快速角膜胶原交联术治疗圆锥角膜的安全及有效性研究  

Efficacy and safety of accelerated collagen crosslinking for treatment of keratoconus

作　　者：李彩红[1] 赵宏[1] 贾博[1] 马时光 郭慧娟[1] LI Caihong;ZHAO Hong;JIA Bo;MA Shiguang;GUO Huijuan(Zhengzhou Eye Institute,Department of Ophthalmology,Zhengzhou Second People’s Hospital,Zhengzhou 450006,Henan Province,China)

机构地区：[1]郑州市眼科研究所,郑州市第二人民医院眼科,河南省郑州市450006

出　　处：《眼科新进展》2020年第3期243-246,共4页Recent Advances in Ophthalmology

基　　金：河南省科技攻关项目(编号182102310459)。

摘　　要：目的评价快速角膜胶原交联术(accelerated corneal collagen crosslinking,A-CXL)治疗圆锥角膜的安全性及有效性。方法收集2017年4月至2018年3月在郑州市第二人民医院眼科确诊为进展期圆锥角膜的患者37例(61眼),使用Avedro快速角膜胶原交联系统(30 mW·cm-2,4 min)进行手术。随访12个月,观察术前及术后最佳矫正视力(best corrected visual acuity,BCVA)、角膜内皮细胞密度(endothelial cell density,ECD)、角膜内皮细胞面积变异系数(coefficient variation of cell size,CV)及六边形角膜内皮细胞比例(percentage of hexagonal cells,Hex)、等效球镜度(spherical equivalent,SE)、角膜前表面最大曲率(maximum keratometry,Kmax)、角膜后表面高度(posterior corneal elevation,PCE)、最薄点角膜厚度(thinnest corneal thickness,TCT)的变化。结果术后1个月眼前段光学相干断层扫描检查发现39眼(63.9%)交联术后角膜前中基质层信号增强,可见明显分界线,深度(278.2±45.6)μm;角膜ECD和Hex分别较术前平均下降(97.6±138.6)个和(7.8±14.8)%,差异均有统计学意义(均为P<0.05),术后3个月二者均恢复至术前水平;角膜CV由术前(35.6±8.0)%增加至(40.6±7.1)%,差异有显著统计学意义(P<0.01);术后3个月时为(37.3±6.8)%,与术前相比差异仍有统计学意义(P<0.05);术后6个月时恢复至术前水平。术后12个月,BCVA及SE均较术前明显改善,差异均有显著统计学意义(均为P<0.01);Kmax及TCT分别下降(2.06±2.51)D和(8.9±10.8)μm,差异均有显著统计学意义(均为P<0.01);PCE保持稳定,与术前差异无统计学意义(P>0.05)。结论A-CXL手术后早期会出现短暂可逆性内皮细胞数量下降及形态改变,该手术可明显改善圆锥角膜患者角膜形态及视力,阻止或延缓角膜膨隆的进展。Objective To evaluate the efficacy and safety of accelerated corneal collagen crosslinking(A-CXL)for treatment of keratoconus.Methods Sixty-one eyes of 37 patients with progressive keratoconus who received A-CXL(30 mW·cm-2,4 min)at Ophthalmology Department in Zhengzhou Second Hospital from April 2017 to March 2018.All patients took follow-up for 12 months.Changes of best corrected visual acuity(BCVA),endothelial cell density(ECD),coefficient variation of cell size(CV),percentage of hexagonal cells(Hex),spherical equivalent(SE),maximum keratometry(Kmax)at anterior corneal surface,posterior corneal elevation(PCE)and thinnest corneal thickness(TCT)were observed before and after operation.Results At 1 month after A-CXL,OCT of anterior segment showed signal enhancement at medial anterior corneal stroma in 39 eyes(63.9%),there was obvious boundary and with mean depth of(278.2±45.6)μm,corneal ECD and Hex decreased by an average of 97.6±138.6 and(7.8±14.8)%comparing with those before operation(both P<0.05),and both returned to the preoperative level 3 months after the operation;corneal CV increased from(35.6±8.0)%before operation to(40.6±7.1)%,and the difference was statistically significant(P<0.01),and(37.3±6.8)%3 months after operation,which had statistical difference comparing with that before operation(P<0.05).Corneal CV returned to preoperative level 6 months after the operation.At 12 months after operation,BCVA and SE were improved,and the differences were statistically significant(both P<0.01);Kmax and TCT decreased by(2.06±2.51)D and(8.9±10.8)μm,respectively,and the differences were statistically significant(both P<0.01);PCE remained stable,and there was no statistically significant difference comparing with preoperative level(P>0.05).Conclusion In the early stage after A-CXL,there will be a temporary reversible decrease in the number of endothelial cells and morphological changes,which can significantly improve the corneal morphology and vision of patients with keratoconus,and prevent or delay the pro

关 键 词：圆锥角膜 快速角膜交联术 胶原 角膜内皮 

分 类 号：R772.2[医药卫生—眼科]