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目的 评估快速紫外线/核黄素角膜胶原交联(ACXL)联合准分子激光原位角膜磨镶术(LASIK)治疗近视术后6个月的临床效果.方法 前瞻性自身对照研究.选取18例(36眼)近视患者,先进行飞秒激光制瓣的LASIK,角膜瓣复位前用Vibex Xtra核黄素溶液浸润角膜基质床90 s后复位角膜瓣,应用辐照强度为30 mW/cm2的紫外光(KXL系统)照射角膜90 s,总能量为2.7 J/cm2,进行ACXL治疗.术后随访6个月以上.对术前和术后6个月的视力、屈光度、角膜形态参数、角膜内皮细胞密度(ECD)、角膜生物力学特征等进行比较.采用配对t检验比较手术前后各参数的变化情况.结果 术后6个月,裸眼视力(UCVA,IogMAR)从术前0.93±0.34提高到-0.05±0.08,等效球镜度(SE)从(-8.03±1.86)D减少到(-0.29±0.39)D,平均角膜曲率从(44.79±2.10)D减少到(37.96±2.32)D,角膜厚度从(524.6±25.2) μm减少到(437.7±27.0)μm,角膜最大屈膝峰距从术前(5.48±0.31)mm减少到(4.99±0.44)mm,最大压陷深度从术前(1.09±0.12)mm增加到(1.18±0.18)mm.除ECD和最大压陷曲率半径外,其余指标术前、术后差异均有统计学意义(t=-63.02～26.68,P＜0.05).术后6个月随访期内,未见屈光回退、角膜扩张、感染和非感染性角膜炎等并发症.结论 ACXL联合LASIK能够有效矫正近视,术后6个月效果稳定,无明显并发症,但长期效果及临床适应证仍需进一步观察.

Objective To evaluate at six months after myopia surgery the clinical effects of laser in situ keratomileusis (LASIK) combined with accelerated UVA/riboflavin corneal collagen cross-linking (ACXL).Methods This was a prospective and self-controlled study that included 18 myopia patients (36 eyes).LASIK was performed using femtosecond and excimer lasers.Before the flap was reset,single-use Vibe Xtra riboflavin drops were instilled in the corneal stromal bed for 90 seconds.A KXL system (Avedro Inc.) was used to irradiate the cornea with UVA light,delivering 30 mW/cm2 of irradiance for 90 seconds.The total exposure dose was 2.7 J/cm2.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical equivalent (SE),comeal topography,thinnest comeal thickness (TCT),and endothelial cell density (ECD) were evaluated preoperatively and six months postoperatively.Paired t-test were used for statistical analysis.Results Mean UCVA changed from 0.93±0.34 (logMAR) to-0.05±0.08,SE from-8.03±1.86 diopter (D) to-0.29±0.39 D,keratometry from 44.79±2.10 D to 37.96±2.32 D,TCT from 524.6±25.2 μm to 437.7±27.0 μm,corneal peak distance from 5.48±0.31 mm to 4.99±0.44 mm,and corneal deformation amplitude from 1.09±0.12 mm to 1.18±0.18 mm.Aside from the ECD and highest corneal concavity radius,changes in the remaining parameters between preoperative and six-month postoperative values were significant (t=-63.02～26.87,P＜0.05).None of the patients developed signs of significant regression,ectasia,or keratitis during the follow-up period.Conclusion LASIK combined with ACXL can effectively correct refractive error in patients with myopia.There were no significant complications during the six-month follow-up.But the long-term effects and indications of LASIK combined with ACXL need to be further observed and studied.