去上皮快速角膜胶原交联术治疗进展期圆锥角膜

Efficacy of epithelial-off accelerated corneal cross-linking in the treatment of advanced keratoconus

摘要:

目的：研究去上皮快速角膜胶原交联术(CXL)治疗进展期圆锥角膜的疗效。

方法：回顾性研究。收集2020-04/2021-12就诊于宁夏回族自治区人民医院 宁夏眼科医院行去上皮快速CXL的进展期圆锥角膜患者32例43眼。于术前及术后1、3、6mo行裂隙灯、眼压、裸眼视力、矫正视力、角膜内皮镜、眼前节分析仪Pentacam和可视化角膜生物力学Corvis ST检查，记录手术前后角膜情况、裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜内皮数、角膜最大曲率(Kmax)、角膜厚度最薄点(TCT)、前后表面K1、K2值、矫正眼内压(bIOP)、第一次压平时间(A1T)、第一次压平长度(A1L)、第一次压平速度(A1V)、第二次压平时间(A2T)、第二次压平长度(A2L)、第二次压平速度(A2V))、最大形变幅度(HCDA)、最大形变曲率半径(HCR)、最大压陷时两峰间距(HCPD)、第1次压平时角膜硬度(SP-A1))值。

结果：术前、术后6mo UCVA(LogMAR)(1.06±0.49、0.78±0.39)和BCVA(LogMAR)(0.48±0.34、0.38±0.29)比较均有差异(P<0.05)，角膜内皮细胞比较无差异(2917.39±288.38 vs 2959.19±336.27cells/mm²，P=0.477)。手术前后Kmax、TCT、前表面K1、K2值、后表面K1值比较均有差异(P<0.05)，且均在术后1mo升高，术后3mo后恢复至术前水平，而后表面K2值比较无差异。手术前后A1T、HCPD、SP-A1比较差异均有统计学意义(P<0.05)，A1L、A1V、A2T、A2L、A2V、HCDA、HCR、bIOP比较无差异(P>0.05)

结论：去上皮快速CXL在术后6mo内能够阻止进展期圆锥角膜进展并且具有一定的安全性。

Abstract:

AIM: To investigate the efficacy of epithelial-off accelerated corneal cross-linking(CXL)in the treatment of advanced keratoconus.

METHODS: A retrospective study was performed on data collected from 32 patients(43 eyes)with advanced keratoconus who underwent epithelial-off accelerated CXL at Ningxia Eye Hospital from April 2020 to December 2021. Slit-lamp, intraocular pressure, uncorrected visual acuity(UCVA), corrected visual acuity, specular microscope, Pentacam and Corvis ST were tested before and at 1, 3 and 6mo after surgery. Preoperative and postoperative corneal condition, UCVA, best corrected visual acuity(BCVA)and the values of corneal endothelial, maximum keratometry(Kmax), thinnest corneal thickness(TCT), anterior and posterior surfaces of the cornea K1, K2, biomechanically corrected intraocular pressure(bIOP), applanation time 1(A1T), applanation length 1(A1L), applanation velocity 1(A1V), applanation time 2(A2T), applanation length 2(A2L), applanation velocity 2(A2V), highest concavity deformation amplitude(HCDA), radius at highest curvature(HCR), highest concavity peak distance(HCPD)and stiffness parameter at first applanation(SP-A1)were recorded.

RESULTS: There were differences between UCVA(LogMAR; 1.06±0.49, 0.78±0.39)and BCVA(LogMAR; 0.48±0.34, 0.38±0.29)before and at 6mo after surgery(P<0.05), but there were no differences in corneal endothelial cells(2917.39±288.38 vs. 2959.19±336.27 cells/mm², P=0.477). There were differences among Kmax, TCT, anterior surface K1 and K2 and posterior surface K1 before and after surgery(P<0.05), and all increased at 1mo after surgery then returned to preoperative level at 3mo after surgery, while there was no difference in the posterior K2. Furthermore, there were statistical significance in A1T, HCPD and SP-A1 before and after surgery(P<0.05), while there were no statistical significance in A1L, A1V,A2T, A2L, A2V, HCDA, HCR and bIOP(P>0.05).

CONCLUSION: Epithelial-off accelerated CXL can prevent the progression of keratoconus within half year after surgery, and it has certain safety.