• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Visual outcomes of Orbiflex K? lenses in patients with keratoconus

    2016-11-08 09:19:17BerkayAkmazAyseYesimOralBaranKandemirYusufOzerturk
    國(guó)際眼科雜志 2016年11期
    關(guān)鍵詞:圓錐眼科平均值

    Berkay Akmaz, Ayse Yesim Oral, Baran Kandemir, Yusuf Ozerturk

    ?

    Visual outcomes of Orbiflex K?lenses in patients with keratoconus

    Berkay Akmaz1, Ayse Yesim Oral2, Baran Kandemir2, Yusuf Ozerturk2

    1Department of Ophthalmology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir 35360, Turkey

    2Department of Ophthalmology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul 34890, Turkey

    方法:選取研究對(duì)象為2012-11/2013-12在Dr. Lütfi Krdar Kartal培訓(xùn)和研究醫(yī)院確診為圓錐角膜的52例患者80眼。所有患者接受硬性角膜接觸鏡治療,術(shù)后隨訪12mo?;颊叩钠骄挲g為26.1±6.9歲(范圍:15~43歲)?;颊咭勒誂msler-Krumeich分型以及各階段角膜曲率值進(jìn)行分組。在配戴角膜接觸鏡治療前后進(jìn)行裸眼視力(UCVA),最佳矯正視力(BCVA),主觀驗(yàn)光,角膜形態(tài),角膜曲率,中央角膜厚度和生物顯微鏡檢查。

    結(jié)果:角膜橫軸屈光度(K1)平均值為50.25±4.17D,而角膜縱軸屈光度(K2)平均值為53.82±4.81D。K的平均值為52.03±4.42D。UCVA的平均值為1.31±0.21 LogMAR(Snellen 0.05±0.04),戴眼鏡和戴角膜接觸鏡下BCVA的平均值分別為0.79±0.33 LogMAR(Snellen 0.21±0.17)和0.05±0.08 LogMAR(Snellen 0.91±0.13)。比較角膜接觸鏡治療前后的視力結(jié)果,差異有統(tǒng)計(jì)學(xué)意義(P<0.001)。第1,2,3和4階段圓錐角膜患者視力提高平均行數(shù)分別為5.18±1.38(范圍:2~8)行,5.86±1.79(范圍:2~8)行, 6.32±2.16(范圍:3~9)行和6.92±2.35(范圍:3~9)行。

    結(jié)論:OrbiflexK?角膜接觸鏡顯著地改善了所有階段的圓錐角膜患者的視力。

    ?AIM: To evaluate the outcomes of Orbiflex K?(SwissLens SA, Prilly, Switzerland) contact lenses in the visual rehabilitation of patients with keratoconus at different disease stages.

    ?METHODS: This study included 80 eyes of 52 patients who were admitted to the eye clinic of Dr. Lütfi Krdar Kartal Training and Research Hospital between Nov. 2012 and Dec. 2013 with a diagnosis of keratoconus. All patients received a rigid contact lens prescription and were followed up for 12 months. The mean age of the patients was 26.1±6.9y (range:15-43y). The patients were grouped according to the Amsler-Krumeich classification and staging using their keratometric values. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective refraction, corneal topography, keratometry, central corneal thickness measurements, and biomicroscopic examination were performed for all eyes before and after contact lens application.

    ?RESULTS: The mean value of the flat meridian (K1) was 50.25±4.17 diopters (D), whereas the mean value of the vertical meridian (K2) was 53.82±4.81D. The mean K value was 52.03±4.42D. The mean UCVA was 1.31±0.21 logMAR (Snellen 0.05±0.04), and the mean BCVA while wearing spectacles and the contact lens were 0.79±0.33 logMAR (Snellen 0.21±0.17) and 0.05±0.08 logMAR (Snellen 0.91±0.13), respectively. Visual acuities were compared before and after contact lens application, and the differences were statistically significant (P<0.001). The mean line increases for stages 1, 2, 3, and 4 keratoconus groups were 5.18±1.38 (range: 2-8), 5.86±1.79 (range: 2-8), 6.32±2.16 (range: 3-9), and 6.92±2.35 (range: 3-9) lines, respectively.

    ?CONCLUSION: Orbiflex K?lens provide significant visual improvement in patients with keratoconus at all stages of the disease.

    Keratoconus, contact lens, Orbiflex K?

    INTRODUCTION

    Keratoconus is usually a bilateral, asymmetric and progressive corneal disorder, resulting in myopia, irregular astigmatism and reduced vision related to central and paracentral corneal thinning, steepening and scarring. This ectatic condition commonly appears during the second decade of life and puberty, progressing until the fourth decade of life, when it usually stabilizes[1]. During the past two decades, new developments in visual rehabilitation of keratoconus have been introduced, including new contact lens designs, photorefractive keratectomy, collagen cross-linking, intrastromal corneal ring segments, phakic intraocular lenses, and penetrating or lamellar keratoplasty in advanced stages[2]. Placido disk-based corneal topography in combination with biomicroscopic examination is widely used in the diagnosis of keratoconus in daily practice. The development of new technologies, such as slit-scanning technologies, rotating Scheimpflug devices, and optical coherence tomography, makes it now possible to quantitatively measure the posterior corneal curvature, and to provide useful diagnostic information for the detection of keratoconus in a clinical setting[3-5].

    In the early stages of keratoconus, vision can be managed with spectacles but as the disease progresses, rigid gas-permeable (RGP) contact lenses are preferred for reducing distortion and providing better vision[6-8]. Contact lenses are the main treatment modality in the treatment of keratoconus, and are the appropriate treatment option in 90% of keratoconus patients[9].When spectacles fail to improve visual acuity, contact lenses must be tried before exploring surgical options. Today, advances in surgical alternatives such as corneal ring segments, deep anterior lamellar keratoplasty and penetrating keratoplasty are considered to be efficient and permanent solutions by patients who do not know the advantages and disadvantages of surgery and contact lens use. However, we, as ophthalmologists, should inform patients that contact lenses are good alternative to improve visual acuity, but there is no evidence that it can stop the progression of keratoconus. Corneal Collagen Crosslinking (CXL) is a surgical procedure that stops the progression of the disease and can improve the visual acuity and contrast sensitivity in patients with keratoconus[10]. Many patients treated with CXL will benefit from using contact lens to improve their visual acuity.

    In our study,we used a new model RGP lens in 52 patients (80 eyes) with keratoconus at different stages and evaluated their visual outcomes.

    MATERIALS AND METHODS

    This study included 80 eyes of 52 patients whowere admitted to the eye clinic of Dr. Lütfi Krdar Kartal Training and Research Hospital between Nov. 2012 and Dec. 2013 with a diagnosis of keratoconus at different disease stages. All patients who received a rigid contact lens prescription were followed up for 12 months.

    Figure 1Orbiflex?K lens geometry.

    Demographic data, including age, gender, indications for the use of the contact lens, autorefractometric measurements before and after contact lens application, best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA), and topographic keratometric values, were recorded. Visual acuities were taken using Snellen acuity chart. Visual acuity data were converted from Snellen equivalent to logMAR. Based on the Amsler-Krumeich classification of keratoconus[11], stage 1 included 12 eyes with a keratometric value <48 diopters (D); stage 2 included 40 eyes with a keratometric value <53D; stage 3 included 10 eyes with a keratometric value >53D; and stage 4 included 18 eyes with a keratometric value >55D. Patients in all keratoconus stages were prescribed Orbiflex K?(SwissLens SA, Prilly, Switzerland) lens, and the values of logMAR BCVA before and after lens application for each group were compared statistically (paired sample t-test). Inter-group differences for this parameter were compared with one way analysis of variance (ANOVA).

    Orbiflex K?RGP lenses are made of Boston XO (Hexafocon A) material. Geometrically, the anterior and posterior optic zones are spherical. Peripherally, the lens has a spherical structure with three basic curves (Figure 1). The transmissibility level (Dk/t) value is equal to 100, the posterior surface basic curves range from 5.5 to 7.5 mm (in 0.1 mm increments), and the lens diameter ranges from 8.70 to 9.20 mm (in 0.1 mm increments). The posterior vertex power reaches up to 40D with 0.25 intervals.

    Before the application of the trial lenses, the mean keratometric measurements were calculated using the Sirius Corneal Topography device (Sirius, CSO, Florence, Italy). Keratometric values were converted to millimeters using a corneal refraction index of 1.3375. Lenses with a basic curvature value of 0.1 mm more vertical than the mean keratometric value were chosen as the initial trial contact lens. Twenty minutes later, the fit of the contact lens was evaluated using a biomicroscope to assess the lens-cornea relationship, fluorescein pattern, and movement and centralization of the lens. A three-point-touch fitting technique was used. We tried to find a lens that slightly touched the apical surface of the central cornea. After deciding on the accurate lens, the refraction examination with the contact lens was repeated and corrected. The dioptric power of the contact lens was calculated according to the final correction values, and final lens parameters were prescribed. Healthy contact lens wear and care were explained to the patients in detail. All contact lens examinations were made by the same physician (BA).

    Routine control visits and examinations were performedat 1 week, 2 weeks, 6 months, and 1 year after commencing wear of the contact lens. At each visit, we recorded the following: refraction using an auto refractometer, BCVA with spectacles and contact lenses, position and movement of the lens, relationship between the cornea and the edge of the lens, and fluorescein pattern using a slit-lamp biomicroscope. Any complications were also recorded. Exclusion criteria for this study included corneal leukoma, a non-centralized contact lens, vernal conjunctivitis, and non-compliance. All procedures conformed to the tenets of the Declaration of Helsinki, and written informed consent was obtained from all subjects.

    BCVA with contact lens at the first day were compared withat the 1 year follow-up statistically for each group (paired sample t test). Inter-group differences for this parameter were compared with ANOVA.

    Statistical AnalysesStudy data were analyzed using SPSS 17.0 (SPSS, Chicago, IL, USA) software. Intra group comparisons were made by paired t-test and one way analysis of variance (ANOVA) for inter-group comparisons.P< 0.05 was considered to be statistically significant.

    RESULTS

    Eighty eyes of 52 patients (30 males, 22 females) with keratoconus were included in the study. A rigid contact lens (Orbiflex K?) was applied to all eyes, and patients were followed up for 12 months. The mean age was 26.1±6.9 (range: 15-43) years (Table 1). According to the Amsler-Krumeich keratoconus classification, 12 eyes were stage 1, 40 eyes were stage 2, 10 eyes were stage 3, and 18 eyes were stage 4 (Table 2).

    The mean value ofthe flat meridian (K1) was 50.25±4.17D (range: 43.50-62.40D), whereas the mean vertical meridian (K2) was 53.82±4.81D (range: 46.91-66.02D) in the keratoconus patients. The mean K value was 52.03±4.42D (range: 45.36-64.21D) (Figure 2).

    The mean best spectacle- and best contact lens-corrected visual acuity measurements of all keratoconus patients in all stages are given in Table 3. BCVA with contact lenses (0.04±0.88 logMAR) was significantly better than the uncorrected visual acuity (1.30±0.39 logMAR) for logMAR chart (P<0.001, paired samplest-test). Further, BCVA with contact lenses (0.04±0.88 logMAR) was also significantly higher than BCVA with spectacles (0.67±0.77 logMAR) for logMAR charts (P<0.001, paired samplest-test).

    Average number of trials was 1.57 (range: 1-4). The best fitting contact lens was found at the first trial in 48 eyes (60%), at the second trial in 20 eyes (25%), at the third trial in 10 eyes (12.5%), at the fourth trial in 2 eyes (2.5%). The mean line gain in BCVA with the contact lenses was 6.08±2.56 (range: 3-9) lines in the Snellen chart compared with that in BCVA with spectacles. Of the 80 eyes, 74 (92.5%) increased by >3 lines in the Snellen chart. During the follow-up period, BCVA with contact lenses remained stable and unchanged (Table 4). The mean line increases for the stages 1, 2, 3, and 4 keratoconus groups were 5.18±1.38 (range: 2-8), 5.86±1.79 (range: 2-8), 6.32±2.16 (range: 3-9), and 6.92±2.35 (range: 3-9) lines, respectively (Figure 2).

    Figure 2 The mean visual acuity measurements before and after contact lens application in different stages ofkeratoconusUVA: Uncorrected visual acuity; BCVA-S: Best-corrected visual acuity-spectacles; BCVA-CL: Best-corrected visual acuity-contact lenses.

    Table 1Demographic and clinical characteristics of the patients

    Numberofpatients52M30(50eyes)F22(30eyes)Mean±SDage(a)26.1±6.9

    Table 2Classification of keratoconus

    KeratoconusstageNo.(eye)Stage112Stage240Stage310Stage418

    Table 3Visual acuity (logMAR) before and after rigid contact lenses wearing in different stages of keratoconus patients at the first day

    StageUCVABCVA-SpectaclesBCVA-ContactlensesStage1(n=12)1.22±1.390.38±0.820.03±1.00Stage2(n=40)1.30±1.220.69±0.790.04±0.77Stage3(n=10)1.22±1.000.67±0.770.04±0.69Stage4(n=18)1.52±1.300.79±0.820.04±0.74Total(n=80)1.30±1.390.67±0.770.04±0.88

    UCVA: Uncorrected visual acuity; BCVA: Best corrected visual acuity.

    The Snellen line gain with contact lenses was significantly higher in the stage 4 patients than in the other groups (one-way analysis of variance;P<0.05). BCVA did not change in any of the patients after contact lens application during the follow-up period.

    Table 4Visual acuity (logMAR) before and after rigid contact lenses wearing in different stages of keratoconus patients at the first year

    StageUCVABCVA-SpectaclesBCVA-ContactlensesStage1(n=12)1.20±1.350.39±0.760.03±0.90Stage2(n=40)1.33±1.320.71±0.680.04±0.65Stage3(n=10)1.35±0.930.65±0.730.04±0.74Stage4(n=18)1.54±1.240.81±0.710.04±0.78Total(n=80)1.34±1.360.66±0.690.04±0.81

    UCVA: Uncorrected visual acuity; BCVA: Best corrected visual acuity.

    DISCUSSION

    In early stages ofkeratoconus, spectacles, soft CLs and even custom aberration-correcting soft CLs may be adequate to correct for vision changes. But as the keratoconus progresses, the optically smooth surface from a rigid gas permeable lens is necessary to ameliorate the irregular corneal surface of the ectatic eye to provide clearer vision. Corneal RGPs, and now more popularized scleral lenses, are the mainstay visual treatments for these eyes[12]. RGPs comprise 65% of contact lens correction for keratoconus and has delayed the need for surgery in approximately 80% to 98.9% of all fittings[13-15].Whereas the current treatments for ectasias revolve around visual rehabilitation, CXL is a promising treatment to actually delay and potentially halt the progression of many ectasias, including keratoconus. Considering all these treatments, rigid contact lenses are an alternative optic rehabilitation method that can successfully correct high corneal astigmatism in keratoconus patients who fail to achieve sufficient vision using glasses. Kazunoetal[16]stated in their study that contact lenses correct irregular optical surfaces of corneas, and provide acceptable vision for keratoconus patients. In addition, they showed that RGP contact lenses increase visual performance by reducing high-order aberrations in eyes with keratoconus.

    In our study, BCVA with contact lens was found to be significantly better than BCVA with glasses in 80 eyes with keratoconus (P<0.001). Similarly, Yanaietal[17]established that the mean visual acuity was 0.70 logMAR (20/111) with glasses and 0.20 logMAR (20/29) with contact lenses. Cagiletal[18]reported that the mean BCVA was 0.40±0.19 logMAR with glasses and 0.14±0.11 logMAR with Rose K contact lenses in patients with keratoconus, and the difference was statistically significant (P=0.001). Further, Gunesetal[19]reported the efficacy of Rose K RGP contact lenses in patients with keratoconus. The mean BCVA with glasses in 31 eyes of 17 patients (5 early, 18 moderate, and 8 advanced stage) was 0.54±0.21 logMAR, whereas it improved to 0.04±0.09 logMAR following Rose K application. During the follow-up period in our study, the BCVA with contact lenses remained stable. The visual acuity increased immediately following contact lens fitting in most of the patients.

    In our study,the increase in Snellen visual acuity following contact lens fitting was significantly larger in the advanced keratoconus patients than in the other groups (P<0.05). This may be due to lower initial visual acuity levels in the advanced group. Canetal[20]applied Rose K2 rigid lenses to 80 eyes of 47 keratoconus patients and found that the mean visual acuity was significantly higher with these lenses than with glasses; additionally, these lenses were more effective at improving visual acuity in both the moderate and severe keratoconus groups than in the mild group.

    RGP contact lenses playan important role in improving visual acuity in irregular astigmatism and keratoconus; however, they have some practical difficulties. Firstly, they may decentralize easily because the cornea is flat at the upper part and vertical at the lower part. Moreover, many patients cannot tolerate RGP lenses due to a foreign body sensation and complaint about scratchy eyes, despite a good visual outcome. On the other hand, while soft contact lenses provide excellent comfort and physiological response, the visual rehabilitation outcome may not be as good as for rigid lenses[21].

    Other contact lens options in keratoconus include scleral lenses, hybrid lenses, special soft lenses, and piggyback lens systems. The piggyback lens system comprises a RGP lens fitted onto a soft lens and can be successfully used in keratoconus patients; however, using two different lenses makes cleaning and disinfecting difficult[22].

    Hybrid lenses are made of an RGP center, with a hydrogel periphery surrounding this center, and may be easily used in patients with astigmatism and keratoconus as they provide both comfort and good centralization. However, their lower oxygen permeability may lead to complications such as hypoxia and corneal neovascularization, which limit their indications[23]. Scleral lenses are also used in the treatment of keratoconus, but they are difficult to use and need more time for adaptation compared to corneal contact lenses. New generation scleral lenses are made from gas-permeable materials rather than polymethyl methacrylate (PMMA), and thus, their oxygen permeability is higher. Despite various drawbacks, this type of lens may be successfully used in patients for whom corneal contact lenses fail[24-27].

    When previous studies on contact lenses in keratoconus patients are taken into account, it is clear that the most widely used lens is the RGP lens. Corneal RGP lens is the first lens of choice for visual improvement in patients with keratoconus[28]. Both Bettsetal[29]and Jainetal[30]reported 90% compliance rates for Rose K lenses in their studies, which evaluated visual performance and comfort. Ozkurtetal[31]also reported a 96% success rate using the same lenses. Mandatharaetal[32]the success rate of fitting Rose K lens in keratoconus was reported to be more than 90% and they have shown similar results in 95% patients with an average number of trials being 1.73 (range: 1-5) and in 95% of the cases, the final fit was achieved within the first three trials. In our study, we used a similar type of RGP contact lens (Orbiflex K?), and none of the patients stopped wearing them during the 1-year follow-up period (success rate, 100%). Further, no severe complications were observed. Two patients lost their lenses at the third and sixth months; new lenses were prescribed using the same parameters. Artificial tear drops were recommended in patients with gritty eye irritation.

    As in all the other contact lenses, complications related to Orbiflex K?lenses included dry eye, keratitis, hypoxia-induced neovascularization, lens into lerance, and issues with centralization and stabilization of the lens. In our study, we did not observe any of these complications. In the long term, apical scarring may be seen in keratoconus[33]. In addition, corneal erosion due to direct physical trauma and hypoxia may lead to scarring in the central cornea. Several studies have reported that contact lenses may increase the possibility of apical scar formation[34],and Esginetal[35]found as 8.2% rate of apical scar development in keratoconus patients wearing RGP contact lenses during 33 months of follow-up. Moreover, Tunceretal[36]reported a 28.8% rate of apical scar development in keratoconus patients with a 7-year follow-up. In our study group, we observed no apical scarring or other complications during the 1-year follow-up. This may be due to the relatively shorter follow-up period and the higher Dk/t values (100 Dk/t) of the contact lenses used in our study. Keratoconus patients using any contact lenses should be monitored closely for such complications.

    In conclusion, visual rehabilitation outcomes from the use of rigid contact lenses in keratoconus are promising compared with other treatment modalities. Rigid contact lenses are an effective method for correcting visual acuity, and area non-invasive and reversible method of treating keratoconus in certain patients.

    1 Romero-Jiménez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: A review.ContLensAnteriorEye2010;33(4):157-166

    2 Fadlallah A, Dirani A, El Rami H, Cherfane G, Jarade E. Safety and visual outcome of Visian toric ICL implantation after corneal collagen cross-linking in keratoconus.JRefractSurg2013;29:84-89

    3 Ishii R, Kamiya K, Igarashi A, Shimizu K, Utsumi Y, Kumanomido T. Correlation of corneal elevation with severity of keratoconus by means of anterior and posterior topographic analysis.Cornea2012;31(3):253-258

    4 Miha’ltz K, Kova’cs I, Taka’cs A, Nagy ZZ. Evaluation of keratometric, pachymetric, and elevation parameters of keratoconic corneas with Pentacam.Cornea2009;28(9):976-980

    5 Kamiya K, Ishii R, Shimizu K, Igarashi A. Evaluation of corneal elevation, pachymetry and keratometry in keratoconic eyes with respect to the stage of Amsler-Krumeich classification.BrJOphthalmol2014;98(4):459-463

    6 Jhanji V, Sharma N, Vajpayee RB. Management of keratoconus: current scenario.BrJOphthalmol2011;95:1044-1050

    7 Barnett M, Mannis MJ. Contact lenses in the management of keratoconus.Cornea2011;30:1510-1516

    8 Vazirani J, Basu S. Keratoconus: current perspectives.ClinOphthalmol2013;7:2019-2030

    9 Rabinowitz YS. Keratoconus.SurvOphthalmol1998;42:297-319

    10 Lamy R, Netto CF, Reis RG, Procopio B, Porco TC, Stewart JM, Dantas AM, Moraes HV Jr. Effects of corneal cross-linking on contrast sensitivity, visual acuity, and corneal topography in patients with keratoconus.Cornea2013;32(5):591-596

    11 Alió JL, Shabayek MH. Corneal higher order aberrations: a method to grade keratoconus.JRefractSurg2006;22(6):539-545

    12 Weed KH, MacEwen CJ, McGhee CN. The Dundee University Scottish Keratoconus Study II: a prospective study of optical and surgical correction.OphthalmicPhysiol2007;27(6):561-567

    13 Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus.AmJOphthalmol1986;101:267-273

    14 Wagner H, Barr JT, Zadnik K. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: methods and findings to date.ContLensAnteriorEye2007;30(4):223-232

    15 Bilgin LK, Yilmaz S, Araz B, Yüksel SB, Sezen T. 30 years of contact lens prescribing for keratoconic patients in Turkey.ContactLensAntEye2009;32(1):16-21

    16 Negishi K, Kumanomido T, Utsumi Y, Tsubota K. Effect of high-order aberrations on visual function in keratoconic eyes with a rigid gas permeable contact lens.AmJOphthalmol2007;144(6):924-929

    17 Yanai R, Ueda K, Nishida T. Retrospective analysis of vision correction and lens tolerance in keratoconus patients prescribed a contact lens with dual aspherical curves.EyeContactLens2010;36:86-89

    20 Can ?ü. Keratokonuslu Olgularda Rose K2 Kontakt Lens Uygulama Sonu?larmz.MNOphtalmology2008;15:10-13

    21 Maguen E, Caroline P, Rosner IR, Macy JI, Nesburn AB. The use of SoftPerm lens for the correction of irregular astigmatism.CLAOJ1992;18(3):173-176

    22 Giasson CJ, Perreault N, Brazeau D. Oxygen tension beneath piggyback contact lenses and clinical outcomes of users.CLAOJ2001;27:144-150

    23 O’Donnell C, Maldonado-Codina C. A hyper-Dk piggyback contact lens system for keratoconus.EyeContactLens2004;30:44-48

    24 Pullum KW, Whiting MA, Buckley R. Scleral contact lenses: the expanding role.Cornea2005;24:269-277

    25 Segal O, Barkana Y, Hourovitz D, et al. Scleral contact lenses may help where other modalities fail.Cornea2003;22:308-310

    26 Schornack MM, Patel SV. Scleral lenses in the management of keratoconus.EyeContactLens2010;36:39-44

    27 Rathi VM, Mandathara PS, Dumpati S, Vaddavalli PK, Sangwan VS. Boston ocular surface prosthesis: An Indian experience.IndianJOphthalmol2011;59:279-281

    28 Rathi, Varsha M., Preeji S. Mandathara, and Srikanth Dumpati. "Contact lens in keratoconus."IndianJophthalmol2013;61(8):410

    29 Betts AM, Mitchell GL, Zadnik K. Visual performance and comfort with the Rose K lens for keratoconus.OptomVisSci2002;79:493-501

    30 Jain AK, Sukhija J. Rose-K contact lens for keratoconus.IndianJOphthalmol2007;55:121-125

    31 Ozkurt YB, Sengor T, Kurna S, Evciman T, Acikgoz S, Haboglu M, Aki S. Rose K contact lens fitting for keratoconus.IntOphthalmol2008;28(6):395-398

    32 Mandathara Sudharman P, Rathi V, Dumapati S. Rose K lenses for keratoconus-An Indian experience.EyeContactLens2010;36:220-222

    33 Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders.SurvOphthalmol1984;28:293-322

    34 Korb DR, Finnemore VM, Herman JP. Apical changes and scarring in keratoconus as related to contact lens fitting techniques.JAmOptomAssoc1982;53:199-205

    35 Esgin H, Erda N, Ozgur S. Keratokonuslu hastalarda cift eliptik kontakt lens uygulamas.MN-Oftalmoloji2002;9:44-47

    36 Tuncer Z, Soylu T. Ileri Keratokonuslu Olgularda Kontakt Lens Uygulamas: Uzun Sureli Takip Sonuclarmz.TurkJOphthalmol. 2012;42:202-206

    配戴Orbiflex K?角膜接觸鏡改善圓錐角膜患者視力的研究

    Berkay Akmaz1, Ayse Yesim Oral2, Baran Kandemir2, Yusuf Ozerturk2

    135360 土耳其伊茲密爾阿塔圖爾克培訓(xùn)與研究醫(yī)院伊茲密爾Katip Celebi大學(xué)眼科;234890 土耳其伊斯坦布爾Lutfi Kirdar Kartal培訓(xùn)與研究醫(yī)院眼科)

    Berkay Akmaz. 土耳其伊茲密爾阿塔圖爾克培訓(xùn)與研究醫(yī)院伊茲密爾Katip Celebi大學(xué)眼科. berkayakmaz@hotmail.com

    目的:評(píng)估圓錐角膜患者配戴Orbiflex K?角膜接觸鏡在不同疾病階段的視力康復(fù)結(jié)果。

    圓錐形角膜;角膜接觸鏡;Orbiflex K?

    Berkay Akmaz. Department of Ophthalmology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.berkayakmaz@hotmail.com

    2015-09-24Accepted: 2016-09-07

    10.3980/j.issn.1672-5123.2016.11.05

    Akmaz B, Oral AY, Kandemir B, Ozerturk Y. Visual outcomes of Orbiflex K?lenses in patients with keratoconus.GuojiYankeZazhi(IntEyeSci) 2016;16(11):2001-2005

    引用:Akmaz B, Oral AY, Kandemir B, Ozerturk Y. 配戴Orbiflex K?角膜接觸鏡改善圓錐角膜患者視力的研究.國(guó)際眼科雜志2016;16(11):2001-2005

    猜你喜歡
    圓錐眼科平均值
    “平均值代換”法在數(shù)學(xué)解題中的應(yīng)用
    眼科診所、眼科門(mén)診、視光中心的區(qū)別
    第二十二屆亞非眼科大會(huì)(AACO 2022)
    第二十二屆亞非眼科大會(huì)(AACO 2022)
    圓錐擺模型的探究與拓展
    圓錐截線與玫瑰線
    “圓柱與圓錐”復(fù)習(xí)指導(dǎo)
    計(jì)算法在圓錐保持架收縮模組合沖頭設(shè)計(jì)中的應(yīng)用
    哈爾濱軸承(2021年4期)2021-03-08 01:00:50
    平面圖形中構(gòu)造調(diào)和平均值幾例
    基于電流平均值的改進(jìn)無(wú)功檢測(cè)法
    大片免费播放器 马上看| 久久久久精品性色| 亚洲aⅴ乱码一区二区在线播放| 午夜福利高清视频| 免费观看a级毛片全部| 成年免费大片在线观看| a级毛色黄片| 亚洲精品日本国产第一区| 亚洲婷婷狠狠爱综合网| 欧美成人一区二区免费高清观看| 卡戴珊不雅视频在线播放| 美女xxoo啪啪120秒动态图| 国产精品日韩av在线免费观看| 亚洲av免费在线观看| 菩萨蛮人人尽说江南好唐韦庄| 婷婷色麻豆天堂久久| 久久热精品热| 久久久久久久久久久丰满| 亚洲精品亚洲一区二区| 精品久久久噜噜| 久久久久久久亚洲中文字幕| 亚洲丝袜综合中文字幕| 熟妇人妻不卡中文字幕| 国产av国产精品国产| 99久久精品热视频| 国产精品一区二区性色av| 免费av不卡在线播放| 黄色配什么色好看| 亚洲无线观看免费| 国内精品美女久久久久久| 国产精品久久久久久精品电影| 亚洲欧美日韩卡通动漫| 国产91av在线免费观看| 老司机影院毛片| 亚洲精品成人久久久久久| 嫩草影院精品99| 亚洲欧美中文字幕日韩二区| 日韩欧美一区视频在线观看 | 国产成人福利小说| 精品人妻熟女av久视频| 久久久久久久久中文| 男的添女的下面高潮视频| 日韩欧美三级三区| 在现免费观看毛片| 成人美女网站在线观看视频| 成人毛片60女人毛片免费| 色吧在线观看| 日韩亚洲欧美综合| 国产伦精品一区二区三区四那| 日本-黄色视频高清免费观看| 菩萨蛮人人尽说江南好唐韦庄| 卡戴珊不雅视频在线播放| 18禁动态无遮挡网站| 国产亚洲精品av在线| 亚洲av日韩在线播放| av免费在线看不卡| 能在线免费看毛片的网站| 久久精品国产亚洲av天美| 大香蕉久久网| 成人亚洲欧美一区二区av| 亚洲欧美成人精品一区二区| 国产精品蜜桃在线观看| 六月丁香七月| 天天躁日日操中文字幕| 亚洲av电影在线观看一区二区三区 | 超碰97精品在线观看| 男插女下体视频免费在线播放| 成人国产麻豆网| 国产乱人视频| 永久免费av网站大全| 麻豆久久精品国产亚洲av| 成人毛片60女人毛片免费| 午夜福利高清视频| 免费高清在线观看视频在线观看| 亚洲av国产av综合av卡| 国产爱豆传媒在线观看| 国产精品综合久久久久久久免费| 白带黄色成豆腐渣| 黄片wwwwww| 国产高清有码在线观看视频| 亚洲av在线观看美女高潮| 国产白丝娇喘喷水9色精品| 在线观看一区二区三区| 最后的刺客免费高清国语| 内地一区二区视频在线| 高清午夜精品一区二区三区| 高清av免费在线| 在现免费观看毛片| 波多野结衣巨乳人妻| 天天躁夜夜躁狠狠久久av| 国产成人福利小说| 国产精品一二三区在线看| 成人午夜精彩视频在线观看| 亚洲欧美日韩无卡精品| 能在线免费看毛片的网站| 丝瓜视频免费看黄片| 精品酒店卫生间| 日韩中字成人| 日韩欧美精品免费久久| 一级爰片在线观看| ponron亚洲| 国产av不卡久久| 亚洲婷婷狠狠爱综合网| 免费少妇av软件| 免费观看在线日韩| av一本久久久久| 非洲黑人性xxxx精品又粗又长| 中文资源天堂在线| 亚洲av成人精品一二三区| 午夜福利在线观看吧| videos熟女内射| 午夜福利在线观看免费完整高清在| 国产男人的电影天堂91| 国产亚洲一区二区精品| 成人欧美大片| 久久久欧美国产精品| 国产一区二区三区综合在线观看 | 久久久精品欧美日韩精品| 91久久精品国产一区二区成人| 三级毛片av免费| 欧美丝袜亚洲另类| av线在线观看网站| 国产成人一区二区在线| 国产免费福利视频在线观看| 热99在线观看视频| 国产综合精华液| 国产成人aa在线观看| av在线老鸭窝| av天堂中文字幕网| 美女主播在线视频| 噜噜噜噜噜久久久久久91| 亚洲精品国产av成人精品| 欧美成人精品欧美一级黄| 国产亚洲精品av在线| 日本色播在线视频| 亚洲最大成人手机在线| 久久久精品免费免费高清| av在线观看视频网站免费| 丝袜美腿在线中文| 啦啦啦韩国在线观看视频| 久久99精品国语久久久| 国模一区二区三区四区视频| 国产激情偷乱视频一区二区| 免费播放大片免费观看视频在线观看| 春色校园在线视频观看| 亚洲性久久影院| 婷婷六月久久综合丁香| 亚洲人与动物交配视频| 成人亚洲精品一区在线观看 | av在线蜜桃| 淫秽高清视频在线观看| 欧美成人精品欧美一级黄| 九九在线视频观看精品| 深爱激情五月婷婷| 十八禁国产超污无遮挡网站| av免费观看日本| 18禁裸乳无遮挡免费网站照片| 国产色婷婷99| 亚洲成人中文字幕在线播放| 中文乱码字字幕精品一区二区三区 | 亚洲美女视频黄频| 精品人妻熟女av久视频| 女人久久www免费人成看片| 国产精品人妻久久久影院| 日韩一区二区三区影片| 99视频精品全部免费 在线| 亚洲国产欧美人成| 欧美极品一区二区三区四区| 亚洲精品视频女| 免费观看性生交大片5| 精品亚洲乱码少妇综合久久| 男的添女的下面高潮视频| 午夜亚洲福利在线播放| 成人综合一区亚洲| 91av网一区二区| 婷婷色综合www| 欧美变态另类bdsm刘玥| 久久精品久久久久久噜噜老黄| 男插女下体视频免费在线播放| 久久久欧美国产精品| 精品国产三级普通话版| 国产视频内射| 插逼视频在线观看| 最近中文字幕高清免费大全6| 在线观看人妻少妇| 91aial.com中文字幕在线观看| 久久午夜福利片| 欧美潮喷喷水| 少妇被粗大猛烈的视频| 欧美xxxx性猛交bbbb| 少妇高潮的动态图| 高清av免费在线| 麻豆av噜噜一区二区三区| 国产午夜精品一二区理论片| 欧美变态另类bdsm刘玥| 高清欧美精品videossex| 好男人在线观看高清免费视频| 久久久久久久大尺度免费视频| 久久久精品免费免费高清| 91久久精品电影网| 成人无遮挡网站| 国产在线男女| 男女下面进入的视频免费午夜| 亚洲欧美中文字幕日韩二区| 精品国产露脸久久av麻豆 | 三级国产精品片| 亚洲av二区三区四区| 欧美另类一区| 日日啪夜夜爽| 97人妻精品一区二区三区麻豆| 日本一二三区视频观看| 黄色一级大片看看| 亚洲内射少妇av| 国产精品蜜桃在线观看| 日韩精品青青久久久久久| 欧美xxxx黑人xx丫x性爽| 精品久久久久久久人妻蜜臀av| 26uuu在线亚洲综合色| 一本一本综合久久| 黄色配什么色好看| 深爱激情五月婷婷| 成人美女网站在线观看视频| 菩萨蛮人人尽说江南好唐韦庄| 非洲黑人性xxxx精品又粗又长| 久久久久久久久久人人人人人人| 视频中文字幕在线观看| 午夜精品一区二区三区免费看| 五月伊人婷婷丁香| 久久久久精品性色| 亚洲av二区三区四区| 日韩强制内射视频| 黄色欧美视频在线观看| 成人国产麻豆网| 非洲黑人性xxxx精品又粗又长| 成人亚洲欧美一区二区av| 一级二级三级毛片免费看| 老女人水多毛片| 国产精品无大码| 亚洲最大成人手机在线| 最近中文字幕2019免费版| 我要看日韩黄色一级片| 精品久久久噜噜| 黄片wwwwww| 三级毛片av免费| 美女脱内裤让男人舔精品视频| av在线天堂中文字幕| 在线观看人妻少妇| 菩萨蛮人人尽说江南好唐韦庄| 建设人人有责人人尽责人人享有的 | 国产老妇伦熟女老妇高清| 大香蕉久久网| 嫩草影院新地址| 国产探花在线观看一区二区| 七月丁香在线播放| videossex国产| 亚洲精品一区蜜桃| 1000部很黄的大片| 综合色av麻豆| 特大巨黑吊av在线直播| 精品不卡国产一区二区三区| 日韩大片免费观看网站| 99久国产av精品国产电影| 天堂av国产一区二区熟女人妻| av播播在线观看一区| 久久午夜福利片| 国产日韩欧美在线精品| 久久久午夜欧美精品| 一夜夜www| 直男gayav资源| 亚洲欧美精品自产自拍| 色哟哟·www| 国产精品国产三级国产专区5o| 搞女人的毛片| 精品国产三级普通话版| 中文乱码字字幕精品一区二区三区 | 亚洲精品自拍成人| 欧美zozozo另类| 久久久a久久爽久久v久久| 日产精品乱码卡一卡2卡三| 亚洲欧美清纯卡通| 久久久久国产网址| 综合色丁香网| 精品久久久久久久人妻蜜臀av| 一本—道久久a久久精品蜜桃钙片 精品乱码久久久久久99久播 | 亚洲精品一区蜜桃| 亚洲欧美成人综合另类久久久| 国产乱来视频区| 1000部很黄的大片| 在现免费观看毛片| 亚洲欧美一区二区三区黑人 | 亚洲真实伦在线观看| 亚洲av免费高清在线观看| 伦理电影大哥的女人| 欧美一区二区亚洲| 久久久久免费精品人妻一区二区| 久久久久久久午夜电影| 亚洲三级黄色毛片| 久久久国产一区二区| 尤物成人国产欧美一区二区三区| 在线观看一区二区三区| 久久久久久久国产电影| 男人舔女人下体高潮全视频| 国产v大片淫在线免费观看| 日产精品乱码卡一卡2卡三| 简卡轻食公司| 久久久久久九九精品二区国产| 亚洲国产最新在线播放| 久久久久久久久久久免费av| 69av精品久久久久久| 欧美激情国产日韩精品一区| 成人漫画全彩无遮挡| 99久久精品一区二区三区| 亚洲精品乱久久久久久| 老女人水多毛片| 99久久精品热视频| 高清在线视频一区二区三区| 久久久久久久久大av| 欧美日韩亚洲高清精品| 精品久久久久久久久亚洲| 美女高潮的动态| 日韩一本色道免费dvd| 亚洲最大成人手机在线| 国产有黄有色有爽视频| 一级毛片我不卡| 国产精品一区二区在线观看99 | 国产又色又爽无遮挡免| 97在线视频观看| 免费观看精品视频网站| 亚洲av免费在线观看| 日韩欧美国产在线观看| 亚洲一级一片aⅴ在线观看| 久久精品国产鲁丝片午夜精品| 日本午夜av视频| 建设人人有责人人尽责人人享有的 | 久久久久久久大尺度免费视频| 亚洲成人精品中文字幕电影| 国产69精品久久久久777片| 日韩av不卡免费在线播放| 简卡轻食公司| 日韩av在线免费看完整版不卡| 久久久色成人| 欧美精品一区二区大全| 国产麻豆成人av免费视频| 国产免费一级a男人的天堂| 午夜精品在线福利| 国产精品一区二区性色av| 国内精品宾馆在线| 边亲边吃奶的免费视频| av女优亚洲男人天堂| 大话2 男鬼变身卡| 中文乱码字字幕精品一区二区三区 | 亚洲欧美日韩卡通动漫| 三级经典国产精品| 亚洲国产最新在线播放| 国产午夜福利久久久久久| 免费观看的影片在线观看| 欧美日韩综合久久久久久| 一区二区三区免费毛片| 欧美区成人在线视频| 美女内射精品一级片tv| 精品不卡国产一区二区三区| 久久久久九九精品影院| 免费观看在线日韩| 成人av在线播放网站| 国产高潮美女av| 亚洲欧美中文字幕日韩二区| 亚洲精品自拍成人| 啦啦啦啦在线视频资源| 久久精品国产自在天天线| 亚洲国产成人一精品久久久| 草草在线视频免费看| 直男gayav资源| www.色视频.com| 日韩欧美国产在线观看| xxx大片免费视频| 国产免费又黄又爽又色| 一级a做视频免费观看| 免费人成在线观看视频色| 有码 亚洲区| 亚洲丝袜综合中文字幕| 我要看日韩黄色一级片| 天天一区二区日本电影三级| 欧美成人a在线观看| 亚洲成色77777| 国模一区二区三区四区视频| 亚洲欧美精品自产自拍| 最近2019中文字幕mv第一页| 久久99蜜桃精品久久| 久久精品久久久久久久性| av播播在线观看一区| 久久草成人影院| 国产不卡一卡二| 国产久久久一区二区三区| 亚洲av成人精品一二三区| 精品亚洲乱码少妇综合久久| 亚洲18禁久久av| 国产免费又黄又爽又色| 激情五月婷婷亚洲| 国产成人一区二区在线| 少妇猛男粗大的猛烈进出视频 | 久久久久久伊人网av| 最近最新中文字幕大全电影3| 亚洲自偷自拍三级| 国产午夜精品一二区理论片| 国产黄色小视频在线观看| 亚洲欧美日韩东京热| 少妇猛男粗大的猛烈进出视频 | 亚洲一级一片aⅴ在线观看| 国产日韩欧美在线精品| 淫秽高清视频在线观看| 少妇熟女aⅴ在线视频| 性插视频无遮挡在线免费观看| 成人亚洲欧美一区二区av| 高清欧美精品videossex| 国产免费一级a男人的天堂| 51国产日韩欧美| 汤姆久久久久久久影院中文字幕 | 亚洲激情五月婷婷啪啪| 亚洲精品中文字幕在线视频 | 麻豆av噜噜一区二区三区| 精华霜和精华液先用哪个| 欧美成人午夜免费资源| 国产一区亚洲一区在线观看| 日韩一区二区视频免费看| 亚洲精品国产成人久久av| 国产午夜精品论理片| 极品少妇高潮喷水抽搐| 日本色播在线视频| 水蜜桃什么品种好| 国产老妇女一区| 天美传媒精品一区二区| 一级毛片aaaaaa免费看小| 亚洲欧洲国产日韩| 国产精品国产三级国产专区5o| 亚洲欧美一区二区三区黑人 | 日本一二三区视频观看| 国产伦一二天堂av在线观看| 久久久国产一区二区| 丝瓜视频免费看黄片| 91av网一区二区| 青春草国产在线视频| 国产精品综合久久久久久久免费| 精品久久久精品久久久| 国产毛片a区久久久久| 日本免费a在线| 亚洲精品一二三| 国产精品一及| 别揉我奶头 嗯啊视频| 免费观看a级毛片全部| 国产中年淑女户外野战色| 我的老师免费观看完整版| 最近手机中文字幕大全| 欧美不卡视频在线免费观看| 青青草视频在线视频观看| 国产伦在线观看视频一区| 国产精品日韩av在线免费观看| 天堂网av新在线| 床上黄色一级片| 男的添女的下面高潮视频| 三级毛片av免费| av免费观看日本| 极品少妇高潮喷水抽搐| 久久久精品94久久精品| 黄色一级大片看看| 午夜精品在线福利| 日本与韩国留学比较| 蜜桃久久精品国产亚洲av| 丰满人妻一区二区三区视频av| av在线老鸭窝| 国产精品爽爽va在线观看网站| 人妻制服诱惑在线中文字幕| 国内精品宾馆在线| 亚洲乱码一区二区免费版| 熟妇人妻不卡中文字幕| 亚洲国产欧美在线一区| 91精品一卡2卡3卡4卡| 卡戴珊不雅视频在线播放| 亚洲第一区二区三区不卡| 秋霞在线观看毛片| 久久这里只有精品中国| 成人一区二区视频在线观看| 国产综合精华液| 久久久久久久久久人人人人人人| 亚洲人与动物交配视频| 最新中文字幕久久久久| 免费观看精品视频网站| 亚洲精品久久午夜乱码| 日本-黄色视频高清免费观看| 秋霞在线观看毛片| 亚洲国产av新网站| 美女被艹到高潮喷水动态| 嫩草影院新地址| 欧美日韩一区二区视频在线观看视频在线 | 美女内射精品一级片tv| 在线观看av片永久免费下载| 午夜精品国产一区二区电影 | 搡老妇女老女人老熟妇| 免费观看av网站的网址| 麻豆精品久久久久久蜜桃| 亚洲国产av新网站| 小蜜桃在线观看免费完整版高清| 91精品伊人久久大香线蕉| 1000部很黄的大片| 久久久久久久大尺度免费视频| 国产成年人精品一区二区| 中文资源天堂在线| 日韩欧美精品免费久久| 蜜臀久久99精品久久宅男| 99久久人妻综合| 国产成人福利小说| 色综合色国产| 水蜜桃什么品种好| 亚洲欧美成人综合另类久久久| 日韩电影二区| 欧美zozozo另类| 国产女主播在线喷水免费视频网站 | av网站免费在线观看视频 | 日日啪夜夜撸| 精品人妻一区二区三区麻豆| 国产高清国产精品国产三级 | 国产伦一二天堂av在线观看| 午夜免费激情av| 汤姆久久久久久久影院中文字幕 | 婷婷色综合大香蕉| 国产探花在线观看一区二区| 久久6这里有精品| 亚洲精品aⅴ在线观看| 国产精品伦人一区二区| 亚洲精品色激情综合| 欧美+日韩+精品| 大香蕉97超碰在线| 亚洲成人中文字幕在线播放| 欧美97在线视频| 日日干狠狠操夜夜爽| 两个人的视频大全免费| 国产91av在线免费观看| 丰满乱子伦码专区| 亚洲成人av在线免费| 三级国产精品片| 美女黄网站色视频| 亚洲性久久影院| 国内精品宾馆在线| 日韩中字成人| 天堂av国产一区二区熟女人妻| 一个人观看的视频www高清免费观看| 22中文网久久字幕| 国产久久久一区二区三区| 成人特级av手机在线观看| av福利片在线观看| 人妻系列 视频| 日韩大片免费观看网站| 精品少妇黑人巨大在线播放| 亚洲国产色片| 最新中文字幕久久久久| 午夜免费男女啪啪视频观看| 午夜福利在线观看吧| 亚洲真实伦在线观看| 男女那种视频在线观看| 啦啦啦中文免费视频观看日本| 一区二区三区高清视频在线| 日本三级黄在线观看| 国产黄a三级三级三级人| 少妇高潮的动态图| 午夜激情福利司机影院| 久久久久久伊人网av| 国产伦一二天堂av在线观看| 国产精品嫩草影院av在线观看| av免费观看日本| 秋霞伦理黄片| 18禁在线无遮挡免费观看视频| av网站免费在线观看视频 | 3wmmmm亚洲av在线观看| 精品久久久久久久人妻蜜臀av| 97热精品久久久久久| 国产极品天堂在线| 久久久a久久爽久久v久久| 国产黄片视频在线免费观看| 亚洲电影在线观看av| 三级毛片av免费| 精品久久久久久久久亚洲| 我的女老师完整版在线观看| 国产久久久一区二区三区| 亚洲伊人久久精品综合| 亚洲人成网站在线播| 成人国产麻豆网| 啦啦啦韩国在线观看视频| 一个人免费在线观看电影| av天堂中文字幕网| 欧美xxxx性猛交bbbb| 搡女人真爽免费视频火全软件| 蜜桃久久精品国产亚洲av| 久久久久久久久久黄片| 一级毛片aaaaaa免费看小| 色哟哟·www| 91精品一卡2卡3卡4卡| 免费观看无遮挡的男女| 国产精品久久久久久久电影| 三级毛片av免费| 97人妻精品一区二区三区麻豆| 高清毛片免费看| 国产男人的电影天堂91| 人人妻人人看人人澡| 日本爱情动作片www.在线观看| 国产男女超爽视频在线观看| 午夜爱爱视频在线播放| 久久99蜜桃精品久久| 久久草成人影院| 欧美精品国产亚洲| 亚洲欧美日韩东京热| 男人爽女人下面视频在线观看| 亚洲精品亚洲一区二区| 如何舔出高潮| 美女黄网站色视频| 午夜免费男女啪啪视频观看| 最近中文字幕高清免费大全6|