去上皮和经上皮快速角膜交联术紫外光脉冲输出模式治疗进展期圆锥角膜患者的临床效果

Epithelium-off or epithelium-on accelerated corneal cross-linking using pulsed ultraviolet light for keratoconus

目的探讨去上皮快速角膜交联术紫外光脉冲输出模式(pl-快速CXL)和经上皮pl-快速CXL治疗进展期圆锥角膜患者的临床效果。方法选取2018年1月至2019年6月在河北省眼科医院行pl-快速CXL治疗的进展期圆锥角膜患者16例31眼;根据术式将患眼分为两组,去上皮pl-快速CXL组7例13眼和经上皮pl-快速CXL组9例18眼。术前及术后3个月和6个月进行随访。记录患眼最佳矫正远视力、散光度、角膜前表面最大曲率、角膜前表面最小曲率、角膜最薄点厚度、角膜内皮细胞计数、交联线深度,对各指标进行统计学分析。结果去上皮pl-快速CXL组和经上皮pl-快速CXL组患者术后3个月和术后6个月最佳矫正远视力、散光度、角膜前表面最大曲率、角膜前表面最小曲率、角膜内皮细胞计数与术前相比,差异均无统计学意义(均为P>0.05);术后3个月和术后6个月时两组角膜最薄点厚度均较术前变薄,差异均有统计学意义(均为P<0.05)。两组患者交联线深度术后3个月与术后6个月相比,差异均无统计学意义(均为P>0.05)。术后3个月和术后6个月时,去上皮pl-快速CXL组患者角膜交联线深度均较经上皮pl-快速CXL组更深,差异均有统计学意义(均为P<0.05)。对于相同时间点的其他参数而言,两组间差异均无统计学意义(均为P>0.05)。结论无论是去上皮pl-快速CXL还是经上皮pl-快速CXL都安全可行,在术后6个月内均能够稳定圆锥角膜病情。

Objective To evaluate the clinical efficacy of epithelium-off accelerated corneal cross-linking(Epi-off ACXL)and epithelium-on accelerated corneal cross-linking(Epi-on ACXL)using pulsed ultraviolet light(pl)for keratoconus.Methods The data of 16 patients(31 eyes)performed with Epi-off pl-ACXL and Epi-on pl-ACXL in Hebei Eye Hospital from January 2018 to June 2019 was included and separated into two groups,the Epi-off pl-ACXL group(7 patients 13 eyes)and the Epi-on pl-ACXL group(9 patients 18 eyes).Follow-ups were performed before and 3 months and 6 months after surgery.The two groups were compared in best corrected distance visual acuity(BCDVA),astigmatism,maximum and minimum keratometry,corneal thinnest point thickness,corneal endothelial cells,and depth of demarcation line pre-and postoperatively.Results No statistically difference was found between two groups in the parameters of BCDVA,astigmatism,maximum and minimum keratometry,and corneal endothelial cells between 3 months and 6 months after surgery and before surgery(all P>0.05).The corneal thinnest point thickness decreased significantly at 3 months and 6 months after surgery when compared with before surgery in the two groups(P<0.05).There was no significant differences between the two groups of patients in depth of demarcation line 3 months and 6 months after surgery(both P>0.05).At 3 months and 6 months after surgery,the depth of demarcation line of the patients in the Epi-off pl-ACXL group was deeper than that in the Epi-on pl-ACXL group group,and the difference was statistically significant(all P<0.05).For other parameters at the same time point,there was no statistically significant differences between the two groups(all P>0.05).Conclusion Both Epi-off pl-ACXL and Epi-on pl-ACXL are safe and feasible treatment for keratoconus both of which can stabilise symptoms.