角膜基质透镜联合跨上皮快速角膜胶原交联术治疗重度圆锥角膜

Corneal stromal lenticule-combined accelerated transepithelial corneal collagen cross-linking for severe keratoconus

摘要:

目的：评估角膜基质透镜联合跨上皮快速角膜胶原交联术(SC-A-TE-CXL)治疗重度圆锥角膜的临床疗效。

方法：前瞻性自身前后对照研究。收集2019-03/2022-07于南京医科大学附属眼科医院确诊为重度圆锥角膜且最薄点角膜厚度(含上皮)<400 μm的患者10例14眼，其中男8例12眼，女2例2眼，予以SC-A-TE-CXL进行治疗。观察并记录术前和术后1、3、6、12 mo的角膜曲率、裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜最薄点厚度(TCT)、角膜中心厚度(CCT)、非接触式眼压、内皮细胞密度(ECD)和前后表面最薄点高度以及术后1 mo角膜交联深度。

结果：患者行SC-A-TE-CXL术后1、3、6、12 mo UCVA和BCVA较术前提高，但总体无差异(F=0.793，P=0.535； F=0.783，P=0.542)。术后各时间点K1、K2、Km和Kmax较术前下降，但总体无差异(F=0.627，P=0.574； F=1.264，P=0.296； F=0.727，P=0.520； F=1.115，P=0.359)。术后各时间点前后表面最薄点高度较术前均下降，但总体无差异(F=1.046，P=0.359； F=1.164，P=0.337)。术后各时间点非接触式眼压较术前提高，但总体无差异(F=0.814，P=0.522)。术后各时间点CCT、TCT和术前相比总体无差异(F=0.931，P=0.453； F=0.782，P=0.542)。术后12 mo ECD与术前相比无差异(t=1.266，P=0.228)。术后1 mo，前节光学相干层析成像术(AS-OCT)显示角膜浅层基质密度增高，前后基质间存在“分界线”，平均深度为124.07±25.13 μm。

结论：SC-A-TE-CXL能延缓重度圆锥角膜患者的病情进展，安全性高，其远期疗效有待进一步观察，可以作为一种治疗重度圆锥角膜的手术方式。

Abstract:

AIM: To evaluate the clinical efficacy of corneal stromal lenticule-combined accelerated transepithelial corneal collagen cross-linking(SC-A-TE-CXL)in the treatment of severe keratoconus.

METHODS: Prospective before-after self-control study. A total of 10 cases(14 eyes)of severe keratoconus with the thinnest corneal thickness(including epithelium)less than 400 μm were collected from March 2019 to July 2022 at the ophthalmology department of Affiliated Eye Hospital of Nanjing Medical University. Among them, 8 males(12 eyes)and 2 females(2 eyes)were treated with SC-A-TE-CXL. Corneal curvature, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), the thinnest corneal thickness(TCT), central corneal thickness(CCT), non-contact intraocular pressure, endothelial cell density(ECD)and anterior or posterior elevations at the thinnest point before surgery and at 1, 3, 6 and 12 mo postoperatively were observed and recorded, as well as corneal cross-linking depth at 1 mo postoperatively.

RESULTS: UCVA and BCVA at 1, 3, 6, and 12 mo after SC-A-TE-CXL were higher than those preoperatively, but there were no differences(F=0.793, P=0.535; F=0.783, P=0.542). K1, K2, Km and Kmax decreased at each time point postoperatively compared with those preoperatively, but there were no differences(F=0.627, P=0.574; F=1.264, P=0.296; F=0.727, P=0.520; F=1.115, P=0.359). Anterior and posterior elevations at the thinnest point both decreased compared with those preoperatively, but the differences were not statistically significant(F=1.046, P=0.359; F=1.164, P=0.337). The non-contact intraocular pressure at each time point postoperatively was higher than that preoperatively, but the differences were not statistically significant(F=0.814, P=0.522). There were no differences in CCT and TCT at any time points of the follow-ups compared with those preoperatively(F=0.931, P=0.453; F=0.782, P=0.542). There was no difference in ECD at 12 mo postoperatively versus preoperative value(t=1.266, P=0.228). At 1 mo postoperatively, anterior segment optical coherence tomography(AS-OCT)exhibited an increase of density in the anterior stroma, and there was a demarcation line with an average depth of 124.07±25.13 μm.

CONCLUSION: SC-A-TE-CXL can be considered as a surgical treatment for severe keratoconus, which can delay the progression of severe keratoconus with high safety. However, the long-term efficacy of this treatment requires further observation.