角膜胶原交联手术治疗圆锥角膜的临床研究

Clinical research on corneal collagen cross-linking for the treatment of keratoconus

目的 评价去上皮核黄素诱导的角膜交联术和跨上皮核黄素诱导的角膜胶原交联术治疗圆锥角膜的效果.方法 回顾性分析郑州市第二人民医院角膜厚度>400μm的圆锥角膜38例(46只眼).随机分成两组,去上皮组(26只眼)和跨上皮组(20只眼).观察两组患者角膜胶原交联术后1、3及6个月视力、角膜厚度、角膜前表面最大曲率及角膜后表面高度的变化.结果 两组术后不同时间段视力差异无统计学意义(P>0.05).最薄点角膜厚度去上皮组术后随时间延长不断减小,与术前相比差异有统计学意义(P<0.05),跨上皮组最薄点角膜厚度术后亦较术前减小,但随时间推移无明显变化.两组术后3个月及6个月比较差异有统计学意义(P<0.05).两组角膜最大曲率值读数(maximum k-reading,Kmax)术后均随时间延长不断下降,但去上皮组较跨上皮组下降幅度更大,两组差异有统计学意义(P<0.05).角膜后表面高度术后1、3及6个月与术前相比差异均无统计学意义(P>0.05).结论 两种方法治疗圆锥角膜均安全有效.去上皮法角膜胶原交联术较跨上皮角膜胶原交联术效果确切.

Objective To evaluate the efficacy of standard ( epithelium-off) corneal collagen cross-linking and transepithelial corneal collagen cross-linking with the induction of riboflavin for keratoconus. Methods The data of 46 eyes of 38 cases with keratoconus and corneal thickness > 400 μm were retrospectively analyzed. The patients were divided randomly into two groups:group A, 26 eyes, underwent epithelium-off corneal collagen cross-linking surgery and group B, 20 eyes, underwent transepithelial corneal collagen cross-linking surgery. The visual acuity, corneal thickness, the changes of maximum k-reading (Kmax) and posterior corneal surface height at 1, 3 and 6 months postoperatively between the two groups were compared. Results The difference of visual acuity at different times postoperatively was not significant between the two groups (P>0. 05). The thinnest corneal thickness in group A postoperatively decreased with the time increasing. The difference was significant between before and after surgery(P<0. 05). The thinnest corneal thickness in group B postoperatively was less than that preoperatively, but no changed with time. The thinnest corneal thickness at 3 and 6 months postoperatively were statistically significant between the two groups(P<0. 05). The decreasing amplitude of Kmax postoperatively in group A was higher than that in group B(P <0.05). The differences of posterior elevations at different times postoperatively were not significant between the two groups (P>0. 05). Conclusion The efficacy of epithelial-off corneal collagen cross-linking is significantly better than that of transepithelial collagen cross-linking for keratoconus.