CXL治疗圆锥角膜的中期效果及术后RGPCL配适参数变化的研究  

The mid-term effect of corneal collagen cross-linking for progressive keratoconus and the changes in rigid gas permeable contact lens fitting parameters

作　　者：赵陈培 姬戎媛 韩燕敏 杜显丽 Zhao Chenpei;Ji Rongyuan;Han Yanmin;Du Xianli(Qingdao Eye Hospital of Shandong First Medical University,Eye Institute of Shandong First Medical University,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Qingdao 266071,China)

机构地区：[1]山东第一医科大学附属眼科研究所山东省眼科学重点实验室-省部共建国家重点实验室培育基地山东第一医科大学附属青岛眼科医院,青岛266071

出　　处：《中华眼科杂志》2022年第4期272-278,共7页Chinese Journal of Ophthalmology

基　　金：山东第一医科大学学术提升计划(2019ZL001)。

摘　　要：目的:探讨圆锥角膜患眼行角膜胶原交联术(CXL)后1年的治疗效果及术后硬性透气性角膜接触镜(RGPCL)适配参数的改变。方法:前瞻性队列研究。纳入自2018年5至12月于山东第一医科大学附属青岛眼科医院门诊接受快速CXL的进展期圆锥角膜患者41例(53只眼),其中男性31例,女性10例,年龄(20.46±4.15)岁。根据角膜最薄点厚度是否≥450 μm分为去上皮组(33只眼)和经上皮组(20只眼),分别采用去上皮术式和经上皮术式行CXL。术前及术后6周适配RGPCL并追踪配适情况至术后12个月。所有患眼术前和术后6周检查最佳矫正视力和角膜最薄点厚度,术前、术后6周和3、6、12个月进行角膜地形图检查获取平坦角膜曲率(Kf)、陡峭角膜曲率(Ks)及最大角膜曲率(Kmax)。采用 t检验对数据进行统计学分析。 结果:术后6周时两组框架镜矫正视力、屈光度数及角膜最薄点厚度较术前无改变,但Kf、Ks及Kmax均增加( P均<0.05);至术后3个月两组Kmax呈现下降趋势,其中去上皮术组术前及术后3、6、12个月的Kmax分别为(55.46±6.02)、(55.17±5.83)、(55.14±6.15)、(54.57±6.08)D,其中术后12个月下降显著,为(0.89±1.45)D( t=2.25, P=0.001);经上皮组术前及术后3、6、12个月的Kmax分别为(59.43±8.98)、(57.97±8.79)、(58.19±8.37)、(56.94±7.19)D,术后3、6及12个月均下降显著,且降幅更大,分别为(1.46±2.09)、(1.25±1.82)、(2.49±3.64)D( t=3.12,3.06,3.50;P=0.006,0.006,0.007)。术后两组RGPCL矫正视力、屈光度数及直径均无改变,但RGPCL基弧均减小,去上皮组减小0.07 mm而经上皮组减小0.13 mm( P均<0.05);另外,去上皮组术后抬边翘设计10只眼,较术前8只眼增加,而经上皮组术前(7只眼)较术后(4只眼)减少。环曲面边翘设计眼两组均较术前增多,去上皮组术前为2只眼,术后增加至3只眼,经上皮组术前为1只眼,术后增加至4只眼。两组术后6及12个月时RGPCL配适可接受率均较术后6周增�Objective To investigate the effect of corneal collagen cross-linking(CXL)for progressive keratoconus and to evaluate changes in the parameters of rigid gas permeable contact lens(RGPCL)fitting after surgery.Methods It was a prospective cohort study.Fifty-three eyes of 41 keratoconus patients received accelerated CXL in Qingdao Eye Hospital of Shandong First Medical University from May to December 2018.There were 31 males and 10 females,aged(20.46±4.15)years.According to the corneal thickness,de-epithelial CXL(33 eyes)or trans-epithelial CXL(20 eyes)was performed.The best spectacle-corrected visual acuity,refractive power and the thinnest corneal thickness at baseline and at 6 weeks were compared.Corneal topography was performed at baseline and at 6 weeks,3,6 and 12 months postoperatively.Rose K RGPCLs were used before and 6 weeks after surgery,and the fitting status was monitored until 12 months after surgery.The t test was performed to analyze the difference before and after the operation.Results The best spectacle-corrected visual acuity,refractive power,and the thinnest corneal thickness were not significantly changed over 6 weeks of follow-up,but the Kf,Ks and Kmax values were significantly increased in all patients(all P<0.05).In the de-epithelial group,the Kmax values before the operation,at 3,6 and 12 months after the operation were(55.00±5.51)diopters(D),(54.73±5.34)D,(54.58±6.15)D and(54.20±5.49)D,respectively,and the decrease at 12 months was significant[(0.80±2.05)D;t=2.25,P=0.001].In the trans-epithelial group,the Kmax values were(59.43±8.98)D,(57.97±8.79)D,(58.19±8.37)D and(56.94±7.19)D at the four time points,respectively,and the decreases at 3,6 and 12 months were all significant[(1.46±2.09)D,(1.25±1.82)D,(2.49±3.64)D;t=3.12,3.06,3.50;P=0.006,0.006,0.007].The best RGPCL-corrected visual acuity,the diameter and the average diopters of RGPCLs showed no significant change in both groups.The RGPCL base curve decreased by 0.07 mm in the de-epithelial group and by 0.13 mm in the trans-epith

关 键 词：圆锥角膜 胶原 交联试剂 接触镜 角膜地形图 治疗结果 

分 类 号：R779.6[医药卫生—眼科]