圆锥角膜不同交联方法术后基质分界线发生特点及其对交联效果的影响  

Characteristics of corneal stromal demarcation line after different cross-linking methods in keratoconus and its influence on the cross-linking effect

作　　者：王宁 董巧巧 王姝婷 董沐晨 李素霞 Wang Ning;Dong Qiaoqiao;Wang Shuting;Dong Muchen;Li Suxia(Eye Hospital of Shandong First Medical University,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250021,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)、山东省眼科研究所、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眼科医院,济南250021

出　　处：《中华实验眼科杂志》2023年第2期152-159,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(82271059);山东省自然科学基金青年项目(ZR2020QH146)。

摘　　要：目的比较早期圆锥角膜接受核黄素/紫外线A角膜胶原交联术(CXL)不同手术方式术后基质分界线的特点,并分析基质分界线对交联效果的影响。方法采用非随机对照临床研究方法,选取2019年5月至2021年2月于山东第一医科大学附属眼科医院就诊的圆锥角膜患者69例69眼,所有患者均行CXL治疗,其中经上皮交联组21眼,去上皮交联组48眼;5.4 J能量组25眼,7.2 J能量组44眼。分别于术后2周、1个月、3个月、4个月进行随访,观察角膜基质交联反应(基质分界线)的形态及变化特点;记录角膜最薄处厚度(TCT)、裸眼视力(UCVA,LogMAR)、最佳矫正视力(BCVA,LogMAR)和角膜最大曲率(Kmax)等的变化。结果术后出现基质分界线占63.77%(44/69),未出现基质分界线占36.23%(25/69)。去上皮交联组出现基质分界线占79.17%(38/48),明显高于经上皮交联组的28.57%(6/21),差异有统计学意义(χ^(2)=16.186,P<0.01);5.4 J能量组出现基质分界线占72.00%(18/25),7.2 J能量组占56.80%(25/44),差异无统计学意义(χ^(2)=1.565,P=0.302)。裂隙灯显微镜及眼前节光学相干断层扫描显示基质分界线于术后1~2周时出现,1个月时逐渐汇聚、增强;2~3个月后基质分界线开始变得弥散、边界模糊,并逐渐变淡;4个月时基质分界线基本消失。基质分界线深度可达141~423μm,平均(263.44±84.22)μm。激光扫描共聚焦显微镜观察结果显示,交联术后角膜基质细胞激活,反光增强,胶原纤维纵横伸展并相互交错,纤维排列呈网状。术后4个月,TCT由术前的(458.69±38.28)μm降至(443.86±36.54)μm,差异有统计学意义(t=6.705,P<0.001);有基质分界线组与无基质分界线组术后TCT下降幅度比较,差异无统计学意义(t=1.684,P=0.100)。术后4个月所有术眼UCVA由术前的0.74±0.37提高至0.69±0.38,差异有统计学意义(t=2.109,P=0.039);手术前后BCVA比较,差异无统计学意义(t=1.006,P=0.319)。有基质分界线组与无基质分界线组术�Objective To compare the characteristics of corneal stromal demarcation line after different surgical methods of riboflavin/ultraviolet A corneal collagen cross-linking(CXL)in early keratoconus,and analyze the influence of the demarcation line on the cross-linking effect.Methods A non-randomized controlled clinical study was conducted.Sixty-nine eyes of 69 patients treated with riboflavin/ultraviolet A CXL in the Eye Hospital of Shandong First Medical University from May 2019 to February 2021 were included.According to the cross-linking methods,the patients were divided into epithelium-on treatment group(21 eyes)and epithelium-off treatment group(48 eyes).There were 25 eyes in 5.4 J energy group and 44 eyes in 7.2 J energy group.The morphology and changes of corneal stromal cross-linking reaction(corneal stromal demarcation line)were observed at 2 weeks,1,3 and 4 months after operation.Changes in the thinnest corneal thickness(TCT),uncorrected visual acuity(UCVA,LogMAR),best corrected visual acuity(BCVA,LogMAR)and corneal maximum curvature(Kmax)were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Eye Hospital of Shandong First Medical University(No.2019.05).Written informed consent was obtained from each subject.Results Of the 69 eyes after operation,44 eyes(63.77%)had demarcation lines,and 25 eyes(36.23%)had no demarcation lines.The occurrence rate of demarcation lines in the epithelium-on treatment group was 79.17%(38/48),which was significantly higher than 28.57%(6/21)in the epithelium-off treatment group(χ^(2)=16.186,P<0.01).The occurrence rate of demarcation line in 5.4 J energy group was 72.00%(18/25),and the 7.2 J energy group was 56.80%(25/44),with no significant difference(χ^(2)=1.565,P=0.302).Slit lamp microscopy and anterior segment-optical coherence tomography showed that the demarcation line appeared at 1-2 weeks after operation,gradually converged and strengthened after 1 month,turned diffuse,blurred and faded by degrees after 2

关 键 词：圆锥角膜 核黄素/紫外线A角膜胶原交联术 基质分界线 激光扫描共聚焦显微镜 胶原纤维 

分 类 号：R779.6[医药卫生—眼科]