CAJ | 학술논문

目的观察跨上皮紫外线核黄素角膜胶原交联治疗进展期圆锥角膜的临床效果.方法前瞻性病例研究.对36例(54眼)的进展期圆锥角膜患者行跨上皮角膜胶原交联手术治疗.表面麻醉下采用意大利SOOFT跨上皮角膜胶原交联仪将0.25％的核黄素导入角膜10 min(电流1.0 mA),370 nm的紫外线照射9 min(能量10 mW/cm2).平均随诊(14.1±2.3)个月.术后1d观察角膜上皮愈合情况,术后1、3、6、12个月复诊.检查指标包括UCVA、BCVA、眼压、角膜曲率、角膜厚度、角膜地形图、角膜内皮细胞计数、角膜生物力学、角膜活体激光共聚焦显微镜检查.对手术前后的各项指标行配对t检验.结果术后1d裂隙灯显微镜下发现角膜上皮点状混浊、水肿,次日好转.未出现角膜溃疡、角膜溶解、haze、剧烈眼痛等并发症.术后12个月,患者UCVA从4.27±0.23提高到4.41±0.20(t=3.962,P＜0.01),BCVA从4.69±0.23提高到4.82±0.14(t=3.507,P＜0.01);Kmax下降(1.25±0.68)D(t=9.351,P＜0.01);散光值下降(0.30±0.21)D(t=7.227,P＜0.01).角膜最大压陷深度从(1.21±0.11)mm下降为(1.16±0.12)mm(t=4.131,P＜0.01).眼压、角膜内皮细胞密度、角膜厚度治疗前后差异无统计学意义.结论跨上皮角膜胶原交联法可以有效控制进展期圆锥角膜的发展且未出现类似传统去上皮法导致的多种并发症.跨上皮角膜胶原交联方法是安全、有效的,有望取代去上皮法成为进展期圆锥角膜首选的治疗方式.
목적 관찰과상피자외선핵황소각막효원교련치료진전기원추각막적림상효과.방법 전첨성병례연구.대36례(54안)적진전기원추각막환자행과상피각막효원교련수술치료.표면마취하채용의대리SOOFT과상피각막효원교련의장0.25％적핵황소도입각막10 min(전류1.0 mA),370 nm적자외선조사9 min(능량10 mW/cm2).평균수진(14.1±2.3)개월.술후1d관찰각막상피유합정황,술후1、3、6、12개월복진.검사지표포괄UCVA、BCVA、안압、각막곡솔、각막후도、각막지형도、각막내피세포계수、각막생물역학、각막활체격광공취초현미경검사.대수술전후적각항지표행배대t검험.결과 술후1d렬극등현미경하발현각막상피점상혼탁、수종,차일호전.미출현각막궤양、각막용해、haze、극렬안통등병발증.술후12개월,환자UCVA종4.27±0.23제고도4.41±0.20(t=3.962,P＜0.01),BCVA종4.69±0.23제고도4.82±0.14(t=3.507,P＜0.01);Kmax하강(1.25±0.68)D(t=9.351,P＜0.01);산광치하강(0.30±0.21)D(t=7.227,P＜0.01).각막최대압함심도종(1.21±0.11)mm하강위(1.16±0.12)mm(t=4.131,P＜0.01).안압、각막내피세포밀도、각막후도치료전후차이무통계학의의.결론 과상피각막효원교련법가이유효공제진전기원추각막적발전차미출현유사전통거상피법도치적다충병발증.과상피각막효원교련방법시안전、유효적,유망취대거상피법성위진전기원추각막수선적치료방식.
Objective To observe the therapeutic effects of riboflavin-ultraviolet A(UVA) corneal collagen cross-linking (CXL) performed with a transepithelial method for progressive keratoconus.Methods This was a prospective case series study.Thirty-six patients (54 eyes) with progressive keratoconus who underwent transepithelial corneal collagen cross-linking surgery were reviewed.The procedure was performed under topical anesthesia using a transepithelial corneal collagen cross-linking instrument (SOFT,Italy).riboflavin (0.25％) was imported into the cornea for 10 minutes (current 1.0 mA).The irradiation was performed for 9 minutes using a solid-state UVA illuminator at 370 nm and an irradiance of 10 mW/cm2.The average follow-up time was 14.1±2.3 months.Corneal epithelium healing was observed 1 day after surgery.There were no complications such as corneal ulcer,corneal dissolution,corneal epithelium mist opacity (haze) or severe pain.Uncorrected visual acuity (UCVA); best corrected visual acuity (BCVA); intraocular pressure; corneal curvature; corneal thickness; corneal topography; endothelial cell count; corneal biomechanical properties and in vivo confocal microscopy were evaluated at baseline and at 1,3,6,12 months postoperatively.Data were analyzed using a paired samples t test.Results The day after surgery,the corneal epithelium had opaque spots due to edema but the condition improved by the second day.Postoperative 12 months,UCVA and BCVA increased from 4.27±0.23 to 4.41±0.20 (t=3.962,P＜0.01) and from 4.69±0.23 to 4.82±0.14 (t=3.507,P＜0.01),respectively.Interim analysis of treated eyes showed a flattening of the steepest simulated keratometry value (K-max) and astigmatism by an average of 1.25±0.68 diopters (t=9.351,P＜0.01) and 0.30±0.21 diopters (t=7.227,P＜0.01).The deformation amplitude decreased from 1.21±0.11 mm to 1.16±0.12 mm (t=4.131,P＜0.01).Intraocular pressure,endothelial cell count and central corneal thickness did not change significantly.Conclusion Transepithelial corneal collagen cross-linking can significantly control the development of progressive keratoconus and do not have any of the complications that develop from the traditional epithelium-offmethod.Therefore,the transepithelial corneal collagen cross-linking method is safe and effective,and is expected to replace the traditional epithelium-off method to become the preferred treatment for progressive keratoconus.