屈光手术联合预防性角膜胶原交联矫正屈光不正的疗效及安全性研究进展

Efficacy and safety of refractive surgery combined with prophylactic collagen cross-linking for ametropia

角膜屈光手术是一种安全、有效的屈光不正矫正方式。尽管因术后角膜组织完整性改变,导致角膜生物力学稳定性下降,但术后角膜结构绝大多数是安全的。如果术前存在危险因素,如屈光度数高、角膜薄、角膜地形图形态欠规则、散光度数高、双眼对称性差、过敏体质、有揉眼习惯等,术后有可能发生屈光回退和角膜膨隆。角膜胶原交联术可增强角膜生物力学,有效阻止角膜膨隆、圆锥角膜或其他扩张性疾病的发生和发展。近年来,国内外一些研究者相继尝试一种新型的屈光手术设计,即角膜屈光手术联合预防性角膜胶原交联术,以期改善屈光术后角膜的生物力学稳定性,进而潜在预防角膜扩张和屈光回退。多项研究已经观察到联合手术具有良好的视力和屈光预后,尤其是对于术前评估角膜存在相对扩张风险的患者。本文将主要从有效性、安全性、可预测性、稳定性及并发症5个方面综述该联合手术矫治屈光不正的疗效及安全性。

Corneal refractive surgery is a safe and effective way to correct ametropia.Although the biomechanical stability of the cornea is reduced due to the change in corneal tissue integrity after surgery,the vast majority of postoperative corneal structures are safe.Patients with preoperative risk factors,such as high diopters,thin cornea,irregular corneal topography,high astigmatism,binocular asymmetry,allergic constitution,eye rubbing,etc.,may experience postoperative refractive regression and corneal ectasia.Corneal collagen cross-linking can enhance the biomechanical properties of cornea and effectively prevent the occurrence and progression of corneal ectasia,keratoconus or other ectatic diseases.In recent years,many researchers at home and abroad have tried a new design of refractive surgery,that is,corneal refractive surgery with prophylactic corneal collagen cross-linking to improve the biomechanical stability of the cornea after refractive surgery,and then potentially prevent corneal ectasia and refractive regression.A number of studies have found that combined surgery has a good visual acuity and refractive prognosis,especially in patients at high risk for postoperative ectasia.This article reviews the efficacy,safety,predictability,stability,and complications of combined surgery.