摘要
目的探讨保留上皮瓣的快速角膜胶原交联术（ACXL）治疗圆锥角膜的有效性及安全性。方法自身前后对照研究。对原发性圆锥角膜患者17例（17眼），术中先制作完整的上皮瓣，掀瓣后使用0．1％核黄素浸泡角膜基质10min；再应用KXL系统进行紫外光照，光照强度30mW／cm2．连续照射4min，总能量7.2J／cm2，最后复位上皮瓣。分别于术前，术后1、3个月，1年检查裸眼视力（UCVA）、显然验光、最佳戴镜矫正视力（BCVA）、haze分级、角膜曲率、圆锥角膜指数（KI）、角膜最薄点厚度及角膜内皮细胞密度等。采用一元重复测量方差分析、Dunnett—t检验和配对t检验对数据进行统计分析。结果术后1d3例患者疼痛评分2级，余均为1级。术后5d所有术眼角膜上皮愈合。术后1年UCVA逐渐提高（F=3．245，P〈0．05）；等效球镜度逐渐降低（F=3．466，P〈0．05）；角膜平坦曲率（K1）和陡峭曲率（K2）先升后降（F K1=5．572，P〈0．05；R K2=8．659，P〈0．01）；KI逐渐降低（F=3．660，P〈0．05）；角膜最薄点厚度变薄6％（F=20．501，P〈0．01）；BCVA、角膜内皮细胞密度及六角形细胞百分比变化差异无统计学意义。结论保留上皮瓣的ACXL控制圆锥角膜进展可能是安全有效的。
Objective To investigate the safety and effectiveness of subepithelial accelerated corneal collagen cross-linking （ACXL） in primary keratoconus. Methods Seventeen primary keratoconus eyes of 17 patients were enrolled in this self-controlled study. After making a complete epithelial flap, the underlying stroma was bathed in a 0.1% riboflavin solution for 10 minutes. The cornea was then treated with a KXL system with 30 mW/cm2 UVA for 4 minutes, providing a total energy of 7.2 J/cm2. The flap was then repositioned. Uncorrected visual acuity （UCVA）, manifest refraction, best corrected visual acuity （BCVA）, haze score, corneal keratometry, keratoconus index （KI）, minimum corneal thickness （CT）, and endothelial cell density （ECD） were evaluated preoperatively and at 1 month, 3 months, and 1 year postoperatively. The general linear model of repeated measures, Dunnett t-test, and paired t-test were used for analysis. Results On the first postoperative day, 3 patients had level 2 pain scores and the others had level 1. The corneal epithelium of all eyes recovered on postoperative day 5. One year postoperation, UCVA gradually improved （F=3.245, P〈0.05）, and the spherical equivalent slowly decreased （F=3.466, P〈0.05）. The flat K-value and steep K-value decreased following an initial increase （FK1=5.572, P〈0.05; F K2=8.659, P〈0.01）. The decrease in KI was significant （F=3.660, P〈0.05）. CT decreased by 6% （F=20.501, P〈0.01）. BCVA, ECD, and the percentage of hexagonal cells did not change significantly. Conclusion Subepithelial ACXL is safe and effective in controlling the progression of primary keratoconus.
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2017年第1期14-19,共6页
Chinese Journal Of Optometry Ophthalmology And Visual Science
关键词
圆锥角膜
治疗结果
上皮瓣
角膜胶原交联术
快速交联
Keratoconus
Therapy outcome
Epithelial flap
Corneal collagen cross-linking
Accelerated cross-linking
