CAJ | 학술논문

目的探讨高能量紫外线核黄素角膜胶原交联术对难治性大泡性角膜病变的疗效及意义.方法回顾性研究.收集自2011年3月至2013年3月期间在厦门大学附属厦门眼科中心就诊的药物及羊膜移植手术治疗无效的难治性大泡性角膜病变患者,予行高能量紫外线核黄素角膜胶原交联术.手术前及术后1周、1个月、3个月时随访,对患者行疼痛感评分、常规裂隙灯显微镜检查、IOP、视力、前节OCT角膜厚度测量及内皮数量和形态检查.使用方差分析对术前及术后参数差异进行比较.结果 13例(13眼)患者入选并顺利接受高能量角膜胶原交联术.患者术前疼痛指数为7.6±1.2,术后1个月及3个月时均较术前明显下降,分别为5.3±1.6和5.5±1.7,差异均具统计学意义(F=8.593,P＜0.01);术前角膜上皮缺损评分为4.5±0.5,术后1周及1个月时评分显著下降,分别为3.4±0.6和2.8±0.9(F=12.580,P＜0.01);术前角膜透明度评分为2.7±0.5,术后1周及1个月时角膜透明度显著增加,评分分别下降至1.9±0.5和2.2±0.6(F=6.122,P＜0.01);术前角膜厚度为(862.2±146.4)μm,术后1周及1个月时角膜厚度显著降低,分别为(707.5±92.7)μm和(718.8±47.2) μm(F=5.859,P＜0.01).但术后3个月时部分患者角膜上皮缺损增加、角膜透明度下降,角膜厚度回升,且与术前相比差异无统计学意义.结论高能量角膜胶原交联术能够在术后早期显著改善难治性大泡性角膜病变眼部症状,增加角膜透明度,降低角膜厚度;但其疗效并不持久.
목적 탐토고능량자외선핵황소각막효원교련술대난치성대포성각막병변적료효급의의.방법 회고성연구.수집자2011년3월지2013년3월기간재하문대학부속하문안과중심취진적약물급양막이식수술치료무효적난치성대포성각막병변환자,여행고능량자외선핵황소각막효원교련술.수술전급술후1주、1개월、3개월시수방,대환자행동통감평분、상규렬극등현미경검사、IOP、시력、전절OCT각막후도측량급내피수량화형태검사.사용방차분석대술전급술후삼수차이진행비교.결과 13례(13안)환자입선병순리접수고능량각막효원교련술.환자술전동통지수위7.6±1.2,술후1개월급3개월시균교술전명현하강,분별위5.3±1.6화5.5±1.7,차이균구통계학의의(F=8.593,P＜0.01);술전각막상피결손평분위4.5±0.5,술후1주급1개월시평분현저하강,분별위3.4±0.6화2.8±0.9(F=12.580,P＜0.01);술전각막투명도평분위2.7±0.5,술후1주급1개월시각막투명도현저증가,평분분별하강지1.9±0.5화2.2±0.6(F=6.122,P＜0.01);술전각막후도위(862.2±146.4)μm,술후1주급1개월시각막후도현저강저,분별위(707.5±92.7)μm화(718.8±47.2) μm(F=5.859,P＜0.01).단술후3개월시부분환자각막상피결손증가、각막투명도하강,각막후도회승,차여술전상비차이무통계학의의.결론 고능량각막효원교련술능구재술후조기현저개선난치성대포성각막병변안부증상,증가각막투명도,강저각막후도;단기료효병불지구.
Objective To evaluate the efficacy of accelerated corneal collagen cross-linking (a-CXL) in patients with incurable bullous keratopathy.Methods This was a retrospective,nonrandomized study.Patients with incurable bullous keratopathy who were consecutively diagnosed at the hospital of the Affiliated Xiamen Eye Center of Xiamen University from March 2011 to March 2013 were included in the study.Patients received accelerated CXL surgery.The following parameters were accessed preoperatively and 1 week,1 month and 3 months postoperatively:ocular pain index using the Numeric Rating Scale (NRS),visual acuity,noncontact tonometer measurement,slit-lamp examination for corneal epithelium defects and corneal opacity,and anterior-segment OCT for corneal thickness.Differences between groups were analyzed using one-way ANOVA.Results Thirteen eyes were chosen and underwent a-CXL.The ocular pain index was 7.6±1.2 on average preoperatively and significantly decreased to 5.3±1.6 at 1 month and to 5.5±1.7 at 3 months postoperatively (F=8.593,P＜0.01).The corneal epithelial staining score was 4.5±0.5 preoperatively and was significantly reduced to 3.4±0.6 at 1 week and to 2.8±0.9 at 1 month (F=12.580,P＜0.01) postoperatively.The corneal transparency score was 2.7±0.5 preoperatively and improved significantly to 1.9±0.5 at 1 week and 2.2±0.6 at 1 month (F=6.122,P＜0.01) postoperatively.Preoperative corneal thickness was 862.2±146.4 μm and decreased significantly to 707.5±92.7 μm at 1 week and 718.8±47.2 μm at 1 month (F=5.859,P＜0.01) postoperatively.At 3 months postoperatively,the corneal epithelial staining score,corneal transparency score and corneal thickness were not significantly different from preoperative conditions.Conclusion Accelerated CXL significantly reduces ocular pain,improves corneal epithelium defects,corneal transparency and corneal thickness within a short period postoperatively.However,a-CXL do not seem to have long-lasting effects in patients with bullous keratopathy.