非角膜地形图引导PRK联合角膜胶原交联术治疗圆锥角膜（英文）

Non-topography-guided photorefractive keratectomy combined with accelerated collagen cross linking for treatment of keratoconus

目的:评估非角膜地形图引导圆锥角膜患者行光折变角膜切除术(PRK)和角膜胶原交联术(CXL)的视力、屈光度和临床疗效。方法:术后1mo, 3mo, 6mo and 12mo对34例患者未矫正视力(UDVA)和矫正距离视力(CDVA),平、陡角膜测量读数以及并发症进行评估。结果:共34例患者平均年龄为23.3±4.0岁。UDVA和CDVA显著提高,且术后1a恢复平稳。通过超过1a的定期随访,T检验显示术前术后值有显著不同(P<0.05)包括视力,球面和柱面变化。Fourier术后图像分析显示轴向位移垂直于术前轴。结论:非角膜地形图引导PRK联合CXL对于治疗圆锥角膜是一种安全有效的手术选择,能够提高UDVA,CDVA和屈光状态。术后3mo达到稳定状态,与非角膜地形图引导PRK相比,地形图引导的唯一优势可能是通过Fourier术后分析,在某些患者中,球镜和柱镜轴位漂移。

·AIM:To evaluate the visual,refractive and clinical outcomes of non-topography-guided photorefractive keratectomy(PRK)and corneal collagen cross linking(CXL)in eyes with keratoconus.·METHODS:Totally 34 cases were evaluated for uncorrected distance visual acuities(UDVA)and corrected distance visual acuities(CDVA),flat and steep keratometry readings,and complications were evaluated at 1 mo,3 mo,6 mo and 12 mo postoperatively.·RESULTS:Thirty-four patients with mean age of 23.3±4.0 years.Statistically significant improvement was shown in UCVA and CDVA,with steadiness of refection for 1y postoperative.T-test showed a significant difference(P<0.05)in all means between the preoperative and postoperative values(visual acuity,spherical and cylinder changes),with stability over a 1y follow up.Fourier analysis of postoperative images showed an axis shift perpendicular to the preoperative axis.·CONCLUSION:Simultaneous non-topography-guided PRK and CXL is safe and effective surgical alternative for keratoconus,yielding improvement in the UDVA,CDVA,and refractive status.Stabilization was achieved as early as 3 mo after surgery,the only advantage of topography-guided over non-topography-guided PRK might be the minimal over correction of sphere and the cylindrical axis shift in some patients as detected by Fourier analysis of postoperative pentacam.