AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive pr...AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive progressive keratoconus patients were randomized to receive either conventional CXL(CCXL)or accelerated CXL(ACXL;using hydroxypropyl methylcellulose-assisted riboflavin imbibition for 10 min at 9 mW/cm^2).Visual,refractive,keratometric,topographic,and aberrometric outcomes and stromal demarcation line depth(DLD)measurements were compared at the end of a 2-year follow-up.RESULTS:Thirty-two eyes from 32 patients in the CCXL and 27 eyes from 27 patients in the ACXL groups completed 2-year follow-up.At 2y post-CXL,both uncorrected and corrected visual acuities improved significantly in both groups.The improvements in keratometric readings,flattening rate(flattening of the maximum keratometry more than 1 D),3 topographic indices,and vertical coma were significantly better in the CCXL group compared to the ACXL group(P<0.05).The DLD as measured by anterior segment optical coherence tomography or in vivo confocal microscopy was better detectable and significantly deeper in the CCXL group compared to the ACXL group.The deeper DLD was found to be significantly correlated with improvements in the mean keratometry measurements.Progression was noted in 11.1%of eyes in the ACXL group,whereas progression was not observed in any patient eye in the CCXL group.CONCLUSION:In this prospective randomized study,ACXL is less effective in halting the progression of keratoconus at a 2-year follow-up compared to CCXL.展开更多
Dear Sir,UVA/riboflavin cross-linking （CXL） has been used clinically applied for the treatment of keratoconus and corneal edema via enhancement of corneal stiffness The safety of the corneal endothelium is of prime...Dear Sir,UVA/riboflavin cross-linking （CXL） has been used clinically applied for the treatment of keratoconus and corneal edema via enhancement of corneal stiffness The safety of the corneal endothelium is of prime importance during CXL treatment. In clinical practice, a corneal thickness （CT） of 400um has traditionally been regarded as the minimum treatable thickness, thereby avoiding damage to the corneal endothelium Although CXL has been applied to thinner corneas, using a hypoosmotic solution onto cornea and inducing edema . CXL safety still needs further evaluation because of lower relative concentration of collagen in the hydrated stroma . This study aims to evaluate the changes of corneal endothelial density （ECD） in cases where the CT is 〈400 um before iatrogenic corneal swelling and CXL treatment.展开更多
Background:To compare the safety and efficacy of iontophoresis-assisted epithelial-on corneal crosslinking(I-CXL)using 0.1%riboflavin-distilled water solution with standard epithelium-off corneal crosslinking(S-CXL)fo...Background:To compare the safety and efficacy of iontophoresis-assisted epithelial-on corneal crosslinking(I-CXL)using 0.1%riboflavin-distilled water solution with standard epithelium-off corneal crosslinking(S-CXL)for progressive keratoconus.Methods:In a retrospective analysis,progressive keratoconus patients treated with I-CXL(17 eyes of 17 patients)or S-CXL(13 eyes of 13 patients)were included.All patients were followed up at least 12 months.All patients underwent detailed ophthalmologic examinations involving pre-and postoperative visual acuity,topographic parameters and pachymetry.Intra-and postoperative complications were recorded.Results:No statistically significant differences were observed between the two groups at baseline with respect to visual acuity,age and thinnest corneal thickness(TCT).The postoperative decreases of K1 and Kmean in the S-CXL group represented statistically significantly better results than in the I-CXL group(t=2.093 and 2.123,P=0.046 and 0.043,respectively).Alterations of other parameters showed no significant differences between the two groups.There were no failure cases in the two groups.Conclusions:I-CXL using 0.1%riboflavin-distilled water solution provided effective treatment for progressive keratoconus at 12-month follow-up.However,the decreases of K1 and Kmean caused by I-CXL were less than those by S-CXL.Although treatment time,postoperative patient pain and risk of infection in I-CXL are all less than those in S-CXL,I-CXL is unable to completely replace S-CXL for progressive keratoconus temporarily.展开更多
目的：评价角膜厚度低于400μm 的圆锥角膜患者行核黄素诱导的长波紫外线角膜交联术的安全性和有效性。方法选择角膜厚度低于400μm 的圆锥角膜患者14例18眼，表面麻醉下去除上皮，点低渗核黄素溶液使角膜基质水肿厚度达到400μm 以上...目的：评价角膜厚度低于400μm 的圆锥角膜患者行核黄素诱导的长波紫外线角膜交联术的安全性和有效性。方法选择角膜厚度低于400μm 的圆锥角膜患者14例18眼，表面麻醉下去除上皮，点低渗核黄素溶液使角膜基质水肿厚度达到400μm 以上，行角膜交联术，术后戴软性角膜接触镜。术前、术后记录观察最佳矫正视力、角膜顶点 K 值、角膜厚度、角膜内皮、晶体等变化。结果术后所有患者角膜上皮于1周内愈合，14眼于5 d 内愈合；角膜 Haze 于2～6周内消退；最佳矫正视力：术前为4．76±0．61，术后3个月为4．83±0．46，6个月为4．84±0．51；角膜顶点 K 值：术前为（56．29±7．33）D，3个月为（52．42±5．76）D，6个月为（48．12±6．6）D；角膜厚度：治疗前为（318±33）μm，水肿后为（447±18）μm，3个月为（381±72）μm，6个月为（354±35）μm；角膜内皮密度：术前为（3069±202）／mm2，术后3个月为（2910±213）／mm2，6个月为（2935±215）／mm2；未见晶体、视网膜并发症。结论采用低渗核黄素法行角膜交联术治疗晚期薄角膜圆锥安全、有效。展开更多
文摘AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive progressive keratoconus patients were randomized to receive either conventional CXL(CCXL)or accelerated CXL(ACXL;using hydroxypropyl methylcellulose-assisted riboflavin imbibition for 10 min at 9 mW/cm^2).Visual,refractive,keratometric,topographic,and aberrometric outcomes and stromal demarcation line depth(DLD)measurements were compared at the end of a 2-year follow-up.RESULTS:Thirty-two eyes from 32 patients in the CCXL and 27 eyes from 27 patients in the ACXL groups completed 2-year follow-up.At 2y post-CXL,both uncorrected and corrected visual acuities improved significantly in both groups.The improvements in keratometric readings,flattening rate(flattening of the maximum keratometry more than 1 D),3 topographic indices,and vertical coma were significantly better in the CCXL group compared to the ACXL group(P<0.05).The DLD as measured by anterior segment optical coherence tomography or in vivo confocal microscopy was better detectable and significantly deeper in the CCXL group compared to the ACXL group.The deeper DLD was found to be significantly correlated with improvements in the mean keratometry measurements.Progression was noted in 11.1%of eyes in the ACXL group,whereas progression was not observed in any patient eye in the CCXL group.CONCLUSION:In this prospective randomized study,ACXL is less effective in halting the progression of keratoconus at a 2-year follow-up compared to CCXL.
文摘Dear Sir,UVA/riboflavin cross-linking （CXL） has been used clinically applied for the treatment of keratoconus and corneal edema via enhancement of corneal stiffness The safety of the corneal endothelium is of prime importance during CXL treatment. In clinical practice, a corneal thickness （CT） of 400um has traditionally been regarded as the minimum treatable thickness, thereby avoiding damage to the corneal endothelium Although CXL has been applied to thinner corneas, using a hypoosmotic solution onto cornea and inducing edema . CXL safety still needs further evaluation because of lower relative concentration of collagen in the hydrated stroma . This study aims to evaluate the changes of corneal endothelial density （ECD） in cases where the CT is 〈400 um before iatrogenic corneal swelling and CXL treatment.
基金This work was suppor ted by Beijing Municipal Science and Technology Commission(No.Z151100004015217).
文摘Background:To compare the safety and efficacy of iontophoresis-assisted epithelial-on corneal crosslinking(I-CXL)using 0.1%riboflavin-distilled water solution with standard epithelium-off corneal crosslinking(S-CXL)for progressive keratoconus.Methods:In a retrospective analysis,progressive keratoconus patients treated with I-CXL(17 eyes of 17 patients)or S-CXL(13 eyes of 13 patients)were included.All patients were followed up at least 12 months.All patients underwent detailed ophthalmologic examinations involving pre-and postoperative visual acuity,topographic parameters and pachymetry.Intra-and postoperative complications were recorded.Results:No statistically significant differences were observed between the two groups at baseline with respect to visual acuity,age and thinnest corneal thickness(TCT).The postoperative decreases of K1 and Kmean in the S-CXL group represented statistically significantly better results than in the I-CXL group(t=2.093 and 2.123,P=0.046 and 0.043,respectively).Alterations of other parameters showed no significant differences between the two groups.There were no failure cases in the two groups.Conclusions:I-CXL using 0.1%riboflavin-distilled water solution provided effective treatment for progressive keratoconus at 12-month follow-up.However,the decreases of K1 and Kmean caused by I-CXL were less than those by S-CXL.Although treatment time,postoperative patient pain and risk of infection in I-CXL are all less than those in S-CXL,I-CXL is unable to completely replace S-CXL for progressive keratoconus temporarily.
文摘目的：评价角膜厚度低于400μm 的圆锥角膜患者行核黄素诱导的长波紫外线角膜交联术的安全性和有效性。方法选择角膜厚度低于400μm 的圆锥角膜患者14例18眼，表面麻醉下去除上皮，点低渗核黄素溶液使角膜基质水肿厚度达到400μm 以上，行角膜交联术，术后戴软性角膜接触镜。术前、术后记录观察最佳矫正视力、角膜顶点 K 值、角膜厚度、角膜内皮、晶体等变化。结果术后所有患者角膜上皮于1周内愈合，14眼于5 d 内愈合；角膜 Haze 于2～6周内消退；最佳矫正视力：术前为4．76±0．61，术后3个月为4．83±0．46，6个月为4．84±0．51；角膜顶点 K 值：术前为（56．29±7．33）D，3个月为（52．42±5．76）D，6个月为（48．12±6．6）D；角膜厚度：治疗前为（318±33）μm，水肿后为（447±18）μm，3个月为（381±72）μm，6个月为（354±35）μm；角膜内皮密度：术前为（3069±202）／mm2，术后3个月为（2910±213）／mm2，6个月为（2935±215）／mm2；未见晶体、视网膜并发症。结论采用低渗核黄素法行角膜交联术治疗晚期薄角膜圆锥安全、有效。
