高能量紫外线角膜胶原交联术治疗难治性大泡性角膜病变的短期疗效

Accelerated corneal collagen cross-linking in eyes with incurable bullous keratopathy

目的 探讨高能量紫外线核黄素角膜胶原交联术对难治性大泡性角膜病变的疗效及意义.方法 回顾性研究.收集自2011年3月至2013年3月期间在厦门大学附属厦门眼科中心就诊的药物及羊膜移植手术治疗无效的难治性大泡性角膜病变患者,予行高能量紫外线核黄素角膜胶原交联术.手术前及术后1周、1个月、3个月时随访,对患者行疼痛感评分、常规裂隙灯显微镜检查、IOP、视力、前节OCT角膜厚度测量及内皮数量和形态检查.使用方差分析对术前及术后参数差异进行比较.结果 13例（13眼）患者入选并顺利接受高能量角膜胶原交联术.患者术前疼痛指数为7.6±1.2,术后1个月及3个月时均较术前明显下降,分别为5.3±1.6和5.5±1.7,差异均具统计学意义（F=8.593,P＜0.01）;术前角膜上皮缺损评分为4.5±0.5,术后1周及1个月时评分显著下降,分别为3.4±0.6和2.8±0.9（F=12.580,P＜0.01）;术前角膜透明度评分为2.7±0.5,术后1周及1个月时角膜透明度显著增加,评分分别下降至1.9±0.5和2.2±0.6（F=6.122,P＜0.01）;术前角膜厚度为（862.2±146.4）μm,术后1周及1个月时角膜厚度显著降低,分别为（707.5±92.7）μm和（718.8±47.2） μm（F=5.859,P＜0.01）.但术后3个月时部分患者角膜上皮缺损增加、角膜透明度下降,角膜厚度回升,且与术前相比差异无统计学意义.结论 高能量角膜胶原交联术能够在术后早期显著改善难治性大泡性角膜病变眼部症状,增加角膜透明度,降低角膜厚度;但其疗效并不持久.

Objective To evaluate the efficacy of accelerated corneal collagen cross-linking （a-CXL） in patients with incurable bullous keratopathy.Methods This was a retrospective,nonrandomized study.Patients with incurable bullous keratopathy who were consecutively diagnosed at the hospital of the Affiliated Xiamen Eye Center of Xiamen University from March 2011 to March 2013 were included in the study.Patients received accelerated CXL surgery.The following parameters were accessed preoperatively and 1 week,1 month and 3 months postoperatively：ocular pain index using the Numeric Rating Scale （NRS）,visual acuity,noncontact tonometer measurement,slit-lamp examination for corneal epithelium defects and corneal opacity,and anterior-segment OCT for corneal thickness.Differences between groups were analyzed using one-way ANOVA.Results Thirteen eyes were chosen and underwent a-CXL.The ocular pain index was 7.6±1.2 on average preoperatively and significantly decreased to 5.3±1.6 at 1 month and to 5.5±1.7 at 3 months postoperatively （F=8.593,P〈0.01）.The corneal epithelial staining score was 4.5±0.5 preoperatively and was significantly reduced to 3.4±0.6 at 1 week and to 2.8±0.9 at 1 month （F=12.580,P〈0.01） postoperatively.The corneal transparency score was 2.7±0.5 preoperatively and improved significantly to 1.9±0.5 at 1 week and 2.2±0.6 at 1 month （F=6.122,P〈0.01） postoperatively.Preoperative corneal thickness was 862.2±146.4 μm and decreased significantly to 707.5±92.7 μm at 1 week and 718.8±47.2 μm at 1 month （F=5.859,P〈0.01） postoperatively.At 3 months postoperatively,the corneal epithelial staining score,corneal transparency score and corneal thickness were not significantly different from preoperative conditions.Conclusion Accelerated CXL significantly reduces ocular pain,improves corneal epithelium defects,corneal transparency and corneal thickness within a short period postoperatively.However,a-CXL do not seem to have long-lasting effects in patients with bullous keratopathy.