Effects of the epithelium-off and epithelium-on accelerated comeal collagen cross-linking in the treatment of progressive keratoconus

doi:10.3877/cma.j.issn.2095-2007.2024.04.003

Abstract

Abstract:

Objective

To investigate the clinical efficacy and safety of epithelium-off accelerated comeal collagen cross-linking（ACXL）and epithelium-on ACXL in the treatment of progressive keratoconus.

Methods

A total of 69 patients（102 eyes）with progressive keratoconus at the Department of Ophthalmology and Corneal in Chengdu East Aier Eye Hospital from January 2020 to March 2022 was included.There were 40 males（58 eyes）and 29 females（44 eyes）with a mean age of（21.6±6.9）years（ranging from 10 to 48 years）.The patients were divided into43 cases（62 eyes）in the corneal thinnest point thickness（TCT）≥450μm group and 26 cases（40 eyes）in the 400μm≤TCT＜450μm group according to TCT，with the former being treated with Epi-off ACXL，and the latter with Epi-on ACXL.The two groups were compared in uncorrected visual acuity（UCVA），best corrected visual acuity（BCVA），refractive status，corneal transparency，maximumkeratometry value of the anterior corneal surface（Kmax），TCT，corneal endothelial cell counts and intraocular pressure were analysed preoperatively and after surgery for 1，3，6 and 12 months.The UCVA，BCVA，spherical diopter，cylinder diopter，TCT，Kmax and corneal endothelial cell counts were tested for conformity with normal distribution and expressed as，and compared before and after surgery using one-way repeated measures ANOVA，and when the differences were statistically significant then further LSD-t tests were used；the preoperative and postoperative corneal endothelial counts within the group were compared using paired t test.

Results

The BCVA and Kmax of patients in the Epi-on ACXL group at preoperative，1，3，6 and 12 months postoperatively were（0.27±0.13）logarithm of the minimum angle of resolution（logMAR），（0.26±0.17）logMAR，（0.22±0.13）logMAR，（0.22±0.14）logMAR，（0.18±0.14）logMAR，（62.96±10.91）D，（63.01±10.13）D，（62.76±10.42）D，（62.44±10.29）D，（61.83±9.40）D.There were a statistically significant difference between the preoperative and postoperative BCVA and Kmax in patients with Epi-on ACXL（F=6.848，2.678；P＜0.05）.After LSD-t test，BCVA at 3，6 and 12 months postoperatively was increased compared with preoperatively，and the difference was statistically significant（t=3.250，5.414，6.485；P＜0.05）；Kmax at 12 months postoperatively was decreased compared with preoperatively，and the difference was statistically significant（t=2.672，P＜0.05）.The preoperative，1，3，6，and 12 months postoperative examinations of cylinder diopter，TCT，and Kmax in patients in the Epi-off ACXL group were（-3.79±1.92）D，（-3.87±2.19）D，（-3.66±2.14）D，（-3.36±2.09）D，（-3.20±2.14）D，（488.29±34.20）μm，（475.55±31.20）μm，（477.71±30.97）μm，（479.76±28.82）μm，（486.18±30.83）μm，（52.49±6.31）D，（53.58±6.63）D，（52.35±5.30）D，（52.13±5.43）D，（51.63±5.17）D.The difference in columnar lens refraction，TCT and Kmax in patients in the Epi-off ACXL group was statistically significant when compared preoperatively and postoperatively（F=4.618，12.133，12.794；P＜0.05）.By LSD-t test，postoperative cylinder diopter was lower at 12 months postoperatively compared with preoperative，and the difference was statistically significant（t=-3.499，P＜0.05）；TCTwas lower at 1 month，3 months，and 6 months postoperatively compared with preoperative，and the difference was statistically significant（t=6.995，4.997，3.893；P＜0.05）；and Kmax at 1 month and 12 months postoperatively compared with preoperative，the difference was statistically significant（t=-5.963，3.533；P＜0.05）.There were no complications of UV light induced eye injury in all patients after crosslinking.After operation，all patients had ocular pain，and their symptoms were significantly relieved the next day.After ACXL，corneal haze appeared in 1 case（1 eye）and 3 patients（3 eyes）in the two groups，accouting for 1.61% and 7.50%，respectively；the former subsided after surgery for 3 months and the cornea returned to transparency；the latter subsided after surgery for 3 months and the cornea returned to transparency，and 1 case（1 eye）with central corneal stromal linear haze for latter patients，which did not affect BCVA.After surgery，there were 7 cases（10 eyes）and 12 cases（18 eyes）of dry eye in the two groups，accouting for 16.13%and 45.00%，respectively.1 case（1 eye）with Epi-on ACXL failure underwent keratoplasty.

Conclusions

According to the patient's TCT，the appropriate choice of Epi-off ACXL or Epi-on ACXL should be made，taking into account the effectiveness and safety of ACXL.Both cross-linking methods can stabilize the condition of keratoconus at 12 months postoperatively，and have good effectiveness and safety for the treatment of progressive keratoconus.

Key words: Keratoconus, Corneal cross-linking, Ultraviolet, Riboflavin

Ping Ma, Jing Lu, Changjun Lan. Effects of the epithelium-off and epithelium-on accelerated comeal collagen cross-linking in the treatment of progressive keratoconus[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(04): 206-211.

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References 27

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时间	眼数（只眼）	跨上皮快速角膜交联术
时间	眼数（只眼）	UCVA（logMAR）	BCVA（logMAR）	球镜屈光度（D）	柱镜屈光度（D）	TCT（μm）	Kmax（D）
术前	40	0.85±0.38	0.27±0.13	-5.88±4.60	-3.93±1.83	415.18±24.22	62.96±10.91
术后1个月	40	0.84±0.38	0.26±0.17	-5.12±4.20	-3.51±1.44	421.20±28.00	63.01±10.13
术后3个月	40	0.85±0.36	0.22±0.13^*	-5.27±5.23	-3.37±1.86	416.98±28.49	62.76±10.42
术后6个月	40	0.85±0.35	0.22±0.14^*	-4.92±4.75	-3.77±1.72	417.75±25.34	62.44±10.29
术后12个月	40	0.81±0.39	0.18±0.14^*	-4.76±4.66	-3.51±1.90	417.15±23.37	61.83±9.40^*
F值		0.509	6.848	1.737	1.286	0.418	2.678
P值		＞0.05	＜0.05	＞0.05	＞0.05	＞0.05	＜0.05
时间	眼数（只眼）	去上皮快速角膜交联术
时间	眼数（只眼）	UCVA（logMAR）	BCVA（logMAR）	球镜屈光度（D）	柱镜屈光度（D）	TCT（μm）	Kmax（D）
术前	62	0.88±0.41	0.11±0.14	-5.00±3.50	-3.79±1.92	488.29±34.20	52.49±6.31
术后1个月	62	0.85±0.38	0.13±0.15	-5.00±3.64	-3.87±2.19	475.55±31.20^*	53.58±6.63^*
术后3个月	62	0.79±0.41	0.12±0.14	-4.92±3.59	-3.66±2.14	477.71±30.97^*	52.35±5.30
术后6个月	62	0.81±0.41	0.10±0.13	-4.98±3.69	-3.36±2.09	479.76±28.82^*	52.13±5.43
术后12个月	62	0.87±0.43	0.10±0.15	-4.77±3.82	-3.20±2.14^*	486.18±30.83	51.63±5.17^*
F值		2.376	1.930	0.716	4.618	12.133	12.794
P值		＞0.05	＞0.05	＞0.05	＜0.05	＜0.05	＜0.05

时间	眼数（只眼）	跨上皮快速角膜交联术
时间	眼数（只眼）	UCVA（logMAR）	BCVA（logMAR）	球镜屈光度（D）	柱镜屈光度（D）	TCT（μm）	Kmax（D）
术前	40	0.85±0.38	0.27±0.13	-5.88±4.60	-3.93±1.83	415.18±24.22	62.96±10.91
术后1个月	40	0.84±0.38	0.26±0.17	-5.12±4.20	-3.51±1.44	421.20±28.00	63.01±10.13
术后3个月	40	0.85±0.36	0.22±0.13^*	-5.27±5.23	-3.37±1.86	416.98±28.49	62.76±10.42
术后6个月	40	0.85±0.35	0.22±0.14^*	-4.92±4.75	-3.77±1.72	417.75±25.34	62.44±10.29
术后12个月	40	0.81±0.39	0.18±0.14^*	-4.76±4.66	-3.51±1.90	417.15±23.37	61.83±9.40^*
F值		0.509	6.848	1.737	1.286	0.418	2.678
P值		＞0.05	＜0.05	＞0.05	＞0.05	＞0.05	＜0.05
时间	眼数（只眼）	去上皮快速角膜交联术
时间	眼数（只眼）	UCVA（logMAR）	BCVA（logMAR）	球镜屈光度（D）	柱镜屈光度（D）	TCT（μm）	Kmax（D）
术前	62	0.88±0.41	0.11±0.14	-5.00±3.50	-3.79±1.92	488.29±34.20	52.49±6.31
术后1个月	62	0.85±0.38	0.13±0.15	-5.00±3.64	-3.87±2.19	475.55±31.20^*	53.58±6.63^*
术后3个月	62	0.79±0.41	0.12±0.14	-4.92±3.59	-3.66±2.14	477.71±30.97^*	52.35±5.30
术后6个月	62	0.81±0.41	0.10±0.13	-4.98±3.69	-3.36±2.09	479.76±28.82^*	52.13±5.43
术后12个月	62	0.87±0.43	0.10±0.15	-4.77±3.82	-3.20±2.14^*	486.18±30.83	51.63±5.17^*
F值		2.376	1.930	0.716	4.618	12.133	12.794
P值		＞0.05	＞0.05	＞0.05	＜0.05	＜0.05	＜0.05

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