Kanellopoulos Anastasios John
Laservision.gr Institute, Athens, Greece; New York University Medical College and Manhattan Eye, EAr and Throat Hospital, New York, NY, USA.
J Refract Surg. 2009 Sep;25(9):S812-8. doi: 10.3928/1081597X-20090813-10. Epub 2009 Sep 11.
The safety and efficacy of corneal collagen cross-linking (CXL) and topography-guided photorefractive keratectomy (PRK) using a different sequence and timing were evaluated in consecutive keratoconus cases.
This study included a total of 325 eyes with keratoconus. Eyes were divided into two groups. The first group (n=127 eyes) underwent CXL with subsequent topography-guided PRK performed 6 months later (sequential group) and the second group (n=198 eyes) underwent CXL and PRK in a combined procedure on the same day (simultaneous group). Statistical differences were examined for pre- to postoperative changes in uncorrected (UCVA, logMAR) and best-spectacle-corrected visual acuity (BSCVA, logMAR), manifest refraction spherical equivalent (MRSE), keratometry (K), topography, central corneal thickness, endothelial cell count, corneal haze, and ectatic progression. Mean follow-up was 36+/-18 months (range: 24 to 68 months).
At last follow-up in the sequential group, the mean UCVA improved from 0.9+/-0.3 logMAR to 0.49+/-0.25 logMAR, and mean BSCVA from 0.41+/-0.25 logMAR to 0.16+/-0.22 logMAR. Mean reduction in spherical equivalent refraction was 2.50+/-1.20 diopters (D), mean haze score was 1.2+/-0.5, and mean reduction in K was 2.75+/-1.30 D. In the simultaneous group, mean UCVA improved from 0.96+/-0.2 logMAR to 0.3+/-0.2 logMAR, and mean BSCVA from 0.39+/-0.3 logMAR to 0.11+/-0.16 logMAR. Mean reduction in spherical equivalent refraction was 3.20+/-1.40 D, mean haze score was 0.5+/-0.3, and mean reduction in K was 3.50+/-1.3 D. Endothelial cell count preoperatively and at last follow-up was unchanged (P<.05) in both groups. Statistically, the simultaneous group did better (P<.05) in all fields evaluated, with improvement in UCVA and BSCVA, a greater mean reduction in spherical equivalent refraction and keratometry, and less corneal haze.
Same-day simultaneous topography-guided PRK and CXL appears to be superior to sequential CXL with later PRK in the visual rehabilitation of progressing keratoconus.
在连续性圆锥角膜病例中，评估采用不同顺序和时间安排的角膜胶原交联（CXL）和地形图引导的准分子激光原位角膜磨镶术（PRK）的安全性和有效性。
本研究共纳入325只圆锥角膜眼。将眼睛分为两组。第一组（127只眼）先接受CXL，6个月后再进行地形图引导的PRK（序贯组），第二组（198只眼）在同一天接受CXL和PRK联合手术（同步组）。检查两组术前至术后未矫正视力（UCVA，logMAR）和最佳矫正视力（BSCVA，logMAR）、明显验光球镜等效度（MRSE）、角膜曲率计测量值（K）、地形图、中央角膜厚度、内皮细胞计数、角膜混浊及扩张进展的变化的统计学差异。平均随访时间为36±18个月（范围：24至68个月）。
在序贯组的最后随访中，平均UCVA从0.9±0.3 logMAR提高到0.49±0.25 logMAR，平均BSCVA从0.41±0.25 logMAR提高到0.16±0.22 logMAR。球镜等效度屈光平均降低2.50±1.20屈光度（D），平均混浊评分为1.2±0.5，平均K值降低2.75±1.30 D。在同步组中，平均UCVA从0.96±0.2 logMAR提高到0.3±0.2 logMAR，平均BSCVA从0.39±0.3 logMAR提高到0.11±0.16 logMAR。球镜等效度屈光平均降低3.20±1.40 D，平均混浊评分为0.5±0.3，平均K值降低3.50±1.3 D。两组术前和最后随访时的内皮细胞计数均无变化（P<0.05）。在统计学上，同步组在所有评估指标上表现更好（P<0.05），包括UCVA和BSCVA的改善、球镜等效度屈光和角膜曲率计测量值的更大平均降低以及更少的角膜混浊。
在进行性圆锥角膜的视觉康复中，同一天同步进行地形图引导的PRK和CXL似乎优于先进行CXL后进行PRK的序贯治疗。
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