保留角膜上皮瓣的角膜胶原交联术治疗较薄型圆锥角膜的临床研究  

The clinical study of corneal cross-linking with preserved corneal epithelial flap in thin keratoconic corneas

作　　者：孙吉君 黄晓静 史伟云[1] 王婷[1] Sun Jijun;Huang Xiaojing;Shi Weiyun;Wang Ting(Shandong Eye Institute, Shandong Eye Hospital, Jinan 250021, China)

机构地区：[1]山东省眼科研究所山东省眼科医院,济南250021

出　　处：《中华眼科杂志》2018年第6期421-425,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨保留角膜上皮瓣的角膜胶原交联术（CXL）治疗较薄型圆锥角膜眼的疗效和安全性。方法前瞻性病例对照研究。收集自2013年9月至2014年3月于山东省眼科医院住院治疗的20例（22只眼）较薄型圆锥角膜患者（去除角膜上皮后角膜基质厚度〈400μm），其中男性16例，女性4例；年龄（23．5±4．9）岁。CXL中应用等渗性核黄素后再进行紫外线照射。照射时将上皮瓣复位，治疗前及治疗后12个月检查视力和角膜内皮细胞计数，采用角膜地形图测量角膜厚度和角膜曲率。对治疗前后的各项数据进行配对t检验。结果治疗前及治疗后12个月的所有患眼角膜厚度分别为（400．6±14．9）和（396．5±16．3）μm，角膜内皮细胞计数分别为（2824±308）和（2753±372）个／mm^2，差异均无统计学意义（t=1．973，0．928；P〉0．05）。治疗前角膜最大曲率（Kmax）、角膜最小曲率（Kmin）、角膜前表面K值（Km）分别为（54．73＋4．39）、（48．97＋3．72）、（51．67＋3．77）D，治疗后分别为（53．46±3．85）、（48．41±3．17）、（50．77±3．28）D，差异均有统计学意义（t=-3．138，-2．170，-3．532；P〈0．05）。所有患者治疗后均无角膜内皮失代偿、角膜瘢痕形成等并发症。患者视力经过治疗有所提高。结论保留角膜上皮瓣的CXL治疗较薄型圆锥角膜，术后角膜地形图参数改善，角膜内皮细胞无损伤，无明显不良反应，提示该治疗方法安全、有效。Objective To evaluate the therapeutic effect of corneal collagen cross-linking （CXL） with preserved corneal epithelial flap and isotonic riboflavin for treatment of keratoconus eyes with thin corneas. Methods Prospective case-control study. Twenty two eyes of 20 patients （16 males and 4 females, with age of 23.5±4.9）, who have been diagnosed with progressive keratoeonus and the corneal stroma thickness of whom were less than 400μm （without the epithelium）, were included in this study. Corneal collagen erosslinking was performed under preserved corneal epithelial flap （8.5mm）, followed by instillation of 0.1% riboflavin and then UV irradiation. The corneal epithelial flap must be restored prior to the application of UVA irradiation. Visual acuity, corneal topography and endothelial cell count were evaluated at baseline and at 12 months follow-up. Data were analyzed using paired samples t test. Results Corneal topography results of 12m before and after the therapy revealed the significant reductions of Kmax from （54.73±4.39）D to （53.46±3.85）D and Kmin from （48.97±3.72）D to （48.41±3.17）D, and also Km from （51.67±3.77） D to （50.77±3.28） D （Kmax： t=-3.138, P〈0.05; Kmin： t=-2.170, P〈0.05; Km： t=-3.532, P〈0.05）. No statistically significant differences were found between the average corneal thickness of pre therapy [（400.6±14.9） μm] and post therapy [（396.5± 16.3）μm] （t=1.973, P〉O.05）. Endothelial cell counts of pre therapy [（2 824±308）/mm2] and post therapy [（2 753±372）/mm2] were of no statistical significance as well （t=0.928, P〉0.05）. No complications such as scarring lesions in the stroma and corneal endothelial damage were observed throughout the study period. Most of the patient＇s vision improved after treatment. Conclusion The application of isotonic ribonavin solution in a cross-linking procedure in thin corneas with preserved corneal epithelial flap seems to be safe and effective as keratoconus tend to be stable

关 键 词：圆锥角膜 胶原 角膜基质 交联试剂 光化学疗法 

分 类 号：R779.6[医药卫生—眼科]