跨上皮和去上皮快速角膜交联术治疗进展期圆锥角膜的临床研究  

Effects of the epithelium-off and epithelium-on accelerated comeal collagen cross-linking g in the treatment of progressive keratoconus

作　　者：马萍 鲁静[1] 兰长骏 Ma Ping;Lu Jing;Lan Changjun(Department of Ophthalmology and Corneal,Chengdu Eastern Aier Eye Hospital,Chengdu 610056,China;Affiliated Hospital of North Sichuan Medical College,Medical School of Ophthalmology&Optometry,North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]成都东区爱尔眼科医院眼表角膜科,2610056 [2]川北医学院附属医院眼科,川北医学院眼视光医学院,南充637000

出　　处：《中华眼科医学杂志（电子版）》2024年第4期206-211,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：四川省卫生和计划生育委员会科研课题(17PJ550)。

摘　　要：目的分析跨上皮快速角膜交联(ACXL)术和去上皮ACXL术治疗进展期圆锥角膜的有效性和安全性。方法选择2020年1月至2022年3月在成都东区爱尔眼科医院眼表角膜科行ACXL术治疗的进展期圆锥角膜患者69例(102只眼)作为研究对象。其中,男性40例(58只眼),女性29例(44只眼);年龄10~48岁,平均年龄(21.6±6.9)岁。根据角膜最薄点厚度(TCT)分为TCT≥450μm组43例(62只眼)和400μm≤TCT<450μm组26例(40只眼),前者采用去上皮ACXL紫外光连续输出模式治疗,后者采用跨上皮ACXL紫外光脉冲输出模式治疗。两组分别于术前、术后1、3、6及12个月检查角膜透明度、裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜屈光度、柱镜屈光度、眼压、角膜前表面最大曲率(Kmax)、TCT及角膜内皮细胞密度。UCVA、BCVA、球镜屈光度、柱镜屈光度、TCT、Kmax及角膜内皮细胞密度等计量资料经正态性检验符合正态分布,以x珋±s表示,术前术后比较采用单因素重复测量方差分析,当差异有统计学意义时进一步采用LSD-t检验;组内术前术后角膜内皮密度的比较采用配对t检验。结果跨上皮ACXL组患者术前、术后1、3、6及12个月的BCVA和Kmax分别为(0.27±0.13)最小分辨视角的对数(logMAR)、(0.26±0.17)logMAR、(0.22±0.13)logMAR、(0.22±0.14)logMAR、(0.18±0.14)logMAR、(62.96±10.91)D、(63.01±10.13)D、(62.76±10.42)D、(62.44±10.29)D及(61.83±9.40)D。跨上皮ACXL患者术前术后BCVA和Kmax比较,差异有统计学意义(F=6.848,2.678;P<0.05);经LSD-t检验,患者术后3、6及12个月的BCVA较术前提高,差异有统计学意义(t=3.250,5.414,6.485;P<0.05);术后12个月Kmax较术前降低,差异有统计学意义(t=2.672,P<0.05)。去上皮ACXL组患者术前、术后1、3、6及12个月的柱镜屈光度、TCT及Kmax分别为(-3.79±1.92)D、(-3.87±2.19)D、(-3.66±2.14)D、(-3.36±2.09)D、(-3.20±2.14)D、(488.29±34.20)μm、(475.55±31.20)μm、(477.71±30.97)μm、(479.76±28.82)Objective To investigate the clinical efficacy and safety of epithelium-off accelerated comeal collagen cross-linking(ACXL)and epithelium-on ACXL in the treatment of progressive keratoconus.Methods A total of 69 patients(102 eyes)with progressive keratoconus at the Department of Ophthalmology and Corneal in Chengdu East Aier Eye Hospital from January 2020 to March 2022 was included.There were 40 males(58 eyes)and 29 females(44 eyes)with a mean age of(21.6±6.9)years(ranging from 10 to 48 years).The patients were divided into 43 cases(62 eyes)in the corneal thinnest point thickness(TCT)≥450μm group and 26 cases(40 eyes)in the 400μm≤TCT<450μm group according to TCT,with the former being treated with Epi-off ACXL,and the latter with Epi-on ACXL.The two groups were compared in uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),refractive status,corneal transparency,maximum keratometry value of the anterior corneal surface(Kmax),TCT,corneal endothelial cell counts and intraocular pressure were analysed preoperatively and after surgery for 1,3,6 and 12 months.The UCVA,BCVA,spherical diopter,cylinder diopter,TCT,Kmax and corneal endothelial cell counts were tested for conformity with normal distribution and expressed as x+s,and compared before and after surgery using one-way repeated measures ANOVA,and when the differences were statistically significant then further LSD-t tests were used;the preoperative and postoperative corneal endothelial counts within the group were compared using paired t test.Results The BCVA and Kmax of patients in the Epi-on ACXL group at preoperative,1,3,6 and 12 months postoperatively were(0.27±0.13)logarithm of the minimum angle of resolution(logMAR),(0.26±0.17)logMAR,(0.22±0.13)logMAR,(0.22±0.14)logMAR,(0.18±0.14)logMAR,(62.96±10.91)D,(63.01±10.13)D,(62.76±10.42)D,(62.44±10.29)D,(61.83±9.40)D.There were a statistically significant difference between the preoperative and postoperative BCVA and Kmax in patients with Epi-on ACXL(F=6.848,2.678;P<0.05).After LSD-t

关 键 词：圆锥角膜 角膜胶原交联术 紫外线 核黄素 

分 类 号：R772.2[医药卫生—眼科]