Progression of Keratoconus in Patients While Awaiting Corneal Cross-linking: A Prospective Clinical Study
Progression of Keratoconus in Patients While Awaiting Corneal Cross-linking: A Prospective Clinical Study
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DOI：
10.3928/1081597x-20180104-01
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发表时间：
2018-03-01
影响因子：
2.4
通讯作者：
Kaye, Stephen B.
中科院分区：
文献类型：
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作者：
Romano, Vito;Vinciguerra, Riccardo;Kaye, Stephen B.
目得：评估圆锥角膜患者在等待角膜交联（CXL）治疗期间的地形变化。方法：在这项前瞻性、双中心、观察性临床研究中，招募了圆锥角膜患者。进展定义为在切线标测图上锥体区域内曲率变化至少1.00屈光度（D），并且在至少间隔3个月进行测量后，最薄点处变薄20 μ m。在基线（CXL上市当天）和CXL治疗当天评估形态学参数，包括裂隙灯生物显微镜检查、角膜曲率（最大值、最小值和平均值）和使用角膜断层扫描（Pentacam; Oculus Optikgerate GmbH，韦茨拉尔，德国）的最薄角膜厚度。等待时间为84.8 +/- 62.9天。25%的患者在等待治疗期间显示出进展的证据。在等待治疗期间进展的患者（22.2 +/- 6.79岁）比未显示进展证据的患者（25.4 +/- 5.62岁）更年轻（P = 0.02）。按年龄组分层显示，与18 - 26岁和26岁以上患者相比，18岁以下患者的最大角膜曲率显著恶化（1.18 +/- 1.37 D）（分别为P = .002和.042）。多变量模型证实，进展陡峭的最大角膜曲率，而等待治疗与年龄（P = 0.028）。结论：结果表明，分层的等待时间根据患者的年龄是必要的，以减少进一步发展的圆锥角膜的风险。
PURPOSE: To assess topographical changes in patients with keratoconus while awaiting corneal cross-linking (CXL) treatment.METHODS: In this prospective, double-center, observational clinical study, patients with keratoconus were enrolled. Progression was defined as a change in the curvature within the cone area of at least 1.00 diopter (D) on tangential map and a thinning of 20 mu m at the thinnest point after measurements taken at least 3 months apart. Morphological parameters were assessed at baseline (day of listing for CXL) and on the day of CXL treatment, including slit-lamp biomicroscopy, keratometry (maximum, minimum, and mean), and thinnest corneal thickness using corneal tomography (Pentacam; Oculus Optikgerate GmbH, Wetzlar, Germany).RESULTS: One hundred four eyes of 104 patients were included. The waiting time was 84.8 +/- 62.9 days. Twenty-five percent of patients showed evidence of progression while waiting for treatment. Patients who progressed while waiting for treatment were younger (22.2 +/- 6.79 years) compared to those who did not show evidence of progression (25.4 +/- 5.62 years) (P = .02). Stratification by age groups showed a significant worsening of maximum keratometry of 1.18 +/- 1.37 D in patients younger than 18 years compared to those 18 to 26 years of age and those older than 26 years (P = .002 and .042, respectively). The multivariate model confirmed that the progression steepening of the maximum keratometry while waiting for treatment was associated with age (P = .028).CONCLUSIONS: The results suggest that stratification of waiting time according to the patient's age is required to reduce the risk of further progression of keratoconus.