目的：探讨去上皮快速角膜胶原交联术(CXL)治疗进展期圆锥角膜1 a期的临床疗效和安全性。

方法：回顾性自身前后对照研究。收集2018-08/2021-09在我院行去上皮快速CXL治疗进展期圆锥角膜患者中资料完整的63例84眼的临床资料。比较术前，术后1、3、6、12 mo的裸眼视力(UCVA)和最佳矫正视力(BCVA)、屈光度、角膜透明度、角膜前表面最大K值(Kmax)、角膜最薄点厚度、角膜内皮细胞计数和眼压。

结果：手术前后UCVA和球镜比较均无差异(均P>0.05)，BCVA、柱镜、Kmax、角膜最薄点厚度、眼压比较均有差异(均P<0.05)。术后12 mo BCVA、柱镜、角膜最薄点厚度、眼压与术前比较均无差异(均P>0.05)，Kmax较术前降低(P<0.05)。术后1 mo 角膜内皮细胞计数(2519.87±345.28 cells/mm²)较术前(2693.63±313.39 cells/mm²)减少(P<0.001)。术后1 wk 22眼出现角膜haze(0.5-1级)，术后1 mo 15眼出现角膜基质细线状混浊，7眼角膜混浊在术后3-6 mo消退，5眼遗留角膜点片状云翳或斑翳，但均未对视力造成影响。

结论：去上皮快速CXL术后随着时间的延长，患者UCVA、BCVA和球镜度数保持稳定，散光度数和角膜曲率短暂升高后逐渐下降，角膜最薄点厚度减少后逐渐恢复到术前水平。术后6、12 mo的角膜曲率较术前明显降低，可有效地阻止圆锥角膜的进展。该术式可引起角膜局限混浊和斑翳，角膜内皮细胞数量减少，但是对BCVA没有影响，具有较好的安全性。

METHODS:A retrospective pre-post self-controlled study. Data were collected from complete cases of 63 patients(84 eyes)with progressive keratoconus who underwent epithelial-off accelerated CXL between August 2018 and September 2021. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refraction, corneal transparency, maximum keratometry(Kmax)of the anterior corneal surface, minimum corneal thickness, endothelial cell counts, and intraocular pressure(IOP)were analyzed preoperatively and at 1, 3, 6, and 12 mo postoperatively.

RESULTS:No significant differences were observed in UCVA and spherical power before and after surgery(all P>0.05). However, there were significant differences in BCVA, cylinder power, Kmax, minimum corneal thickness, and IOP(all P<0.05). At 12 mo postoperatively, there were no significant differences in BCVA, cylinder power, minimum corneal thickness, and IOP compared with preoperative values(all P>0.05), while Kmax was decreased compared with preoperative value(P<0.05). At 1 mo postoperatively, the corneal endothelial cell count(2519.87±345.28 cells/mm²)was decreased compared with preoperative value(2693.63±313.39 cells/mm²; P<0.001). At 1 wk postoperatively, 22 eyes developed corneal haze(grade 0.5 to 1), and 15 eyes presented with linear corneal stromal opacity at 1 mo postoperatively. In 7 eyes, corneal opacity subsided within 3 to 6 mo after the operation, however, 5 eyes still exhibited corneal nebula or macula without affecting visual acuity.

CONCLUSION: After epithelial-off accelerated CXL, the UCVA, BCVA and spherical diopter of patients remained stable over time. The astigmatism and corneal curvature temporarily increased and then gradually decreased. The cornea minimum thickness decreased initially but subsequently returned to preoperative levels. The corneal curvature at 6 and 12 mo after surgery was significantly lower than that before surgery, which could effectively prevent the progression of keratoconus. Despite potential localized corneal opacity and macular complications, as well as a possible decrease in corneal endothelial cell count, BCVA remained unaffected, demonstrating favorable safety outcomes.