Combined Transepithelial Phototherapeutic Keratectomy and Corneal Collagen Cross-Linking for Progressive Keratoconus
Combined Transepithelial Phototherapeutic Keratectomy and Corneal Collagen Cross-Linking for Progressive Keratoconus
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DOI：
10.1016/j.ophtha.2012.03.038
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发表时间：
2012-09-01
期刊：
影响因子：
13.7
通讯作者：
Panagopoulou, Sophia I.
中科院分区：
文献类型：
--
作者：
Kymionis, George D.;Grentzelos, Michael A.;Panagopoulou, Sophia I.
目的：比较角膜胶原交联（CXL）治疗进行性圆锥角膜使用2种不同的上皮去除技术的结果：经上皮激光治疗性角膜切除术（t-PTK）与机械上皮清创术。设计：前瞻性，比较，干预性病例系列。参与者：34例（38只眼）进行性圆锥角膜入组。方法：所有患者均接受了顺利的CXL治疗。在CXL治疗期间，16例患者（19只眼）使用t-PTK（组1）进行了上皮切除术，18例患者（19只眼）使用旋转刷（组2）进行了机械上皮清创术。在术前和术后1、3、6和12个月，根据角膜共焦显微镜检查结果对视力和屈光结果进行沿着评估。主要结果测量：未矫正远视力（UDVA）、矫正远视力（CDVA）、明显屈光度和角膜曲率读数。在第1组中，平均UDVA和平均CDVA的最小分辨角对数分别从术前的0.99 +/- 0.71和0.30 +/- 0.26改善至术后12个月的0.63 +/- 0.42（P = 0.02）和0.19 +/- 0.18（P = 0.008）。在第2组中，术后12个月的平均UDVA和平均CDVA均未显示出显著改善（P > 0.05）。在第1组中，平均角膜散光从术前的-5.84 +/- 3.80 D（D）改善到末次随访时的-4.31 +/- 2.90 D（P = 0.015），而在第2组中，在相同的术后间隔时间内没有显著差异（P > 0.05）。在整个随访期间，两组均未观察到内皮细胞密度的变化（P > 0.05）。结论：与机械上皮清创术相比，CXL期间使用t-PTK进行上皮细胞去除可获得更好的视力和屈光结果。财务披露：作者对本文中讨论的任何材料均无专有或商业利益。Ophthalmology 2012; 119：1777-1784（C）2012，美国眼科学会。
Purpose: To compare the outcomes of corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus using 2 different techniques for epithelial removal: transepithelial phototherapeutic keratectomy (t-PTK) versus mechanical epithelial debridement.Design: Prospective, comparative, interventional case series.Participants: Thirty-four patients (38 eyes) with progressive keratoconus were enrolled.Methods: All patients underwent uneventful CXL treatment. Sixteen patients (19 eyes) underwent epithelial removal using t-PTK (group 1) and 18 patients (19 eyes) underwent mechanical epithelial debridement using a rotating brush (group 2) during CXL treatment. Visual and refractive outcomes were evaluated along with corneal confocal microscopy findings preoperatively and at 1, 3, 6, and 12 months postoperatively.Main Outcome Measures: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and keratometry readings.Results: No intraoperative or postoperative complications were observed in any of the patients. In group 1, logarithm of the minimum angle of resolution mean UDVA and mean CDVA improved from 0.99 +/- 0.71 and 0.30 +/- 0.26 preoperatively to 0.63 +/- 0.42 (P = 0.02) and 0.19 +/- 0.18 (P = 0.008) at 12 months postoperatively, respectively. In group 2, neither mean UDVA nor mean CDVA demonstrated a significant improvement at 12 months postoperatively (P > 0.05). In group 1, mean corneal astigmatism improved from -5.84 +/- 3.80 diopters (D) preoperatively to -4.31 +/- 2.90 D (P = 0.015) at the last follow-up, whereas in group 2 there was no significant difference at the same postoperative interval (P > 0.05). No endothelial cell density alterations were observed throughout the follow-up period for both groups (P > 0.05).Conclusions: Epithelial removal using t-PTK during CXL results in better visual and refractive outcomes in comparison with mechanical epithelial debridement.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012; 119: 1777-1784 (C) 2012 by the American Academy of Ophthalmology.