跨上皮快速角膜交联术治疗圆锥角膜的1年期疗效观察

One-year follow-up of accelerated transepithelial corneal collagen cross-linking for progressive keratoconus

目的评估跨上皮快速角膜胶原交联术(ATE-CXL)治疗圆锥角膜的1年期有效性和安全性。方法选取22例(29只眼)术前处于进展状态的圆锥角膜行跨上皮快速角膜胶原交联术,术后随访平均时长为13.2个月;对比分析术前、术后SimK1、SimK2、Kmax、角膜内皮细胞计数和形态、裸眼视力(UCVA)、最佳镜片矫正视力(BSCVA)、角膜及晶状体情况、主觉验光及角膜最薄处厚度等指标的变化。结果所有患者均顺利完成手术,未见术中并发症,术后1~2d术眼有刺激症状。术后1个月、3个月和6个月的散光较术前减少,所有随访节点的球镜度、等效球镜度以及术后1年的散光度数较术前的减少均无统计学意义。UCVA从术前的(1.07±0.43)LogMAR提高到术后6个月的(0.86±0.40)LogMAR,以及术后1年的(0.75±0.41)LogMAR,而BSCVA从术前的(0.38±0.43)LogMAR提高到术后1年的(0.22±0.17)LogMAR。SimK1、SimK2、Kmax、角膜散光、角膜内皮细胞计数和形态及角膜最薄处厚度是稳定的。结论跨上皮快速角膜胶原交联术治疗圆锥角膜是有效、安全的。

Objective To evaluate the one-year efficacy and safety of accelerated transepithelial corneal collagen cross-linking (ATE-CXL) for the treatment of keratoconus.[WT5”HZ]Methods Twenty-nine eyes with progressive keratoconus of 22 patients were enrolled.Mean postoperative follow-up time was 13.2 months.Manifest refraction,uncorrected visual acuity (UCVA),best spectacle corrected visual acuity (BSCVA),flattest meridian keratometry (Sim K1),steepest meridian keratometry (Sim K2),maximum keratometry(Kmax),thinnest corneal thickness(TCT),counts of corneal endothelial cells,corneal and lens status were measured before and after ATE-CXL.[WT5”HZ]Results No complications were observed in any case during or after ATE-CXL.Irritations were observed within 1~2 days after the surgery.Astigmatism was reduced at 1 month,3 months and 6 months postoperatively.Spherical power, spherical equivalence and astigmatism at 1 year after the surgery was reduced as compared with that before the surgery,but the difference was not statistically significant.UCVA improved from 1.07 ± 0.43 LogMAR preoperatively to 0.86 ± 0.40 LogMAR at 6-month postoperatively,and to 0.75±0.41 LogMAR at 1-year postoperatively.BSCVA improved from 0.38 ± 0.43 LogMAR preoperatively to 0.22 ± 0.17 LogMAR at 1-year postoperatively.There were no statistical significant differences in Sim K1,Sim K2,Kmax,corneal astigmatism,counts of corneal endothelial cells and TCT before and after ATE-CXL during the follow-up ( P >0.05).[WT5”HZ]Conclusions ATE-CXL is an effective and safe method for halting the progression of keratoconus,while slightly improving visual function.