Transepithelial corneal collagen crosslinking for progressive keratoconus: 24-month clinical results
Transepithelial corneal collagen crosslinking for progressive keratoconus: 24-month clinical results
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DOI：
10.1016/j.jcrs.2013.03.026
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发表时间：
2013-08-01
影响因子：
2.8
通讯作者：
Caporossi, Tomaso
中科院分区：
文献类型：
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作者：
Caporossi, Aldo;Mazzotta, Cosimo;Caporossi, Tomaso
目的：评价经上皮胶原交联术治疗26岁及以下进行性圆锥角膜患者的临床效果。设计：意大利锡耶纳锡耶纳大学医院眼科，采用经上皮胶原交联术治疗26例(26眼)进行性圆锥角膜。平均年龄22岁(11~26岁)(18岁以下10例，19~26岁16例)。术前和术后检查包括裸眼视力(UDVA)和矫正视力(CDVA)、模拟最大角膜曲率(K)、眼球差和球差，以及角膜光学相干断层扫描光学厚度。跨皮细胞CXL(Rmicrolin TE)溶液由0.1%的核黄素、15.0%的葡聚糖、氨丁三醇(Tris)和乙二胺四乙酸组成。紫外线A治疗采用Caporossi Baiocchi Mazzotta X Linker Vega，功率为3 mW/cm(2)。结果：经过3~6个月的相对改善，UDVA和CDVA逐渐恢复到术前水平。经过12个月的稳定后，模拟的最大K值在24个月时恶化。昏迷像差无统计学意义。术后24个月球差增加。24个月时，角膜厚度显示出进行性的、统计学上显著的下降。50%的儿童患者在12个月的随访中由于所有参数的显著恶化而重新接受了外翻CXL。结论：圆锥角膜移植术后的功能结果显示出角膜不稳定，特别是在18岁及以下的儿童患者；在19岁至26岁的患者经过24个月的随访后，也有功能退化。
PURPOSE: To assess the clinical results of transepithelial collagen crosslinking (CXL) in patients 26 years and younger with progressive keratoconus suitable for epithelium-off (epi-off) CXL.SETTING: Department of Ophthalmology, Siena University Hospital, Siena, Italy.DESIGN: Prospective case series.METHODS: The study included 26 eyes (26 patients) treated by transepithelial (epithelium-on) CXL. The mean age was 22 years (range 11 to 26 years) (10 younger than 18 years; 16 between 19 years and 26 years). Preoperative and postoperative examinations included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, simulated maximum keratometry (K), coma and spherical aberration, and corneal optical coherence tomography optical pachymetry. The solution for transepithelial CXL (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with the Caporossi Baiocchi Mazzotta X Linker Vega at 3 mW/cm(2).RESULTS: After relative improvement in the first 3 to 6 months, the UDVA and CDVA gradually returned to baseline preoperative values. After 12 months of stability, the simulated maximum K value worsened at 24 months. Coma aberration showed no statistically significant change. Spherical aberration increased at 24 months. Pachymetry showed a progressive, statistically significant decrease at 24 months. Fifty percent of pediatric patients were retreated with epi-off CXL due to significant deterioration of all parameters after 12 months of follow-up.CONCLUSIONS: Functional results after transepithelial CXL showed keratoconus instability, in particular in pediatric patients 18 years old and younger; there was also functional regression in patients between 19 years and 26 years old after 24 months of follow-up.