Corneal collagen cross-linking.
Corneal collagen cross-linking.
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DOI：
10.4103/0974-9233.61213
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发表时间：
2010-01
影响因子：
0.6
通讯作者：
Coskunseven E
中科院分区：
文献类型：
--
作者：
Jankov Ii MR;Jovanovic V;Nikolic L;Lake JC;Kymionis G;Coskunseven E
角膜胶原交联（CornealCollagenCross-linking，CXL）是一种新型的角膜组织强化技术，利用核黄素作为光敏剂，UVA通过光敏氧化作用促进角膜纤维内和纤维间共价键的形成。已经描述了角膜基质前段中的角膜细胞凋亡，一直到约300微米的深度，并且已经清楚地显示了经处理和未经处理的角膜之间的分界线。通过严格遵守最小角膜厚度，确保未超过内皮细胞毒性阈值，这一点很重要。共聚焦显微镜研究表明，角膜细胞的再增殖在治疗后1个月已经可见，在治疗后6个月内就功能形态而言达到其术前数量和质量。使用CXL的主要适应症是抑制角膜扩张的进展，如圆锥角膜和透明边缘变性。CXL也可有效治疗和预防过度侵袭性光消融导致的医源性角膜扩张。这种治疗方法也被用于治疗感染性角膜溃疡，效果明显。与其他治疗方法结合，如角膜环段植入术、局部地形图引导的光消融术和传导性角膜移植术，已获得不同程度的成功。
Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of corneal tissue strengthening by using riboflavin as a photosensitizer and UVA to increase the formation of intra and interfibrillar covalent bonds by photosensitized oxidation. Keratocyte apoptosis in the anterior segment of the corneal stroma all the way down to a depth of about 300 microns has been described and a demarcation line between the treated and untreated cornea has been clearly shown. It is important to ensure that the cytotoxic threshold for the endothelium has not been exceeded by strictly respecting the minimal corneal thickness. Confocal microscopy studies show that repopulation of keratocytes is already visible 1 month after the treatment, reaching its pre-operative quantity and quality in terms of functional morphology within 6 months after the treatment. The major indication for the use of CXL is to inhibit the progression of corneal ectasias, such as keratoconus and pellucid marginal degeneration. CXL may also be effective in the treatment and prophylaxis of iatrogenic keratectasia, resulting from excessively aggressive photoablation. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. Combination with other treatments, such as intracorneal ring segment implantation, limited topography-guided photoablation and conductive keratoplasty have been used with different levels of success.