TAP CHl Y D I / O C L A M SANG 108 Tap 12-S6 3/2017
Dac diem cua loan th| khong deu do seo giac mac sau ch4n thtfotig va ket qua dieu chinh bang kinh tilp xue crnig
Characteristics of irregular astigmatism due to eye trauma and the results of correction with hard contact lens
Nguyin Dire Anh*, *TnrdngDgi hgc YHa Ngi Vu Khanh Toan** **Trudng Dgi hgc YHai Phong TomtSt
Muc tiiu: Danh gia dac diem ciia loan thi khdng deu do seo giac mac sau vet thuang xuyen va hieu qud dieu chinh loan thi bang ki'nh tiep xue cdng d cdc benh nhdn kham tai Binh vien Mdt Trung uong. Ddi tugng vd phuang phdp: Cae benh nhan loan thj khdng deu do seo giac mac sau vet thuong xuyen va thj lUc tdng vdi chinh ki'nh gpng hoac kinh tiep xiic. Nghien edu thuc nghiim Idm sang khdng ddi chdng, sddung kinh tiep xiic Cling UVl cua cdng ty SEED (Nhat Bdn). Cdc thdng so nghien cdu gdm seo gidc mac (do day, vi trf, hinh thai), tdt khiic xa, thi lUc trudc va sau dat ki'nh ti^p xiic d thdi diem kham va sau 2 tuan, 1 thang, 3 thang. Kit qud. Cd 27 mdt (27 benh nhan) tudi trung binh la 23,8 ± 10. Seo trung tdm chiem 44,44%, kich thudc tU 1,7 den 8,0mm. 81,48% la seo dOn gidn, 51,85% Id seo mdng. Dp eau trung binh la -0,02 + 0,98 D (seo trung tdm) va +0,45 ±0,93 D (seo ngoai tdm). Dd try trung binh la-1,60+ 0,51 D (seo trung tam) va-2,48 ±1,1 D (seo ngoai tdm). Thj luc khdng kinh (logMAR) > 0,48 cd 19 mat, thi lUc 0,48 d^n 0,18 ed 8 mat, khdng cd mat ndo cd thj lUe
< 0,18, thj luc trung blnh la 0,69 ± 0,30. Vdi kinh tiep xiic thi 9 mat dat thi lUc < 0,18 va 5 mdt dat thj lUc 0/*8 den 0,18, vdi thj luc trung binh la 0,29 ± 0,29. Kit ludn: Tat ca cdc trUdng hpp loan thj gidc mac do vet thuong xuyin trong nghien cdu deu dupe cdi thien thj lUc dang ke vdi kinh tiep xiic cdng. Thi lUc ti^p tuc tang d cdc thdi diem theo ddi tU 1 den 3 thang. Kinh tiep xue cdng nen dung de chinh quang hpc eho nhdng b i n h nhan loan thj do seo gidc mac do vet thuong xuyin.
Tdkhda: Loan thi khdng d^u, seo gidc mac, kinh tiep xue cdng.
Summary
Objective: To assess the characteristics of irregular astigmatism due to corneal scarafter penetrating injury and the efficacy of correction w/ith RGP lens in patients ofthe National Institute of Ophthalmology.
Subject and method: Patients with irregular astigmatism due to corneal scar after penetrating injury and VA could be improved with correction. This is an experimental, uncontrolled clinical trial using RGP lens of Seed company in Japan). Assessment includes corneal sears (thickness, position, morphology), refractive errors, VA before and after eontart lens insertion, and at tw/o weeks, one month, and three months. Results: The study includes 27 eyes of 27 patients, average age of 23.8 ± 10. Corneal scars central region accounted for 44.44%, size ranging from 1.7 to 8.0 mm. 81,48% was a simple scar, 51,85%
was a thin scar. Average sphere was -0.02 ± 0.98D (central scar) and +0.45 ± 0.93D (peripheral scar).
Average cylinder was -1.60 ± 0.51 D (center sear) and -2.48 ± 1.1D (peripheral scar). 19 eyes had uncorrected VA (logMAR) > 0.48, and 8 eyes had VA from 0.48 to 0.18, no eye had VA <0.18, average VA
Ngdy nhgn bdi. 12/3/2017. ngdy chdp nhdn ddng- 23/3/2017
Ngudi phdn hdi: Nguyen £>uc Anh, Email: [email protected] - Trudng Dgi hoc YHa Ngi
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N''3/20t7 was 0.69 ± 0.30. With RGP lens, nine eyes had VA <0.18 and five eyes achieved VA of 0.48 to 0.18, average VA was 0.29 ± 0.29. Conclusion: VA w/as significantly improved RGP lenses all eases of irregular astigmatism due to corneal scar. VA also improved at follow-up visits at one month and three months.
RGP lenses recommended for patients with irregular astigmatism due to corneal scars.
Keywords: Irregular astigmatism, corneal scar, RGP lens.
1 . Oat va n de
Kinh ti^p xue {KTK) Id mdt trong nhdng phuong phdp dieu ehlnh tat khiic xa da dUpc sd dung phd bien tren the gidi va hien nay bat dau phd bien d V i i t Nam. Mdt trong nhiJfng chi djnh cua KTX la di dieu chinh loan thi vd ed the dp dung cho nhdng trudng hpp loan thj khdng deu do seo giac mac sau chan thuang. Viec dieu chinh khiic xa bang kinh gpng hoac phau thuat d nhdng mat bj seo giac mac Id mdt van de khd khan do thudng khdng dem lai ket qud. Tren the gidi dd cd nhieu nghien cdu sCr dung KTX de chinh loan thi cho nhdng b i n h nhdn seo gidc mac [1 - 9]. Tuy n h i i n , d Viet Nam chda cd nghien edu ve viec sd dung KTX t r i n benh nhdn loan thj khdng d^u do vet thuang xuyen. Nghien cdu nay nham muc tieu Ddnh gid ddc diim cda logn thi khong diu do seo gidc mgc sau chdn thuang vd hiiu qud dieu chinh logn thi bdng KTX cdng 6 cdc binh nhdn din khdm tgi Binh viin Mat Trung uang.
2. D6\ tUdng va phUtfng phap 2.1. Ddi tupng
Ddi tupng n g h i i n cdu la nhdng benh nhan loan thj do seo giac mac sau vet thuong xuyen va thj lUc cd tang vdi kinh gpng hoac KTX. Nghien edu loai t r d cdc benh nhdn cd b i n h 1;^ tai mat khac gdy gidm thj luevd ede b i n h nhdn khdng the kham lai theo hen.
2.2. Phuang phdp Thiet ke va ed mau nghien edu.
Nghien ciiu thue nghiim Idm sang khdng ddi chdng.
Cd mau duoc tinh theo cdng thdc:
n - 7 2 Pa
Trong dd: Z^(1-a/2): Thu dupc XiS bang Z tUdng dng vdi a = 0,05 thi Z = 1,96, p (= 0,925) la t^ l i thdnh
cdng khi dat YJY. tren benh nhan. e la sai sd Udc lUong, chpn e = 0,1. Thay eac chi sd vao cdng thUc t r i n ta thu dupc: n - 26,6. Chiing tdi chpn n = 27 mat.
Thdi gian vd dia diim nghiin cdu
Nghien cdu dUde thdc h i i n tai Khoa Khuc xa vh Khoa Ch^n thuang Benh v i i n Mdt Trung UOng tir thdng 12 - 2014 den thang 9 - 2015.
Phuang tiin nghiin cdu
KTX dupc sd dung trong nghien cdu la kinh ciing UVl cua cdng ty SEED (Nhdt Ban). Kinh cd cdc thong so sau: Khd nang truyen khi 60 x 10"'McmVsee). Chiet suat:
1,455. Cdng suat +5,0 D ~ -25,0 0. Ban kinh cong:
5,0mm ~ 9,00mm. DUdng kinh: 9mm va 10mm. Dp day trung tam: 0,17mm. Khd nang truyen sang: 91 %.
Qui trinh thuc hien: Hdi benh sd, do thj lUcva khuc xa, khdm sinh hien vl. Danh gia khd mdt. Do bdn kinh cong giac mac di chpn KTX thich hpp. Dat t h d KTX trong 15 d^n 30 phiit. Khdm lai di danh gia sU dmh tam eua KTX, chuyen ddng ciia kinh khi chdp mdt, trang thai eua kinh vd nude mat. Do khuc xa vdi KTX d t r i n mat di xdc dinh cdng suat kinh chinh xac.
D o lai thj lUc vdi KTX. Neu thj luc khdng tdng thi loai khdi n g h i i n edu. Benh nhan dUde kham lai sau 2 tuan, 1 thdng, vd 3 thang.
Seo giac mac dupe phan loai theo eac yeu x6:
Kich thudc (nhd: < 3mm, Idn: > 3mm), do day [seo mdng: < 1/2 chieu day gidc mac, seo ddy: >1/2 chieu day giac mac), vj tri (ngoai tam: Cach true quang hoc
> 3mm, trung tdm: Cach true quang hpc < 3mm), hinh thdi (dan gidn: Do 1 dUdng rach giac mac, phiJc tap: Do > 2 dUdng rdeh).
Thi lUe dupe do bang bang Snellen va chuyeri thanh diem so LogMAR. Phdn loai thj Idc theo To chdc Y te The gidi (1997): logMAR > 0,48 (tuang iJng
< 20/60) la thj luc kem, logMAR t d 0,48 den 0,18 (20/60 d^n 20/30) la thj lUc trung binh, logMAR <
0,18 (> 20/30) la thj luc tdt.
TAP CHf Y Dl/OC LAM SANG 108 Tapl2-S63/2017
XdHsoliiu
Sd lieu dupc xd \-y bdng phan mem SPSS 22.0. SCf dung kiem djnh x\ t-test, va Fisher Exact d i ' ddnh gia su khac biet gida 2 1 ^ le.
Dgo ddc nghien cdu
Tat ca ede ddi t u o n g n g h i i n cUu dupe giai thich rd muc dich cCia nghien cdu va nhdng tac hai hoac dnh hudng ed the xdy ra khi tham gia nghien cdu.
Cdc ddi tupng nghien edu deu tU nguyen tham gia.
3. K^t qua
Ddc diem doi tugng nghiin cdu
Nghien cdu bao gdm 27 mat cda 27 b i n h nhan, trong dd ed 18 benh nhdn nam (66,67%) vd 9 b i n h nhan n d (33,33%), su khac b i i t t y le nam vd n d khdng cd y nghla thdng ke (p>0,05).
Doi tupng nghien edu ed tuoi nhd nhat la 8 tudi va Idn nhat Id 42 (trung binh la 23,8 ± 10,0), trong do
t j le eao nhat Id d d tuoi t d 20 den 40 vdi 17 benh nhan (62,97%). Nhdm tudi < 20 ed 9 b i n h nhdn (33,33%), nhdm tudi tren 40 ehi cd 1 benh nhdn (3,70%). Su khdc biet gida cae nhdm cd y nghTa thdng ke(p<0,01).
Ddc diim cda seo gidc mgc Vj tri va kich thUdc seo giac mac.
Cd 12 mdt (44,44%) cd seo d trung tdm vd 15 mat (55,56%) mat cd seo d ngoai tam. 14 mdt ed seo nhd va 13 mdt cd seo Idn, kich thUdc seo nhd nhat la 1,7mm va Idn nhat Id 8,0mm. SU khac biet v ^ v j trf vd kfch thude seo khdng ed y nghTa thdng ke (p>0,05).
Kich thudc trung blnh ciia nhdm seo trung tdm la 2,76 ± 0,68mm, kich thudc trung binh eua nhdm seo ngoai tam la 4,24 ± 1,92mm. SU khac b i i t kich thUde eiia seo trung tdm va ngoai tam cd y nghla thong k i (p=0,013)(Bang1).
Bilng 1 . Vj tri va kich thudc seo gidc mac
^ ^ ~ ~ ~ - ^ ^ _ ^ Vj tri KfchthllAc ~ ~ ~ ^ — - _ _ _ Nh6(s3mm)
Ldn {> 3mm) TSngl%l
Trung tam 8 4 12 (44,44)
Ngoai tam 6 9 15 f55,S6;
Tdng(%) 14(51,85) 13(48,15) 27(100)
Vi trivd hlnh thdi seo gidc mgc
Cd 22 mat (81,48%) cd seo don gidn va 5 mat (18,52%) cd seo phdc tap, sU khdc b i i t la cd y nghTa thdng ke (p=0,01). Toan bd 5 m I t cd seo phdc tap
deu d vi trf ngoai tam, trong 22 mat ed seo don gidn thi 12 mat cd seo d trung tam va cd 10 mdt cd seo d ngoai tdm (Bdng 2).
Bdng 2. Vj tri vd hinh thai seo giac mac
~~~-~~___^^ Vj tri Hinh thai ~ ^ ^ - ^ Phiictap
Bon gian TonJ(%)
Trung tSm 0 12 12(44,44)
Ngoai tam 5 10 1S(5S,56)
Tdng(%) 5(18,52) 22(81,48) 27(100)
JOURNAL OF 108 • CLINICAL MEDICINE AND PHARMACY
Dp ddy seo gidc mgc
Seo mdng gap d 14 m^t (51,85%) va seo day gap d 13 mat (48,15%). Khdng cd sU khac biet gida cd •} nghTa thdng ke gida 2 nhdm seo giac mac theo dp ddy (p>0,05). Trong 14 mdt seo mdng thi 10 mat cd seo trung tdm va 4 mdt cd seo ngoai tdm. 6 13 mat seo ddy thi 2 mat ed seo trung tam va 11 mat cd seo ngoai tam.
Tdf khucxg vd vi tri seo gidc mgc
Dp cau trung blnh cCia nhdm seo trung tam la - 0,02 ± 0,98 D, eiia nhdm seo ngoai tam la + 0,45 + 0,93 D, sU khde biet nay khdng cd "y nghTa thdng ke (p>0,05). Do tru trung binh ciia nhdm seo trung tam la -1,60 + 0,51 D, cLia nhdm seo ngoai tam Id-2,48 ± 1,1 D. SU khdc b i i t ndy ed y nghTa thdng ke (p<0,05) (Bang 3).
Bang 3. Tat khuc xa va vj tri seo giac mac
~ ~ ^ ~ — ~ ~ - ^ _ ^ Vi trf 0 6 K X ^ ~ ~ ~ ~ - ^ — ^ _
Cau (D) Tru (D)
Trung tam -0,02 ± 0,98 -1,60 ±0,51
Ngoai tam + 0,45 ± 0,93
-2,48 ±1,10
P 0,22 0,01
Thi luc vdi KD(
Trong so cdc mat n g h i i n edu, nhdm cd thj lUe kem (> 0,48) ed 19 mat, nhdm cd thj lUc trung binh (0,48 den 0,18) cd 8 mdt. Khdng cd mat ndo thudc nhdm thj luc t d t (<0,18). Thj luc logMAR trung binh eCia ede mat khi chUa cd kinh chinh la 0,69 ± 0,30.
Vdi KTX dieu chinh, cd 9 mat dat thi luc tdt, so mat thi lUc trung binh gidm xudng cdn 5 mat. Thj luc trung blnh vdi KTX la 0,29 ± 0,29. Ngay sau khi chinh KTX thi thj luc cda ede benh nhan da cai t h i i n trung binh 3,52 ± 1,34 ddng. Khdng ed b i n h nhan nao khdng dat duac sU cdi t h i i n thj lUc vdi KTX, co 1 b i n h nhan dat dupe su cai thien len den 8 ddng thj luc so vdi khdng deo kinh (Bdng 4).
Bang 4. Cdi thien thj lUc vdi KTX Thi iuc
Kem Trung binh Tot
LogMAR trung blnh
Khong iti'nh n (%) 19(70,37)
8 (29,63) 0 0,69 ± 0,30
Vori KTX n (%) 13(48,15)
5(18,52) 9(33,3) 0,29 ±0,29
Thi luc d cdc thdi diem theo ddi
Sau khi dupe dieu ehfnh bang KTX, sd mat cd thj luc kem gidm dan t d 9 mat d Ian kham dau xudng 7 mat tai thdi diem kham lai 1 thang va den 3 thdng thi chi cdn 5 mat (1 b i n h nhdn cua nhdm nay khdng tdi khdm d thdi diem 3 thang vi ly do mat kfnh). So mat d nhdm thj lUc trung binh khdng cd su thay ddi
(van ed 5 mat). Nhdm ed thj lUc t o t thi tang dan tir 13 mat d Ian kham dau len 15 mdt sau 1 thdng va len tdi 16 mdt sau 3 thang (Bleu do 1). Thi life t r u n g blnh d Ian kham dau tien vd sau 2 tuan khdng thay ddi (0,29 ± 0,29). Thj luc trung binh eac t h d i diem 1 thang va 3 thang ldn lUpt la 0,27 ± 0,28 vd 0,25 ± 0 , 2 7 .
TAPCHfYOaqc LAM SANG 108 Tapl2-S6 3/2017
Kham Ian dau 2 tuin 1 thang 3 Uiang
• >048 •0.46 din 0.18 •<018 Bieu do 1 . Thj luc vdi KTX tai cdc thdi i^em theo ddi
Ddnh gia mdc dp cdi thien thj lUc vdi KTX eho t d t la 21 mat (77,77% vd 80,76%). Sd mat cd thi luc thay cd 19 mat (70,37%) thi lUc tang t d t (£ 3 ddng), 8 tang trung blnh tuong dng d thdi diem 1 thdng vd 3 mat (29,62%) thj lue tdng trung binh (1 - 2 ddng). thang la 6 mdt (22,22%) va 5 mat (19,53%) (cd 1 Khdng cd mdt ndo khdng tang thj lUc. Tai cac thdi benh nhan khdng tai kham vi mat kfnh).
diem 1 thang va 3 thang thi sd mat cd thj luc tang
Bdng 5. Cdi t h i e n t h j lUc vdi KTX ai thien t h i iUc
Tot (tang > 3 dong) Trung blnh (tang 1 - 2 dong)
Tong So dong tang (trung binh)
l.an Icham dau 19(70,37%)
8 (29,62%) 27(100%) 3,52 ±1,34
1 t h a n g 21 (77,77%)
6 (22,22%) 27(100%) 3,67 ±1,44
S t h ^ n g 21 (80,76%)
5(19,23%) 26 (100%) 3,81 ±1,59
4. Ban luan
4.1. Dac diem cua doi tUdng nghien curu Trong nghien edu nay, ty le nam gidi la 66,67%
(18 b i n h nhan) eao hdn X^ le gap d n d gidi 33,33% (9 benh nhdn). Ty l i n a m / n d = 2 / 1 . Ket qua nay la tuong duang vdi Okan B (2000) bao gdm 12 nam vd 5 nd [1]. N g h i i n cdu Titiyal JS cd t^ le n a m / n d = 2,3/1 (p-0,01) [2]. Nghien cdu ciia Zheng B (2015) cung CO 12 nam (66,67%) va 6 nO (33,33%) [2]. Trong nghien cdu ndy, tudi trung blnh ciia cdc ddi tupng ia 23,8 ± 10,0. Ket qud nay phu hpp vdi mdt sd nghien cdu khdc: Okan B dat KTX RGP tren mdt cd seo giac mac d 17 benh nhdn cd dp tuoi t r u n g blnh la 29,80
± 2,90. Trong nghien cdu eua Titiyal JS t r i n 40
b i n h nhdn t h i dp t u d i t r u n g binh eiia Id 16,40 ± 9,04 tuoi [2]. Cdn t r o n g n g h i i n edu cCia Zheng B (2015) ddt KTX dieu chinh loan t h j gidc mac sau chan t h u a n g d 18 benh nhdn thi dp t u o i t r u n g binh id 20,9 ± 1 3 , 4 t u o i [3].
4.2. Dac diem cua seo gidc mgc
Todn bd 5 mat cd hlnh thdi seo gidc mac phdc tap deu la nhdng benh nhan cd kfch thUdc seo Idn (> 3mm) va ndm d ngoai tam. Cdn trong 22 mdt ed hlnh thai seo ddn gidn cd 12 mat (54,55%) d trung tam va 10 m^t (45,45%) d ngoai tam. Do n g h i i n edu nay loai t r d nhdng b i n h nhan cd t o n thuang phdi hpp ciia phan sau nhdn cau nen nhdng benh nhdn cd tdn thuang tai trung tdm gidc mac ciia chung toi
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''3/2017
deu cd tdn thuong nhe vd vda. Do dd hlnh thai seo ciia nhdm trung tdm khdng gap nhijYig mat cd seo phdc tap.
Trong nghien cdu nay, 11/13 mat (84,61%) cd seo day nam ngodi trung tdm cua gidc mac, chi ed 2/13 mdt (15,39%) seo day d trung tam. Nguoc lai thi ede mat ed seo mdng lai d trung tam nhieu ban vdi 10/14 mdt (71,42%) vd ehi cd 4/14 mat (28,57%) ed seo mdng d ngoai tam. Sd khac b i i t Id cd y nghTa thong k i (p<0,05). Do nhdng mat cd seo tai trung tdm deu bj ton thUdng d mdc dp nhe va vda nen ehi ed 2/13 mat la cd seo day. Cdn nhdm seo ngoai tam thi cd den 11/13 mat Id seo day.
4.3. Dgcdiem cda tat khucxg
Bdng 3 cho thay dd edu trung binh eCia nhdm seo trung tdm la -0,02 ± 0,98 D, cOa nhdm seo ngoai tam la + 0,45 ± 0,93 D. Dp tru trung blnh cua nhdm seo trung tdm la -1,60 ± 0,51 D, cCia nhdm seo ngoai tdm la -2,48 ± 1,1 D. Ket qud ndy thap han so vdi Zheng B va cdng sU (2015) vdi dp loan thj gidc mac trung binh cua 18 mat la -3,44 ± 2,09 D (dao ddng trong khodng -0,75 den -8,00 D) [3]. K^t qud nghien edu eua Pradhan ZS va cdng sU (2014) tren 12 mat cua 12 be trai cd seo gtde mac sau chan thuong, eung eho ket qua dp loan thi gidc mac eao hon ehung tdi vdi dp loan thi trung binh la -4,28 ± 2,0 D [6]. Do da sd cac seo ldn (9/13) va phdc tap (5/5) deu d ngoai tam vi t h ^ lam cho dp tru cua nhdm seo ngoai tdm (-2,48 + 1,10 D) Idn ban eiia nhdm seo trung tam (-1,60 ± 0,51 D) vdi p<0,05.
4.4. Hieu qua cua KTX doi vol thi lUc Ket qud d Bdng 4 cho thdy ngay sau chinh KTX thi sd mat cd thj luc kem da gidm t d 19 mat xudng cdn 9 mat. 0 nhdm thj luc trung binh thi sd mat cung gidm t d 8 mdt xudng cdn 5 mdt. 6 nhdm thj lUc t d t thi cd sU thay doi rd ret, tU cho khdng ed mat nao tdng len 9 mat. Ket qud nay tuang ddng vdi nhieu nghien cdu khde: Titiyal JS [3] dat KTX eho 40 benh nhdn h\ seo giac mac sau chan thuang cho thay sau khi chinh KTX ed 37 m^t (92,5%) dat dUpc thi luc ndy (p<0,001). Jeewan TS [4] ddt KTX RPG cho 28 mat cCia 26 benh nhan cho thay ed tdi 50% benh nhdn dat dude thj luc t d 20/30 t r d len.
Thi luc trung blnh vdi KTX cung tang d cac Ian tai kham. Cf Ian kham dau tien va sau 2 tuan thi thi lUc la 0,29 ± 0,29; nhUng d thdi diem 1 thang va 3 thang thi thj lUc trung binh tang len Ian luat la 0,27
± 0,28 va 0,25 ± 0,27. Nhdm mat thj luc kem cung gidm dan t d 9 mat d Ian kham dau, den 3 thdng chi cdn 5 mdt. Nhu vay thj luc khdng nhOfng cdi thien ngay sau khi deo KTX ma cdn tiep tyc dUpc edl thien trong thdi gian deo kfnh. 6 nhdm mdt thi lUc trung binh thi cd 3 mat chuyen sang nhdm thi luc tot.
Trong khi dd, sd m I t ciia nhdm thj lUc tdt tdng tU 13 mat d Ian kham dau len 15 mat sau 1 thang va 16 mat sau 3 thdng. Theo chiing tdi, ket qud ndy cd the la do su thfch nghi cua b i n h nhdn vdi KTX. Khi mdi deo KTX thi benh nhan edn cdm thay com, vudng va chdy nudc mat do su kfch thfch, ede trieu chCi'ng nay cd the ton tai trong khodng 1 - 2 tuan. Do dd khi hudng dan benh nhan deo KTX, chung tdi khuyen benh nhan n i n bat dau deo kfnh vdi thdi gian khodng 6 gid/ngay sau dd tdng dan len 8 - 10 gid/ngay tCiy theo nhu cau cdng v i i c cua benh nhan.
Sau khi mdt thich nghi dUpc vdi KTK thi cdc triiu ehdng t r i n se mat di, nhd dd thj lUc tiep tuc dupc cai thien. Khi benh nhdn hoan toan thich nghi vdi KTX thi thj lUe se t r d thanh dn djnh. Kanpolat A [7] dat KTX eho 26 b i n h nhan ed seo gidc mac eho ket qua 12/26 benh nhdn (46,15%) dat duac thi lUc 0,18 trong thdi gian theo ddi trung binh 10,1 thdng.
Bang 5 cho thay sau khi chinh KTX thi cd 19 mat thj lUc tdng > 3 ddng va 8 mat thj lUe tang 1 - 2 ddng. Khdng ed mat nao khdng tang thj lUe vdi KT)(.
Tai eac thdi diem 1 thang va 3 thang thi nhdm cdthj lUe cai thien t d t vdi KTX tang len Id 21 mdt. Nhdm co thi lUc cdi t h i i n trung blnh giam xudng cdn 6 mdt tai thdi diem 1 thdng vd 5 mat tai thdi di^m 3 thdng. Ve mdc dp tdng thj lUc trung binh thi d thdi diem kham dau tien thj luc tdng 3,52 ± 1,34 ddng so vdi thi lac khdng kinh, tang 3,67 ± 1,44 ddng d thdi diem 1 thdng va 3,81 ± 1,59 ddng d thdi diem 3 thdng. Co 1 benh nhdn thj luc tdng dupe 8 ddng. Nghien cdu cDa Luo WL va cdng su [8] eung cho thay cd sUeai thien thj lUe vdi KTX d tat cd cac nhdm benh nhdn loan thj khdng deu do seo gidc mac. 6 nhdm thj Idc 0,18 den 0,097 thi KTX cai t h i i n thj lUc trung binh 1 ddng.
TAP CHlYDUOC LAM SANG108 Tap 12-563/2017
nhdm ed thj luc 0,30 cd tang trung blnh 2 ddng, 2.
nhdm thi luc t d 1,00 den 0,40 cd tang trung binh la 4 ddng. Nhdm thj lUc 1,30 cd tang trung blnh 6 ddng.
5. Ket luan
N g h i i n edu cho thay loan thj khdng deu ed seo trung tdm chiem 44,44%, vdi kfch thudc khde nhau, 81,48% la seo ddn gidn, 51,85% la seo mdng. Dp eau i.
trung binh la -0,02 ± 0,98 D (seo trung tam) va -i-0,45
±0,93 D (seo ngoai tam). Dp tru trung binh la-1,60 ± 0,51 D (seo trung tam) va -2,48 ± 1,1 D (seo ngoai 5.
tam). 70,37% ed thi lue khdng kfnh d mde kem, khdng cd mat ndo d mdc thi luc tot. Vdi KTX thi 18,52% dat thj lUc trung binh va 33,3% dat thj Idc d 6.
mde tdt. Thj lUe vcri KTX t i ^ p tuc tang d eac thdi diem theo ddi 1 thang va 3 thang. K^t qud chdng t d viec dieu chinh loan thj giac mac bang KD( cUng cd h i i u 7.
qud d nhOng benh nhan loan thj do seo giac mac sau vet thuang xuyen.
Tai lieu tham khao
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