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中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (06) : 332 -337. doi: 10.3877/cma.j.issn.2095-2007.2023.06.003

论著

去上皮与跨上皮快速角膜胶原交联术治疗圆锥角膜长期疗效的临床观察
徐静1, 申笛1, 孙西宇1, 周堃1, 王亚妮2, 韦伟1,†()   
  1. 1. 71002　西北大学附属第一医院（西安市第一医院）眼科
    2. 71002　西安，陕西省眼科研究所
  • 收稿日期:2023-11-13 出版日期:2023-12-28
  • 通信作者: 韦伟
  • 基金资助:
    陕西省重点研发计划项目(2022SF－404); 陕西省自然科学基础研究计划一般（面上）项目(2021JM－593); 西安市科技计划项目(2023JH－YXYB－0079)

Clinical observation of epithelium-offversus transepithelial corneal collagen cross-linking for keratoconus

Jing Xu1, Di Shen1, Xiyu Sun1, Kun Zhou1, Yani Wang2, Wei Wei1,†()   

  1. 1. Department of Ophthalmology, First Affiliated Hospital of Northwestern University, Xi′an No.1 Hospital Xi′an 710002, China
    2. Shaanxi Ophthalmolgical Institute, Xi′an 710002, China
  • Received:2023-11-13 Published:2023-12-28
  • Corresponding author: Wei Wei
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徐静, 申笛, 孙西宇, 周堃, 王亚妮, 韦伟. 去上皮与跨上皮快速角膜胶原交联术治疗圆锥角膜长期疗效的临床观察[J]. 中华眼科医学杂志(电子版), 2023, 13(06): 332-337.

Jing Xu, Di Shen, Xiyu Sun, Kun Zhou, Yani Wang, Wei Wei. Clinical observation of epithelium-offversus transepithelial corneal collagen cross-linking for keratoconus[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(06): 332-337.

目的

探讨去上皮快速角膜交联术(ACXL)和跨上皮ACXL治疗进展期圆锥角膜的长期临床疗效。

方法

选取2019年8月到2021年10月在西安市第一医院眼科进行ACXL治疗的进展期圆锥角膜患者53例(61只眼)进行回顾性研究。其中，男性30例(32只眼)，女性23例(29只眼)；年龄18～30岁，平均年龄(24.3±6.9)岁。依据所行ACXL术式不同将患者分为去上皮组(31只眼)和跨上皮组(30只眼)。比较两组患者术前、术后3个月、6个月、12个月、18个月及24个月时最佳裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜(SE)、角膜散光(CA)、角膜前表面平坦子午线曲率(K1)、角膜前表面陡峭子午线曲率(K2)、角膜前表面最大曲率(Kmax)、角膜后表面曲率(PCC)、角膜最薄点厚度(TCT)及交联手术失效率。UCVA、BCVA、TCT、K1、K2、Kmax、PCC、CA及SE等均符合正态分布，以±s表示，术前比较采用独立样本t检验，组间比较采用多样本重复测量方差分析，组内比较采用重复测量方差分析；术后手术失效率以眼数和百分比表示，组间比较采用Fisher精确概率法。

结果

术后24个月时去上皮ACXL组的UVCA、BCVA、SE、CA、K1、K2、Kmax、PCC及TCT分别为(0.83±0.36)最小分辨角度的对数视力(logMAR)、(0.20±0.15)logMAR、(－8.84±4.20)D、(－3.38±2.14)D、(44.85±1.74)D、(48.16±2.27)D、(49.86±10.51)D、(－6.89±0.48)D及(456.80±33.69)μm；跨上皮CXL组患者分别为(1.01±0.46)logMAR、(0.33±0.66)logMAR、(－7.78±6.19)D、(－2.67±2.34)D、(46.63±3.40)D、(49.59±3.54)D、(55.92±7.69)D、(－7.15±0.55)D及(442.93±34.49)μm。两组患者UVCA、BCVA、SE、CA、K1、K2、Kmax、PCC及TCT术前、术后3个月、6个月、12个月、18个月及24个月各时间交互作用的差异均无统计学意义(F交互＝0.56，0.80，0.84，0.32，0.59，1.70，1.07，0.31，1.93；P>0.05)；两组患者BCVA组间差异有统计学意义(F组间＝4.27，P<0.05)；去上皮ACXL组CA各时间点差异有统计学意义(F＝3.95，P<0.05)；去上皮ACXL组各时间点K2比较差异有统计学意义(F＝7.96，P<0.05)；去上皮ACXL组各时间点Kmax比较差异有统计学意义(F时间＝3.56，P<0.05)；去上皮ACXL组各时间点TCT比较差异有统计学意义(F时间＝7.72，P<0.05)。去上皮ACXL组和跨上皮ACXL组术后手术失效率分别为2只眼(6.45%)和6只眼(20.00%)，其差异无统计学意义(P>0.05)。

结论

长期观察发现去上皮ACXL和跨上皮ACXL对稳定圆锥角膜形态和控制圆锥角膜进展方面均具有良好的安全性和有效性。去上皮ACXL术对稳定角膜最薄点厚度大于400 μm进展期圆锥角膜患者的视力、角膜曲率及散光方面明显优于跨上皮ACXL。

关键词: 角膜胶原交联术, 圆锥角膜, 角膜前表面曲率, 角膜最薄点厚度, 核黄素
Objective

The aim of this study is to investigate the clinical efficacy of epithelium-off versus transepithelial accelerated corneal collagen cross-linking (ACXL) in the treatment of advanced keratoconus.

Methods

Fifty-three keratoconus patients (61 eyes) who underwent ACXL were selected from August 2019 to October 2021 at laser Myopia Treatment Center of Xi′an First Hospital for retrospective study. Among them, there were 30 cases (32 eyes) male and 23 cases (29 eyes) female with the mean age of (24.3±6.9) years. Patients were divided into epithelium-off group (31 eyes) and transepithelial group (30 eyes) according to different ACXL operation types. The preoperative and postoperative at 3 months, 6 months, 12 months, 18 months, 24 months uncorrected visual acuity (UCVA), the best corrected visual acuity (BCVA), spherical equivalent (SE), the corneal astigmatism (CA), theanterior flat keratometry (K1), theanterior steep keratometry (K2), the maximal anterior keratometric power (Kmax), the posterior corneal curvature (PCC), and the thinnest corneal thickness (TCT) were performed and recorded the postoperative failure rate. UCVA, BCVA, TCT, K1, K2, Kmax, PCC, CA and SE were in accordance with normal distribution, and expressed as ±s and compared by independent sample t-test for intra groups before operation, multi-sample repeated measurement analysis of variance for inter-group, and repeated measurement analysis of variance for intra-group before and after treatment. The postoperative failure rate of the two cross-linking operations was expressed as eye number and percentage, and compared by Fisher′s exact test.

Results

After surgery for 24 months, UVCA, BCVA, SE, CA, K1, K2, Kmax, PCC and TCT of patients in the epithelium-off group were (0.83±0.36) logarithmic minimum angle of resolution (logMAR), (0.20±0.15)logMAR, (-8.84±4.20)D, (-3.38±2.14)D, (44.85±1.74)D, (48.16±2.27)D, (49.86±10.51)D, (-6.89±0.48)D and (456.80±33.69)μm, respectively; those of patients in the transepithelial group were (1.01±0.46)logMAR, (0.33±0.66)logMAR, (-7.78±6.19)D, (-2.67±2.34)D, (46.63±3.40)D, (49.59±3.54)D, (55.92±7.69)D, (-7.15±0.55)D及(442.93±34.49)μm, respectively. There was no significant difference in the interaction of UVCA, BCVA, SE, CA, K1, K2, Kmax, PCC and TCT at different time point between the two groups (Finteraction=0.56, 0.80, 0.84, 0.32, 0.59, 1.70, 1.07, 0.31, 1.93; P>0.05). The difference in BCVA between the two groups was statistically significant (Fintra-group=4.27, P<0.05). There were significant differences in K2 at each time point in epithelium-off group (F=7.96, P<0.05). There were significant differences in Kmax at each time point in epithelium-off group (Ftime=3.56, P<0.05). There were significant differences in TCT of epithelium-off group at each time point (Ftime=7.72, P<0.05). After operation for one year, the failure rate of epithelium-off group and transepithelial group were 2 eyes (6.45%) and 6 eyes (20.00%), respectively, and there was no significant difference between them(P>0.05).

Conclusions

Long-term observation showed that epithelium-off CXL and transepithelial CXL are safe and effective in stabilizing keratoconus morphology and controlling keratoconus progression. In advanced keratoconus patients with the thinnest corneal thickness greater than 400 μm, epithelium-off CXL was superior to transepithelial CXL in controlling vision, corneal curvature and astigmatism.

Key words: Corneal collagen crosslinking, Keratoconus, Anterior surface curvature of the cornea, The thinnest corneal thickness, Riboflavin
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