等渗与低渗核黄素诱导的角膜交联术治疗圆锥角膜的疗效观察

The result of riboflavin/UVA corneal collagen cross-linking with isotonic riboflavin solution and hypotonic riboflavin solution in the treatment of keratoconus

目的观察等渗与低渗核黄素溶液进行角膜交联治疗圆锥角膜的疗效。方法将圆锥角膜患者根据治疗前角膜厚度分为两组,厚角膜组采用等渗核黄素溶液进行胶原交联,薄角膜组采用低渗核黄素溶液进行胶原交联。观察交联后两组患者角膜厚度、裸眼视力、矫正视力、顶点K值、角膜内皮细胞计数等指标。结果交联术后两年两组患者角膜厚度分别降低(11±14)μm(厚角膜组)、(7±9)μm(薄角膜组),差异有统计学意义;顶点K值分别降低(1.61±2.30)D(厚角膜组)、(2.58±3.22)D(薄角膜组),差异有统计学意义;两组裸眼视力、矫正视力均较治疗前有统计学意义提高;两组患者角膜内皮细胞计数治疗前后差异无统计学意义。结论交联可以有效控制圆锥角膜的进展,厚角膜患者可以采用等渗核黄素溶液进行胶原交联,薄角膜患者可以采用低渗核黄素溶液进行胶原交联。

Objective To evaluate the outcome of riboflavin / UVA corneal collagen cross-linking（ CXL） with isotonic riboflavin solution and hypotonic riboflavin solution. Methods Group A（ thick cornea） included 18 patients（ 34eyes） undergone CXL with isotonic riboflavin solution and group B（ thin cornea） included 21 patients（ 40 eyes）undergone CXL with hypotonic riboflavin solution. The thinnest corneal thickness（ T）,uncorrected visual acuity（ UCVA）,corrected visual acuity（ CDVA）,maximum keratometry（ Kmax） and endothelial cell count（ ECD） before CXL and 24-month post-CXL were compared. Results T and Kmax decreased 2 years after CXL in both groups,UCVA and CDVA had improvement in both groups and ECD had no significant changes on 24 months after CXL in both groups.Conclusion CXL can halt the progression of keratoconus. Isotonic riboflavin solution can be used for CXL in thick cornea keratoconus patients and hypotonic riboflavin solution can be used for CXL in thin cornea keratoconus patiens.