探讨VSL型巩膜镜治疗角膜不规则散光的有效性和安全性。

选取2024年1月至2024年12月在北京大学第三医院眼科行VSL型巩膜镜验配的角膜不规则散光患者10例(11只眼)作为研究对象。其中，男性5例(5只眼)，女性5例(6只眼)；年龄6～44岁，平均(22.4±13.9)岁。根据患者眼部情况进行巩膜镜个性化装配，根据其角膜地形图、前节光学相干断层扫描及裂隙灯显微镜检查来确定VSL型巩膜镜参数以及拟合情况。患者试戴2 h后确认有效且无不适后记录为基线。在戴镜后第1周、第1个月及此后每3个月进行随访，使用标准对数视力表检查患者的最佳矫正视力(BCVA)并测定眼压，行眼前节照相、前节光学相干断层扫描及角膜地形图检查，询问患者戴镜舒适度、眼部症状改善效果及每天人工泪液的使用量。收集患者的病例资料，记录患者性别、年龄、眼别、病史、配镜参数等；检测并记录治疗前后患眼的裸眼视力、BCVA、眼压、屈光度及并发症。以上临床观察指标全部采用频数和百分比进行描述。

所有患者10例(11只眼)随访3～10个月，平均随访(7.0±2.8)个月。所有患者均有不规则散光疾病病史，角膜移植术后者4例(4只眼)，圆锥角膜者8例(9只眼)，分别占36%和82%。在圆锥角膜患者中，K1值范围为39.7～57.8 D，平均值为(45.5±4.8)D；K2值范围为46.1～67.5 D，平均值为(50.6±5.9)D；最薄角膜厚度301～584 μm，平均最薄角膜厚度为(488.3±72.6)μm。患者每日配戴时长范围为6～14 h，平均每日配戴(10.2±2.5)h。在随访过程中巩膜镜矫正后的BCVA为0～0.3最小分辨角的对数(logMAR)，平均值为(0.06±0.11)logMAR，平均增益为(0.52±0.39)logMAR。配戴巩膜镜后自觉视力明显好转者8例(9只眼)，配镜后人工泪液使用量减少者3例(3只眼)，分别占81.8%和27.3%。3例(3只眼)弱视患儿配戴巩膜镜弱视训练后视力提升效果较好。所有患者配戴巩膜镜的舒适度评分平均值为(8.7±1.49)分。其中，评分10分者5例(5只眼)，占45.5%，未见并发症发生。

VSL型巩膜镜能够显著提高角膜不规则散光患者的BCVA，改善患眼不适，具有良好的配戴舒适度和较高的安全性。配戴VSL型巩膜镜对弱视患儿童进行弱视训练可能有助于改善视觉恢复效果。

The aim of this study is to evaluate the efficacy and safety of VSL scleral lenses in the treatment of irregular astigmatism.

A total of 10 patients (11 eyes) with corneal irregular astigmatism who underwent VSL scleral lens fitting at Peking University Third Hospital from January to December 2024 were included. There were 5 males (5 eyes) and 5 females (6 eyes) with an mean age (22.4±13.9) years (ranging from 6 to 44 years). The VSL scleral lenses were customized by optometrists based on patients′ ocular conditions, with parameters determined by corneal topography, anterior segment optical coherence tomography (AS-OCT), and slit-lamp examination to ensure lens fitting properly. Baseline measurements were recorded after a 2-hour trial period confirmed efficacy and absence of discomfort. Follow-up visits were conducted at 1 week, 1 month, and every 3 months thereafter. The best-corrected visual acuity (BCVA) using a standard logarithmic acuity chart, intraocular pressure measurements, anterior segment photography, AS-OCT, corneal topography, patient-reported comfort, ocular symptoms, and daily artificial tear usage were evaluated. The gender, age, ocular history, lens parameters, objective metrics, and subjective feedback were collected. Visual acuity, intraocular pressure, refractive error, BCVA, and complications were analyzed using frequency and percentage distributions.

The mean follow-up duration of all patients (11 eyes) was (7±2.8) months. The indications for scleral lens fitting included irregular astigmatism after corneal transplantation (4 patients, 4 eyes) and keratoconus (8 patients, 9 eyes), accounting for 36% and 82%, respectively. In keratoconus patients, the mean of K1 values was (45.5±4.8)D (ranging from 39.7 to 57.8 D); the mean of K2 was (50.6±5.9)D (ranging from 46.1 to 67.5 D; and the mean of thinnest corneal thickness was (488.3±72.6)μm (ranging from 301 to 584 μm). The mean of daily wear duration was (10.2±2.5)hours (ranging from 6 to14 hours). During follow-up, the best BCVA achieved with scleral lenses ranged from 0 to 0.3 logarithm of the minimum angle of resolution (logMAR), with a mean value of (0.06±0.11) logMAR and a mean improvement of (0.52±0.39) logMAR. After scleral lens fitting, 8 patients (9 eyes) reported significant subjective visual improvement, and 3 patients (3 eyes) showed reduced artificial tear usage, accounting for 81.8% and 27.3%, respectively. Three pediatric patients (3 eyes) exhibited enhanced visual acuity and comfort during amblyopia training with scleral lenses. The mean comfort score was (8.7±1.49) scores, with 5 patients (5 eyes) rating maximum comfort, accouting for 45.5%. No adverse events were observed.

The VSL scleral lenses significantly improved BCVA, alleviated ocular discomfort, and demonstrated favorable wearing comfort and high safety in patients with corneal irregular astigmatism. The VSL scleral lenses may enhance amblyopia training efficacy in children with corneal irregularities.