检索历史 清除

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10 min;再应用KXL系统进行紫外光照,光照强度30 mW/cm2,连续照射4 min,总能量7.2 J/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(FK1=5.572,P＜0.05;FK2=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 comeal 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 comeal epithelium of all eyes recovered on postoperative day 5.One year postoperation,UCVA gradually improved (F=3245,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;FK2=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.