快速角膜胶原交联术联合LASIK治疗近视的早期临床效果  

Early clinical effects of accelerated UVA/riboflavin corneal collagen cross-linking combined with LASIK for myopia

作　　者：吴莹[1] 田磊[2] 王丽强[1] 葛梅[1] 黄一飞[1] 

机构地区：[1]中国人民解放军总医院中国人民解放军医学院,北京100853 [2]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研究所眼科学与视觉科学北京市重点实验室,100730

出　　处：《中华眼视光学与视觉科学杂志》2017年第1期4-8,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金（81271052,31600758）;首都医科大学附属北京同仁医院科研种子基金（2015-YJJ-ZZL-008）;眼科学与视觉科学北京市重点实验室资助项目（2016YKSJ02）

摘　　要：目的评估快速紫外线／核黄素角膜胶原交联（ACXL）联合准分子激光原位角膜磨镶术（LASIK）治疗近视术后6个月的临床效果。方法前瞻性自身对照研究。选取18例（36眼）近视患者，先进行飞秒激光制瓣的LASIK，角膜瓣复位前用VibexXtra核黄素溶液浸润角膜基质床90S后复位角膜瓣，应用辐照强度为30mW／cm2的紫外光（KXL系统）照射角膜90S，总能量为2．7J／cm2。进行ACXL治疗。术后随访6个月以上。对术前和术后6个月的视力、屈光度、角膜形态参数、角膜内皮细胞密度（ECD）、角膜生物力学特征等进行比较。采用配对t检验比较手术前后各参数的变化情况。结果术后6个月，裸眼视力（UCVA，logMAR）从术前0．93±0．34提高到-0．05±0．08，等效球镜度（SE）从（-8．03±1．86）D减少到（-0．29±0．39）D，平均角膜曲率从（44．79±2．10）D减少到（37．96±2．32）D，角膜厚度从（524．6±25．2）μm减少到（437．7±27．0）μm，角膜最大屈膝峰距从术前（5．48±0．31）mm减少到（4．99±0．44）mm，最大压陷深度从术前（1．09±0．12）mm增加到（1．18±0．18）mm。除ECD和最大压陷曲率半径外，其余指标术前、术后差异均有统计学意义（t=-63．02-26．68，P〈0．05）。术后6个月随访期内，未见屈光回退、角膜扩张、感染和非感染性角膜炎等并发症。结论ACXL联合LASIK能够有效矫正近视，术后6个月效果稳定。无明显并发症，但长期效果及临床适应证仍需进一步观察。Objective To evaluate at six months after myopia surgery the clinical effects of laser in situ keratomileusis （LASIK） combined with accelerated UVA/riboflavin corneal collagen cross-linking （ACXL）. Methods This was a prospective and self-controlled study that included 18 myopia patients （36 eyes）. LASIK was performed using femtosecond and excimer lasers. Before the flap was reset, single-use Vibe Xtra riboflavin drops were instilled in the corneal stromal bed for 90 seconds. A KXL system （Avedro Inc.） was used to irradiate the cornea with UVA light, delivering 30 mW/cm： of irradiance for 90 seconds. The total exposure dose was 2.7 J/cm2. Uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, spherical equivalent （SE）, corneal topography, thinnest corneal thickness （TCT）, and endothelial cell density （ECD） were evaluated preoperatively and six months postoperatively. Paired t-test were used for statistical analysis. Results Mean UCVA changed from 0.93±0.34 （logMAR） to -0.05±0.08, SE from -8.03±1.86 diopter （D） to -0.29±0.39 D, keratometry from 44.79±2.10 D to 37.96±2.32 D, TCT from 524.6±25.2μm to 437.7±27.0 μm, corneal peak distance from 5.48±0.31 mm to 4.99±0.44 mm, and corneal deformation amplitude from 1.09± 0.12 mm to 1.18±0.18 mm. Aside from the ECD and highest corneal concavity radius, changes in the remaining parameters between preoperative and six-month postoperative values were significant （t=-63.02-26.87, P〈0.05）. None of the patients developed signs of significant regression, ectasia, or keratitis during the follow-up period. Conclusion LASIK combined with ACXL can effectively correct refractive error in patients with myopia. There were no significant complications during the six-month follow-up. But the long-term effects and indications of LASIK combined with ACXL need to be further observed and studied.

关 键 词：角膜胶原交联术 近视 飞秒激光 角膜磨镶术 激光原位 

分 类 号：R779.63[医药卫生—眼科]