跨上皮快速角膜胶原交联术治疗进展期圆锥角膜

Trans-epithelial accelerated corneal collagen cross-linking for progressive keratoconus

摘要:

目的：研究跨上皮快速角膜胶原交联术(CXL)治疗进展期圆锥角膜的临床效果和安全性。

方法：前瞻性自身前后对照研究。收集自2016-08/2019-11在我院进行跨上皮快速CXL的进展期圆锥角膜患者37例47眼，分析患者术前，术后1、3、6、12mo的裸眼视力(UCVA)和最佳矫正视力(BCVA)、屈光状态、角膜透明度、角膜前表面最大K值(Kmax)、角膜最薄点厚度、角膜内皮细胞计数、眼压。

结果：术后1、3、6、12mo患者UCVA较术前提高，但总体比较无差异(F=1.372，P=0.261)。患者术后1、3、6、12mo的BCVA均较术前提高，总体比较有差异(F=3.308，P=0.019)，进一步比较发现术后3、6、12mo的BCVA与术前比较有差异(P=0.04、0.01、0.007)。患者术后1、3、6、12mo的球镜度数、柱镜度数、Kmax、角膜最薄点厚度与术前总体比较无差异(F=0.293、1.378、2.448、1.970，P=0.881、0.258、0.061、0.116)。术后1mo患者角膜内皮细胞计数与术前比较无差异(t=1.156，P=0.25)。患者术后各时间点眼压与术前比较无差异(F=1.221，P=0.321)。术后7眼出现角膜Haze(1级～2级)，术后3～6mo有5眼Haze消退，角膜恢复透明，1眼遗留角膜云翳，1眼角膜中央基质线状混浊，但均未对视力造成影响。

结论：跨上皮快速CXL可以显著提高圆锥角膜患者BCVA，稳定患者屈光状态、角膜形态和厚度，阻止或延缓圆锥角膜进展，使患者获得更好的视功能，同时手术时间短，术后并发症少，具有较好的安全性。

Abstract:

AIM:To investigate the clinical efficacy and safety of trans-epithelial accelerated corneal collagen cross-linking in the treatment of progressive keratoconus.

METHODS: A prospective before-after self-control study. A total of 47 eyes of 37 patients with progressive keratoconus who underwent trans-epithelial accelerated corneal collagen cross-linking in our hospital from August 2016 to November 2019 were collected. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refractive status, corneal transparency, maximum keratometry value of the anterior corneal surface, thinnest corneal thickness, corneal endothelial cell counts and intraocular pressure(IOP)were analysed preoperatively and at 1, 3, 6 and 12mo postoperative.

RESULTS: UCVA of patients 1, 3, 6 and 12mo after surgery was higher than that before surgery, but there was no difference(F=1.372, P=0.261). BCVA at 1, 3, 6 and 12mo after surgery was higher than that before surgery, the difference was statistically significant(F=3.308, P=0.019). There were no differences in the spherical and cylindrical power, Kmax and thickness of the thinnest point of cornea at 1, 3, 6 and 12mo postoperatively compared with those before surgery(F=0.293, 1.378, 2.448, 1.970; P=0.881, 0.258, 0.061, 0.116). There was no difference in corneal endothelial cell counts between 1mo after surgery and before surgery(t=1.156, P=0.25). There was no difference in IOP at all postoperative time points compared with that before surgery(F=1.221, P=0.321). The corneal Haze(grade 1-2)appeared in 7 eyes after surgery, and subsided in 5 eyes from 3-6mo after surgery, and the corneal transparency recovered. The corneal nebula remained in 1 eye, and the corneal central stroma linear opacity existed in 1 eye, but the visual acuity of both eyes was not affected.

CONCLUSION: Trans-epithelial accelerated corneal collagen cross-linking can significantly improve BCVA, stabilize refractive status, corneal morphology and thickness, prevent or delay the progression of keratoconus, and enable patients to obtain better visual function. At the same time, the operation time is short, postoperative complications are less, and the operation has good safety.