Keratoconus: cross-linking the window of the eye.
Keratoconus: cross-linking the window of the eye.
复制标题
DOI：
10.1177/26330040211003573
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Meek, Keith M
中科院分区：
文献类型：
--
作者：
Hayes, Sally;Morgan, Sian R;Meek, Keith M
圆锥角膜是一种角膜逐渐变薄和变弱的情况，导致严重的不规则散光，并显著降低生活质量。尽管圆锥角膜的确切原因尚不清楚，但生化和结构研究表明，角膜内过度活跃的酶分解组成蛋白(胶原和蛋白多糖)，导致组织变弱。随着疾病的发展，胶原纤维相互滑过，重新分布在角膜上，导致它改变形状。近年来，人们发现，通过利用核黄素和紫外线(UVA)光化学诱导角膜细胞外基质内的交联，可以增加组织的强度和酶的抵抗力，从而阻止圆锥角膜的进展。随着越来越多的证据支持其长期有效性，全世界对核黄素/UVA角膜交联剂疗法用于阻止圆锥角膜进展的接受度和使用率迅速增加。本文综述了核黄素/UVA角膜交联剂治疗圆锥角膜的开始、临床疗效以及旨在缩短患者治疗时间、改善患者舒适度和提高患者可接受治疗资格的最新科学进展。回顾目前使用交联剂阻止圆锥角膜进展的治疗方法圆锥角膜是一种疾病，在这种疾病中，弯曲的角膜，即眼睛前面的透明窗口，变弱，向前凸起，形成圆锥形，变薄。这种曲率的变化意味着光线没有正确地聚焦到视网膜上，视力逐渐受损。传统上，早期圆锥角膜的影响可以通过使用眼镜、专业隐形眼镜、植入角膜的环来缓解，在严重的情况下，还可以通过进行角膜移植来缓解。然而，人们发现，通过在角膜内诱导称为交联键的化学键，可以加强组织，防止进一步变薄和形状变化。标准的交联程序需要一个多小时的时间来完成，包括移除角膜前面的细胞，然后应用维生素B2眼药水和低能量紫外线(UVA)在组织内创建新的交联。临床试验表明，这一标准手术在阻止圆锥角膜进展方面是安全有效的。然而，目前有许多治疗改进正在研究中，旨在减少患者的治疗时间和增加舒适性，例如加速交联程序和不需要去除表面细胞的方案。这篇综述描述了正在开发的不同的技术，以有效和无痛地进行角膜交联术，阻止圆锥角膜的进展，并避免昂贵的手术需要。
Keratoconus is a condition in which the cornea progressively thins and weakens, leading to severe, irregular astigmatism and a significant reduction in quality of life. Although the precise cause of keratoconus is still not known, biochemical and structural studies indicate that overactive enzymes within the cornea break down the constituent proteins (collagen and proteoglycans) and cause the tissue to weaken. As the disease develops, collagen fibres slip past each other and are redistributed across the cornea, causing it to change shape. In recent years, it was discovered that the photochemical induction of cross-links within the corneal extracellular matrix, through the use of riboflavin and ultraviolet (UVA) light, could increase the strength and enzymatic resistance of the tissue and thereby halt keratoconus progression. Worldwide acceptance and use of riboflavin/UVA corneal cross-linking therapy for halting keratoconus progression has increased rapidly, in accordance with the growing body of evidence supporting its long-term effectiveness. This review focusses on the inception of riboflavin/UVA corneal cross-linking therapy for keratoconus, its clinical effectiveness and the latest scientific advances aimed at reducing patient treatment time, improving patient comfort and increasing patient eligibility for treatment. Review of current treatments using cross-linking to halt the progress of keratoconus Keratoconus is a disease in which the curved cornea, the transparent window at the front of the eye, weakens, bulges forward into a cone-shape and becomes thinner. This change of curvature means that light is not focussed onto the retina correctly and vision is progressively impaired. Traditionally, the effects of early keratoconus were alleviated by using glasses, specialist contact lenses, rings inserted into the cornea and in severe cases, by performing a corneal transplant. However, it was discovered that by inducing chemical bonds called cross-links within the cornea, the tissue could be strengthened and further thinning and shape changes prevented. The standard cross-linking procedure takes over an hour to perform and involves the removal of the cells at the front of the cornea, followed by the application of Vitamin B2 eye drops and low energy ultraviolet light (UVA) to create new cross-links within the tissue. Clinical trials have shown this standard procedure to be safe and effective at halting keratoconus progression. However, there are many treatment modifications currently under investigation that aim to reduce patient treatment time and increase comfort, such as accelerated cross-linking procedures and protocols that do not require removal of the surface cells. This review describes the different techniques being developed to carry out corneal cross-linking efficiently and painlessly, to halt keratoconus progression and avoid the need for expensive surgery.