角膜胶原交联术治疗青少年圆锥角膜的临床效果

Clinical effect of corneal collagen cross-linking for keratoconus in teenagers

目的探讨核黄素／紫外线A（UVA）诱导的去上皮角膜胶原交联术（CXL）用于青少年圆锥角膜患者的安全性和有效性。方法回顾性自身前后对照研究。选择山东大学附属省立医院2013年10月至2015年10月收治的青少年原发性圆锥角膜患者19例（30眼），予去上皮核黄素／UVA诱导的CXL治疗，术后随访1年，观察术前与术后第3、6、12个月时的裸眼视力（UCVA）、最佳矫正视力（BCVA）、角膜Kmax值、最薄点角膜厚度（TCT）、角膜内皮细胞计数（ECD）等参数变化。采用单组重复测量的方差分析分析术后各时间点与术前各指标的变化情况。结果术前UCVA（LogMAR）为0．78±0．33，术后第3、6、12个月时分别为0．77±0．34、0．72±0．33、0．67±0．31，术后第12个月UCVA与术前比较差异有统计学意义（P〈0．001）；术前BCVA（LogMAR）为0．42±0．33，术后第3、6、12个月时分别为0.31±0．27、0．29±0．23、0．23±0．20，术后第6、12个月与术前比较差异均有统计学意义（P〈0．05）；术前及术后各时间点Kmax分别为（62．1±11．3）D、（61．6±9．9）D、（60．4±9．9）D、（59．9±9．5）D，术后第6、12个月与术前比较差异均有统计学意义（P〈0．05）；TCT由术前的（446±41）μm降低到术后第12个月的（430±39）μm（P〈0．001），术后第3、6、12个月时的ECD与术前比较差异均无统计学意义。术中及术后无并发症发生。结论核黄素／UVA诱导的去上皮CXL可以有效提高青少年圆锥角膜患者视力，降低角膜K值且安全性高。

Objective To evaluate the safety and efficacy of epithelium-off corneal collagen cross-linking （CXL） induced by riboflavin and ultraviolet A light for keratoconus in teenagers. Methods The medical records of consecutive patients （30 eyes of 19 cases） at the age of 14-18 years treated with epithelium-off CXL for keratoconus were analyzed in this retrospective self-control study. Data from preperative and 3-, 6-, and 12-month postoperative examinations were analyzed by one way repeated ANOVA. The clinical evaluations included uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, maximum keratometry （Kmax）, thinnest corneal thickness （TCT）, and endothelial cell density （ECD）. Results UCVA measured as the log of the minimum angle of resolution （LogMAR） was 0.78±0.33 at baseline before surgery and 0.77±0.34, 0.72±0.33, and 0.67±0.31 at 3-, 6-, and 12-months after surgery. There was significant improvement of UCVA at 12 months compared to the baseline （P〈0.001）. LogMAR BCVA increased from 0.42±0.33 to 0.29±0.23 and 0.23±0.20 at 6- and 12-months after surgery （both P〈0.05）. The Kmax value was 62.1±11.3 diopter （D） before treatment and improved significantlyto 60.4±9.9 D and 59.9±9.5 D at 6 and 12 months after treatment respectively. The preoperative TCT was 446±41 μm and thinned to 430±39 μm at 12 months after surgery （P〈0.001）. There were no significant differences between the preoperative and 12-month postoperative ECD. No complications occurred in the overall group throughout the study period. Conclusion Epithelium-off CXL is safe and effective in treating teenage keratoconus. The procedure improved the visual acuity and keratometry values at 12 months after surgery.