目的：观察比较不同经上皮角膜胶原交联方法(transepithelial corneal collagen cross-linking，TE-CXL)治疗进展期圆锥角膜的早期疗效。

方法：回顾性研究。将24例34眼进展期圆锥角膜分为三组，低渗CXL组10眼接受低渗胶原交联治疗，I-CXL 5min组14眼接受离子导入5min胶原交联治疗，I-CXL 10min组10眼接受离子导入10min胶原交联治疗。治疗前，治疗后1wk，1、3、6mo观察视力、Pentacam眼前节分析仪、角膜激光共焦显微镜、光学相关断层扫描结果变化。

结果：术后6mo，I-CXL 10min组CDVA(矫正远视力，LogMAR)提高-0.21±0.23(t=2.735，P=0.026)； 最大角膜屈光力(K_max)降低2.32±5.21D，但差异无统计学意义(t=1.40，P=0.193)，低渗CXL组与I-CXL 5min组的UDVA、CDVA、Kmax稳定，差异均无统计学意义(P>0.05)。术后1wk时，分界线平均深度在各组分别为：低渗CXL组152.7±42.9μm，I-CXL 5min组213.6±42.3μm，I-CXL 10min组237.0±46.4μm，组间比较，差异有统计学意义(F=7.111，P=0.006)。术后基质细胞的凋亡-活化-再生现象在I-CXL 10min组最明显。三组角膜最薄点厚度、角膜内皮细胞密度与术前比较，差异无统计学意义(P>0.05)。

结论：三种经上皮CXL短期观察均能安全有效控制圆锥角膜病情的发展，其中离子导入10min胶原交联方法组织反应更显著。

METHODS: Retrospective study. Twenty four patients(34 eyes)who were diagnosed with progressive keratoconus were divided into three groups. And 10 eyes in hypotonic CXL group received the treatment of hypotonic corneal collagen cross-linking; 14 eyes in I-CXL 5min group received the treatment of iontophoresis corneal collagen cross-linking for 5min, and 10 eyes from the I-CXL 10min group received the treatment of iontophoresis corneal collagen cross-linking for 10min. Uncorrected distance visual acuity, corrected distance visual acuity, Pentacam, in vivo scanning laser confocal microscopy and anterior segment optical coherence tomography were examined before and after 1wk, 1, 3 and 6mo postoperatively.

RESULTS: Six months postoperatively, corrected distance visual acuity(CDVA)(LogMAR)in I-CXL 10min group increased by -0.21±0.23(t=2.735, P=0.026); Kmax decreased by 2.32±5.21D(t=1.40,P=0.193), but the differences were not statistically significant. Uncorrected distance visual acuity(UDVA), CDVA and Kmax in hypotonic CXL group and I-CXL 5min group were stable, the differences were not statistically significant. The depth of demarcation line was 152.7±42.9μm in hypotonic CXL group, 213.6±42.3μm in I-CXL 5min group and 237.0±46.4μm in I-CXL 10min group 1wk after the surgery, the differences among groups were statistically significant(F=7.111, P=0.006).The phenomenon of stroma cell apotosis-activate-regeneration in I-CXL 10min group was the most significant after the surgery. The changes of corneal thinnest thickness and endothelial cell density in three groups were stable.

CONCLUSION: Three kinds of transepithelial CXL can halt the progression of keratoconus, among which the reaction of corneal tissue in iontophoresis CXL for 10min is the most obvious.