快速跨上皮核黄素-紫外光角膜胶原交联治疗圆锥角膜的临床疗效和安全性评价  

Therapeutic effect and safety of accelarated transepithelial riboflavin-ultraviolet corneal collagen crosslinking for keratoconus

作　　者：张晶[1] 郑燕[1] 刘倩[1] 王玥[1] 李颖[1] 张秋露[1] 徐雯[1] 周跃华[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华实验眼科杂志》2016年第2期160-165,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：北京市科技计划项目（Z131100004013020）

摘　　要：背景研究证实经典角膜胶原交联法（CXL）可有效控制圆锥角膜的进展及角膜扩张，但由于其需要去上皮，因此引起较多不良反应和并发症。目前跨上皮核黄素-紫外线CXL已开始在临床上使用，但其有效性和安全性评价的研究较少。目的评价快速跨上皮核黄素-紫外线CXL治疗圆锥角膜的安全性及有效性。方法采用前瞻性自身对照系列病例观察研究设计，纳入2014年3—10月在北京同仁医院眼科就诊的圆锥角膜患者28例46眼，采用快速跨上皮核黄素-紫外线CXL治疗，术后随访1年。分别于术前、术后1周及术后1个月、3个月、6个月和12个月测定术眼的视力、屈光度、中央角膜厚度（CCT）、角膜内皮细胞计数、角膜地形图参数、眼前节光学相干断层扫描仪检查结果及角膜生物力学参数，对术眼手术前后的检查指标进行比较，评价快速跨上皮核黄素-紫外线CXL治疗的有效性。对随访期间术眼的刺激症状和不良反应进行观察，评价快速跨上皮核黄素-紫外线CXL治疗的安全性。结果所有手术顺利，未发现术中并发症及术后感染。术眼术后1d出现轻度刺激症状，均于术后3d缓解或消失。术眼术后1个月及以后等效球镜度（SE）较术前降低，但手术前后总体比较差异无统计学意义（F=0．722，P=0．614）；术眼术后12个月术眼柱镜度（CD）明显低于术前，差异有统计学意义（t=3．242，P=0．004）。术眼手术后不同时间点角膜内皮细胞密度、角膜内皮细胞面积的变异系数（CV）及六边形角膜内皮细胞比率值均接近于术前值，总体比较差异均无统计学意义（F=0．246、0．465、0．981，均P〉0．05）。术眼术后3个月和6个月的角膜厚度值分别为（467．86±52．92）和（468．51±52．96）μm，高于术前的（453．91±45．78）μm，但差异均无统计学意义（t=0．236、0．469，均P〉0．05），术眼术后1Background Researches showed that classic corneal collagen crosslinking （CXL） can effectively control the progression of keratoconus and corneal eetasia,but its adverse responses and complications arc common due to the de-epithelial procedure. A transepithelial riboflavin-ultraviolet CXL surgery has applied in ophthalmology,but its effectiveness and safety evaluation is less. Objective This study was to evaluate the effectiveness and safety of rapid transepithelial riboflavin-ultraviolet CXL for keratoconus. Methods A prospective self-controlled study was designed. Forty-six eyes of 28 keratoconus patients scheduled to receive the rapid transepithelial riboflavin-ultraviolet CXL in Beijing Tongren Hospital from March to October in 2014 under the approval of this hospital and informed consent with a follow-up duration for one year. The spherical equivalent （SE） , astigmatic power, central corneal thickness （CCT）, endothelial cell count, corneal topography parameters, the parameters from the anterior segment optical coherence tomography （AS-OCT） and corneal biomechanical parameters were examined before surgery and 1 week,1 month,3 months,6 months and 12 months after surgery, and the results were compared among different time points to assess the effectiveness of transepithelial riboflavin-ultraviolet CXL for keratoconus. The postoperative irritation symptoms and adverse response were observed to evaluate the safety of surgery. Results No intraoperative complication and serious adverse postoperative infection were found in all the operated eyes. Slight irritation symptoms occurred in operated eyes 1 day after surgery and disappeared 3 days after surgery. A little reducing was seen in the spherical equivalent 1 month later, without significant difference among various time points （F = 0. 722, P = 0. 614 ）. However, a significant reducing was found in astigmatic power in 12 months after surgery compared with before surgery （t = 3. 242 ,P= 0. 004）. No considerably differences were seen in cornea

关 键 词：圆锥角膜/药物疗法 光化学疗法/方法 光敏剂/治疗用途 核黄素/治疗用途 紫外线 角膜生物力学 快速跨上皮核黄素-紫外线角膜胶原交联 

分 类 号：R779.6[医药卫生—眼科]