Clinical and Corneal Biomechanical Changes After Collagen Cross-Linking With Riboflavin and UV Irradiation in Patients With Progressive Keratoconus: Results After 2 Years of Follow-up
Clinical and Corneal Biomechanical Changes After Collagen Cross-Linking With Riboflavin and UV Irradiation in Patients With Progressive Keratoconus: Results After 2 Years of Follow-up
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DOI：
10.1097/ico.0b013e318226bf4a
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发表时间：
2012-06-01
期刊：
影响因子：
2.8
通讯作者：
Zadok, David
中科院分区：
文献类型：
--
作者：
Goldich, Yakov;Marcovich, Arie L.;Zadok, David
目的：评价紫外线-核黄素-胶原交联剂(CXL)治疗进展性圆锥角膜的生物力学和角膜测量学效应及其安全性。对14例(14只眼)进行性圆锥角膜患者行角膜深化术后行CXL治疗。患者在手术前、治疗后1周、1个月、3个月、6个月、9个月、12个月和24个月进行评估。结果：裸眼视力(UCVA)、最佳矫正眼镜视力(BSCVA)(最小分辨角度的对数)、屈光度、生物显微镜和眼底检查、眼压、眼轴长度、内皮细胞密度、角膜地形图、最小角膜厚度、黄斑光学相干断层扫描和角膜生物力学检查结果与术后24个月结果比较，BCVA明显改善(0.21±-0.1，0.14+/-0.1，P<0.01)。屈光度稳定性(0.62+/-0.50和0.81+/-0.49，P=0.475)。最陡经向角膜屈光度(53.90±-5.9to51.5±-5.4D，P=0.001)和平均柱面屈光度(10.2±-4.1to8.1+/-3.4D，P=0.001)显著降低。术后眼球明显延长，由24.39±-1.7 mm延长至24.71±-1.9 mm(P=0.007)。平均模拟角膜曲率、最小角膜厚度、内皮细胞密度、角膜滞后、角膜阻力系数或中心凹厚度无明显变化。结论：CXL术后2年，稳定的UCVA、改善的BCVA和降低的角膜屈光度提示圆锥角膜的进展趋于稳定。角膜厚度、内皮细胞密度和中心凹厚度不变提示该手术的长期安全性。眼球反应分析仪测量的眼轴长度的增加和角膜生物力学参数的稳定性需要进一步的研究来验证和解释。
Purpose: To assess the biomechanical and keratometric effects and the safety of treatment of progressive keratoconus with UV-riboflavin collagen cross-linking (CXL).Methods: This is a prospective clinical controlled study. Fourteen eyes of 14 patients with progressive keratoconus were treated with CXL after corneal deepithelization. Patients were assessed preoperatively, at week 1 and at months 1, 3, 6, 9, 12, and 24 after treatment. We measured uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution), refraction, biomicroscopy and fundus examination, intraocular pressure, axial length, endothelial cell density, corneal topography, minimal corneal thickness, macular optical coherence tomography, and corneal biomechanics with the ocular response analyzer.Results: Comparing the preoperative results with 24-month postoperative results, we observed significant improvement in BCVA (0.21 +/- 0.1 to 0.14 +/- 0.1, P = 0.002) and stability in UCVA (0.62 +/- 0.5 and 0.81 +/- 0.49, P = 0.475). We observed a significant decrease in steepest-meridian keratometry (diopters) (53.9 +/- 5.9 to 51.5 +/- 5.4, P = 0.001) and in mean cylinder (diopters) (10.2 +/- 4.1 to 8.1 +/- 3.4, P = 0.001). Significant elongation of the eyes was observed, from 24.39 +/- 1.7 mm to 24.71 +/- 1.9 mm (P = 0.007). No significant change was observed in mean simulated keratometry, minimal corneal thickness, endothelial cell density, corneal hysteresis, and corneal resistance factor or foveal thickness.Conclusions: Two years after CXL, the observation of stable UCVA, improved BCVA, and reduced keratometry suggests stabilization in progression of keratoconus. Unchanged corneal thickness, endothelial cell density, and foveal thickness suggest the long-term safety of this procedure. The observed increase in axial length and stability in corneal biomechanical parameters measured with the ocular response analyzer require further study for verification and explanation.