角膜胶原交联治疗圆锥角膜的初步临床观察

The primary clinical observation of corneal collagen crosslinking for treatment of keratoconus

目的观察角膜胶原交联治疗进行性圆锥角膜的早期临床表现。方法10只眼的进行性圆锥角膜接受角膜胶原交联治疗,主要观察术中和术后第1、3、5天术眼反应,以及术后1、3个月视力、角膜情况、眼压、角膜地形图等情况。结果去除角膜上皮后,维生素B2可渗入角膜基质层,紫外线照射下呈黄绿色荧光,治疗后数小时消退。第3天时角膜上皮愈合,角膜轻度水肿。术后1个月在裂隙灯显微镜下可见轻度角膜基质层混浊,可持续至治疗后3个月。3只眼的角膜地形图平均屈光度数较治疗前增加约0.5 D。1只角膜水肿比较重的眼,角膜厚度较治疗前略有增加。结论角膜水肿和角膜轻度混浊现象存在于大多数治疗眼的早期观察中,提示该治疗早期,除了去除角膜上皮继发的组织反应外,可能还有光化学治疗本身对角膜的作用。

Objective To observe the reaction of cornea at the early stage after treatment of corneal collagen crosslinking for keratoconus. Methods Ten eyes of 10 patients with progressive keratoconus were treated by corneal collagen crosslinking. To observe the reaction of cornea at post-operative 1,3 and 5 days under the slit-lamp biomicroscopy, and follow-up 1-3 months. Results The riboflavin could permeate into all corneal stroma even into anterior chamber after deepithelium that appeared yellow-green fluorescence under the ultraviolet irradiation and disappeared several hours. There was mild corneal edema while epithelium healed at the third day. The mild corneal turbid could be seen under the slit-lamp microscope at post-operative first month and lasting to third months. The corneal topographic equivalent spherical value was not decreased but increased at averafe of 0. 5 D in 3 eyes. Conclusion The edema and turbid in corneal stoma appeared at early stage in most treated eyes, that suggested besides tissue reaction following deepithelium, corneal collagen crosslinking procedure play a role.