快速去上皮角膜胶原交联术治疗青少年圆锥角膜1年疗效分析

One-year clinical results of accelerated epithelium-off corneal collagen cross-linking for teenagers with keratoconus

目的评价核黄素/紫外线A诱导的快速去上皮角膜胶原交联术(CXL)治疗青少年圆锥角膜的疗效。方法采用系列病例观察研究。纳入2017年1月至2018年2月于郑州市第二人民医院就诊的青少年原发性圆锥角膜患者18例25眼,平均年龄(14.4±1.3)岁。采用核黄素/紫外线A诱导的快速去上皮CXL治疗,术后随访1年,测量并分析术前与术后裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度(SE)、角膜前表面最大曲率值(K_(max))、最薄点角膜厚度(TCT)、角膜后表面高度值(PCE)、角膜内皮细胞密度(ECD)变化。记录术眼的并发症及不良反应。结果患者UCVA(LogMAR)和BCVA(LogMAR)分别由术前的0.96±0.35和0.45±0.22提高至术后1年的0.84±0.33和0.34±0.26,差异均有统计学意义(t=-5.765、-4.843,均P<0.01)。术前SE为(8.66±5.11)D,明显高于术后1年的(8.07±5.21)D,差异有统计学意义(t=-3.253,P=0.003)。术前K_(max)为(58.58±9.07)D,术后1年降至(56.25±9.98)D,差异有统计学意义(t=-4.357,P<0.01);其中K_(max)下降1 D以上的有17眼,占68%,变化在1 D以内的有6眼,占24%,增加1 D以上的有2眼,占8%。TCT由术前的(485.0±32.5)μm下降至术后1年的(475.3±35.5)μm,差异有统计学意义(t=-4.266,P<0.01)。术前与术后1年PCE和ECD比较,差异均无统计学意义(t=1.023,P=0.316;t=-1.424,P=0.167)。1眼术后2 d出现角膜周边无菌性浸润,经糖皮质激素滴眼液点眼后症状好转,预后良好,其余眼未出现术中及术后并发症。结论核黄素/紫外线A诱导的快速去上皮CXL治疗青少年圆锥角膜具有良好的安全性及有效性,长期疗效有待进一步观察。

Objective To assess the safety and efficacy of riboflavin/ultraviolet-A-induced accelerated epithelium-off corneal collagen cross-linking(CXL)for teenagers with keratoconus.Methods In this case series study,25 eyes of 18 patients with primary keratoconus who underwent riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL in Zhengzhou Second People's Hospital from January 2017 to February 2018 were included,and the average age of patients was(14.4±1.3)years.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),maximum keratometry reading(K_(max)),thinnest corneal thickness(TCT),posterior corneal elevation(PCE)and endothelial cell density(ECD)were measured before and after CXL.The patients were followed up for one year.The complications and adverse reactions were recorded.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Zhengzhou Second People's Hospital(No.KY2017002).Written informed consent was obtained from each patient and their guardian prior to the surgery.Results The mean UCVA(LogMAR)was 0.96±0.35 at baseline,which was significantly improved to 0.84±0.33 at 1 year postoperatively(t=-5.765,P<0.01).The mean BCVA(LogMAR)was 0.45±0.22 preoperatively,which was significantly improved to 0.34±0.26 at 1 year postoperatively(t=-4.843,P<0.01).The mean SE was(8.66±5.11)D at baseline,which was significantly higher than(8.07±5.21)D at 1 year postoperatively(t=-3.253,P=0.003).The K_(max) was reduced from(58.58±9.07)D preoperatively to(56.25±9.98)D at 1 year postoperatively,with significant difference between the two time points(t=-4.357,P<0.01).The K_(max) was reduced more than 1 D in 17 eyes(68%),was stable in 6 eyes(24%),and was increased more than 1 D in 2 eyes(8%).The TCT was reduced from(485.0±32.5)μm at baseline to(475.3±35.5)μm at 1 year postoperatively,with significant difference between the two time points(t=-4.266,P<0.01).The differences of PCE and ECD between preoperative and postoperative 1 year were not statistically significant(t=1.023,P=0.316;t=-1.424,P=0.167).There was one eye suffering peripheral sterile corneal infiltrate 2 days postoperatively,and favorable prognosis was achieved after the topical steroids application.No complication was encountered in other subjects.Conclusions Riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL is safe and effective in teenagers with keratoconus during the 1-year follow-up.The long-term effects need further observation.