 7 cases of one eye. There was no statistical difference in the main basic data of the subjects in the three groups(all P>0.05). OCT showed that the tear film thickness of the lens fitting group, the lens loose group, and the lens tight group was 231.18(219.0, 243.0), 220.41(214.0, 224.3), and 249.00(241.5, 258.0)μm, respectively, and there was statistical significance in the thickness among the three groups(P<0.05).

CONCLUSION: OCT can serve as a safe and reliable method for measuring the tear film thickness, which can help evaluate the suitability of orthokeratology and provide a non-invasive, more intuitive, and quantitative evaluation method for the fitting and evaluation of orthokeratology.