圆锥角膜胶原交联术后进展的影响因素

Influencing factors on the postoperative progression of corneal collagen crosslinking in keratoconus

角膜胶原交联术已被证明可以延缓或阻止圆锥角膜的进展,特别是在疾病的早中期。但研究也显示经胶原交联术后,圆锥角膜仍有一定几率继续进展。交联术后继续进展的影响因素包括:交联术后进展的诊断标准、手术方式(是否保留上皮、核黄素的给药方式、紫外线照射时长与模式)、年龄、锥顶位置、术前Kmax值、揉眼与过敏等。一般认为,阻止进展效果依次为去上皮交联法、离子导入法交联、促渗剂交联,Dresden法优于快速交联法,高龄患者优于低龄患者,锥顶位于角膜中央的圆锥角膜优于周边型圆锥角膜,术前低Kmax者优于术前高Kmax者,无揉眼过敏者优于有揉眼过敏者,可作为临床干预及预后评估的参考。

Corneal collagen crosslinking(CXL)has been demonstrated to retard or arrest progression of the keratoconus,especially in the middle and early stages of the disease.So far,articles have shown that there was still a certain possibility of continuous progression post CXL.Factors of postoperative progression include that:criteria of postoperative progression,surgical protocol(epithelium-off or transepithelial CXL,drug-delivery of riboflavin,duration and pattern of ultraviolet A irradiation),age,cone location,preoperative Kmax value,eye rubbing and(or)allergies.Most articles suggested that the effect of preventing keratoconus progression were as follows:epithelium-off CXL>iontophoretic CXL>riboflavin penetration enhanced CXL,Dresden protocol>accelerated CXL,adult>pediatric,central cone>peripheral cone,preoperative low Kmax>preoperative high Kmax,no eye rubbing and allergy>combined with eye rubbing and(or)allergy.This paper will detail the above factors that influence the progression of the keratoconus after CXL and provide reference for clinical intervention and prognosis evaluation.