不同方式核黄素角膜胶原交联术治疗圆锥角膜的随访观察

A Two-Year Observation Study of Different Ways of Riboflavin Corneal Collagen Crosslinking

目的:比较三种不同方式角膜胶原交联术(CXL)治疗进展期圆锥角膜2年后的临床疗效。方法:本研究为前瞻性研究。选取2016年8月-2018年6月汉口爱尔眼科医院确诊为进展期圆锥角膜并接受CXL的46例74只眼患者为对象,随机分为渗透增强剂型角膜胶原交联组16只眼,离子导入型角膜胶原交联组40只眼,去上皮型角膜胶原交联组18只眼。术前、术后6个月、12个月和24个月检查观察最佳矫正视力(BCVA)、角膜前表面最大曲率值(Kmax)、角膜光密度、角膜最薄点厚度(TCT)、角膜内皮细胞密度(ECD)和等效球镜(SE)。结果:三种CXL术后,BCVA均有所改善;去上皮组术后Kmax较术前降低,而另外两组基保持稳定;离子导入组术后TCT较术前增长,去上皮组TCT较术前略有降低,渗透增强剂组保持稳定;三种CXL术后角膜光密度、ECD和SE均保持稳定。结论:三种类型的CXL都是安全有效的,效果方面去上皮型>离子导入型>渗透增强剂型角膜胶原交联。

Objective:To compare the clinical efficacy of three different methods of corneal collagen crosslinking(CXL)in the treatment of progressive keratoconus during 2 years of follow-ups.Methods:This is a prospective study.A total of 46 patients with 74 eyes who were diagnosed with progressive keratoconus and received CXL from August 2016 to June 2018 in Hankou Aier Eye Hospital were selected as the subjects.They were randomly divided into the penetration enhancer CXL group(16 eyes),ionimporting CXL group(40 eyes)and epithelium-off CXL group(18 eyes).The best corrected visual acuity(BCVA),maximum curvature value of the anterior corneal surface(Kmax),corneal optical density,corneal thinnest point thickness(TCT),corneal endothelial cell density(ECD)and spherical equivalent(SE)were observed before surgery,at 6 months,12 months and 24 months after surgery.Results:BCVA was improved in all three CXL methods after operation;postoperative Kmax in the epithelium-off CXL group was lower than that before operation,while that in the other two groups remained basically stable;postoperative TCT in the ion-importing CXL group increased compared with that before operation,TCT in the epithelium-off CXL group slightly decreased compared with that before operation,and TCT in the penetration enhancer CXL group remained stable;corneal optical density,ECD and SE remained stable after the three CXLs.Conclusion:The three types of CXL are safe and effective,and the effect is epithelium-off CXL>ion-importing CXL>penetration enhancer CXL.