摘要
目的:评价高能量快速跨上皮角膜交联术治疗角膜屈光手术后继发性圆锥角膜的有效性和安全性。方法:前瞻性临床研究。连续募集厦门大学附属厦门眼科中心2019年12月至2021年4月收治的角膜屈光手术后继发进展性圆锥角膜患者36例(62眼),予行高能量快速跨上皮角膜交联术。术后1 d、1周、2周及3、6、12、24个月进行随访。分别在术前,术后3、6、12、24个月时进行视力、验光、眼压、裂隙灯显微镜照相、角膜地形图、活体角膜共聚焦显微镜、眼前节光学相干断层扫描及角膜内皮细胞计数等检查。分析术前及术后各时间点的裸眼视力、最佳矫正视力、球镜度、柱镜度、K1、K2、最大角膜曲率(前表面)、角膜最薄处厚度、角膜内皮细胞密度、角膜神经纤维密度和眼压等的差异。数据分析采用单因素方差分析,进一步两两比较采用Bonferroni检验。结果:最终纳入患者31例(54眼),年龄(28.1±1.2)岁。在角膜交联术前以及术后3、6、12、24个月,术眼的裸眼视力、最佳矫正视力、球镜度、柱镜度、K1、K2、最大角膜曲率、角膜最薄处厚度、眼压等的差异均无统计学意义(均P>0.05)。术后1 d时11眼(11/54,20%)可见角膜上皮缺损,均在术后1周内修复;术后2周时8眼(8/54,15%)可见浅层基质交联分界线,深度约200μm。活体角膜共聚焦显微镜下见术后1 d时角膜上皮下神经纤维密度较术前下降(P<0.001),浅层基质细胞水肿、交错呈网格状;术后3个月时神经纤维密度仍低于术前(P=0.001),浅层基质纤维可见网格状的强反射交联结构;术后6、12、24个月时神经纤维恢复至术前水平(P>0.05),但术后12、24个时浅层基质高反射网状结构较前明显减少。各随访时间点角膜内皮细胞密度无明显变化(F=0.39,P=0.642)。结论:角膜屈光术后继发性圆锥角膜患者在接受高能量快速跨上皮角膜交联术后2年内屈光状态及角膜地形图参数均保持稳定,且无明显并发症。
Objective:To determine the efficacy and safety of high-fluence accelerated transepithelial corneal cross-linking in the treatment of secondary keratoconus after corneal refractive surgery.Methods:In this prospective clinical study,36 patients(62 eyes)who were diagnosed with secondary progressive keratoconus after corneal refractive surgery and underwent high-fluence accelerated transepithelial corneal cross-linking(CXL)at the Affiliated Xiamen Eye Center of Xiamen University from December 2019 to April 2021 were recruited.Follow-up was performed at 1 d,1 week,2 weeks and 3,6,12,24 months(m)postoperatively.Visual acuity,including uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA),intraocular pressure(IOP),slit lamp examination,corneal topography,in vivo corneal confocal microscopy(IVCM),anterior segment optical coherence tomography(AS-OCT),and corneal endothelial cell(EC)count were performed before surgery and at 3 m,6 m,12 m,and 24 m postoperatively.The differences of UCVA,BCVA,spherical diopter,cylindrical diopter,K1,K2,Kmax(front),thickness at the thinnest point of the cornea,corneal endothelial cell density,nerve fiber density and IOP between different time points before and after CXL were analyzed.The overall differences among different time points were analyzed by using one-way ANOVA,and the Bonferroni test was used for pairwise comparison.Results:A total of 31 patients(22 males and 9 females,54 eyes)with mean age of 28.1±1.2 years were eventually included in this study.There was no statistically significant difference in the UCVA,BCVA,spherical diopter,cylinder diopter,K1,K2,Kmax,and the thickness at the thinnest point of the cornea among all the time points(all P>0.05).Corneal epithelial defect was observed in 11 eyes(11/54,20%)at day 1 after surgery and recovered within 1 week after the operation.AS-OCT revealed the demarcation line at an average depth of 200μm in the corneal stroma of 8 eyes(8/54,15%)at 2 weeks after surgery.One day after surgery,IVCM showed that the nerve fiber density was significantly lower than the preoperative level(P<0.001),while the superficial stromal cells were swollen and interlaced in a spongy shape.At 3 m postoperatively,the subepithelial nerve fiber density was still lower compared to that before surgery(P=0.001),and the activated superficial stromal cells still existed with hyper-reflection.At 6 m,12 m,and 24 m postoperatively,the nerve fiber density was increased and close to the preoperative level(P>0.05),but the part of the superficial stromal cells lost the enhanced reflection at 12 m and 24 m.No difference of the endothelial cell density was found among different time points(F=0.39,P=0.642).Conclusions:Refractive status and topographic parameters of patients with secondary keratoconus remained stable without obvious postoperative complications within two years after the high-fluence accelerated transepithelial CXL.
作者
刘彬
林志荣
罗顺荣
方颉
肖显文
谢智文
闫蕾
李学治
董诺
商旭敏
刘昭升
吴护平
Bin Liu;Zhirong Lin;Shunrong Luo;Xie Fang;Xianwen Xiao;Zhiwen Xie;Lei Yan;Xuezhi Li;Nuo Dong;Xumin Shang;Zhaosheng Liu;Huping Wu(Department of Ocular Surface and Corneal Diseases,Affiliated Xiamen Eye Center of Xiamen University,Fujian Provincial Key Laboratory of Corneal&Ocular Surface Diseases,Xiamen Municipal Key Laboratory of Corneal&Ocular Surface Diseases,Xiamen Clinical Research Center for Eye Diseases,Xiamen Municipal Key Laboratory of Ocular Diseases,Xiamen 361003,China)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2023年第11期809-816,共8页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
福建省卫生健康科技计划项目中青年骨干人才计划(2022GGB023)
福建省"创新之星"人才计划(2021)
福建省自然科学基金杰出青年项目(2020D029)
国家自然科学基金项目(81570816)
北京白求恩公益基金会干眼诊疗与研究科研项目(BJ-GY2021011J)
厦门市医疗卫生指导性项目(3502Z20214ZD1210)
厦门市医工结合指导性项目(3502Z20214ZD2192)。
关键词
圆锥角膜
跨上皮角膜交联术
角膜屈光手术
角膜地形图
活体角膜共聚焦显微镜
keratoconus
transepithelial corneal cross-linking
corneal refractive surgery
corneal topography
in vivo corneal confocal microscopy
