快速角膜胶原交联治疗进展期圆锥角膜的临床研究

Results of accelerated trans-epithelial corneal collagen cross-linking protocol for the treatment of progressive keratoconus

摘要:

目的：探讨紫外光照射仪快速跨上皮胶原交联治疗进展期圆锥角膜的临床效果。

方法：收集2014-12/2017-02在我院确诊为进展期圆锥角膜患者52例102眼的临床资料(角膜最大曲率值Kmax<60.0D，角膜厚度≥400μm)，进行回顾性分析和随访，所有患者手术前后常规行裸眼和最佳矫正视力、眼压、裂隙灯显微镜、角膜地形图、光学相干断层扫描(optical coherence tomography，OCT)、角膜内皮镜、眼前节彩照等检查。

结果：原发性圆锥角膜患者52例102眼中，男36例70眼，女16例32眼，平均年龄19.5±4.6岁。所有患者术前最佳矫正视力(LogMAR视力表)平均为0.84±0.89，术后最佳矫正视力平均为0.69±0.72，两者比较差异无统计学意义(P=0.398)。所有患者术前裸眼视力(LogMAR视力表)平均为1.02±0.62，术后裸眼视力平均为0.85±0.59，两者比较差异无统计学意义(P=0.154)。所有患者术前眼压平均为12.95±4.40mmHg，术后眼压平均为11.92±3.66mmHg，两者比较差异无统计学意义(P=0.272)。角膜内皮镜检查结果提示，手术前后内皮细胞密度和形态无改变(P=0.552)。角膜地形图检查结果提示，所有患者术后Kmax平均值为50.83±3.48D，较术前Kmax(平均值为52.05±3.63D)降低，且两者比较差异有统计学意义(P=0.017)，所有患者术后角膜平均曲率值(AveK)为47.74±2.51D，较术前AveK平均值(48.73±4.33D)降低，且两者比较差异有统计学意义(P=0.041)。术后所有患者采用前节OCT随访角膜胶原交联深度，平均交联深度位于192±23.6μm。角膜厚度值术后与术前比较，差异无统计学意义(P=0.816)，无1例患者术后出现严重的手术相关并发症。

结论：快速角膜胶原交联治疗进展期圆锥角膜患者术后角膜K值有下降的趋势，且随访期间情况稳定。同时对角膜内皮和眼内结构没有损伤，无严重手术相关并发症，该治疗方法是一种性价比较高的治疗方式。

Abstract:

AIM: To report the long-term clinical outcomes of accelerated trans-epithelial corneal cross-linking(CXL)protocols using KXL System(Avedro, USA)in the treatment of progressive keratoconus.

METHODS: Totally 52 patients(102 eyes)with progressive keratoconus between December 2014 and February 2017 \〖maximum keratometry values(Kmax)≤60.0D, minimum corneal thickness(Thk)≥400m\〗 were treated with an accelerate trans-epithelial CXL protocol(UV-A irradiation intensity 45mW/cm² with a total fluence of 7.2J/cm²)using KXL system(Avedro, USA)in Southwest Hospital. The average follow-up time was 11.65mo(range: 9-26mo). Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), intra-ocular pressure(IOP), slit-lamp microscope examination, Kmax and average keratometry values(AveK), corneal stromal demarcation line depth and endothelial cell density(ECD)were evaluated.

RESULTS: The 52 patients(102 eyes)were included in this research, male 36(70 eyes)and female 16(32 eyes), average age was 19.5±4.6 years. Preoperative CDVA was 0.84±0.89(LogMAR), postoperative CDVA was 0.69±0.72(P=0.398). Preoperative UDVA was 1.02±0.62(LogMAR), postoperative UDVA was 0.85±0.59(P=0.154). Preoperative IOP was 12.95±4.40mmHg, postoperative IOP was 11.92±3.66mmHg(P=0.272). No statistical difference(P=0.552)has been found between preoperative and postoperative ECD. Nevertheless, on the Sirius anterior system(Sirius, CSO, Itlay), significant statistical difference(P=0.017)was confirmed between preoperative Kmax(50.83±3.48D)and postoperative Kmax(52.05±3.63D). Meanwhile, the postoperative Avek(47.74±2.51D)was significantly lower(P=0.041)than the preoperative Avek(48.73±4.33D). The average corneal stromal demarcation line depth(192±23.6μm)was detected by the anterior segment OCT. No statistical difference(P=0.816)has been found between preoperative and postoperative Thk. No severe complication was observed in all cases.

CONCLUSION: Accelerated trans-epithelial CXL was effective in decreasing keratometry values for progressive keratoconus in this research, and the outcomes remained stable during the follow-up time. No endothelium damage or other severe complications were observed in this clinical research. The accelerated trans-epithelial CXL is as effective as the standard CXL.