Li Gang, Fan Zheng-Jun, Peng Xiu-Jun
Chinese PLA General Hospital & Chinese PLA Postgraduate Medical School, Beijing 100853, China.
Int J Ophthalmol. 2012;5(2):190-5. doi: 10.3980/j.issn.2222-3959.2012.02.15. Epub 2012 Apr 18.
To evaluate the efficacy and safety of corneal collagen crosslinking (CXL) to prevent the progression of post-laser in situ keratomileusis (LASIK) corneal ectasia.
In a prospective, nonrandomized, single-centre study, CXL was performed in 20 eyes of 11 patients who had LASIK for myopic astigmatism and subsequently developed keratectasia.The procedure included instillation of 0.1% riboflavin-20% dextrane solution 30 minutes before UVA irradiation and every 5 minutes for an additional 30 minutes during irradiation. The eyes were evaluated preoperatively and at 1-, 3-, 6-, and 12-month intervals. The complete ophthalmologic examination comprised uncorrected visual acuity, best spectacle-corrected visual acuity, endothelial cell count, ultrasound pachymetry, corneal topography, and in vivo confocal microscopy.
CXL appeared to stabilise or partially reverse the progression of post-LASIK corneal ectasia without apparent complication in our cohort. UCVA and BCVA improvements were statistically significant(P<0.05) beyond 12 months after surgery (improvement of 0.07 and 0.13 logMAR at 1 year, respectively). Mean baseline flattest meridian keratometry and mean steepest meridian keratometry reduction (improvement of 2.00 and 1.50 diopters(D), respectively) were statistically significant (P<0.05) at 12 months postoperatively. At 1 year after CXL, mean endothelial cell count did not deteriorate. Mean thinnest cornea pachymetry increased significantly.
The results of the study showed a long-term stability of post-LASIK corneal ectasia after crosslinking without relevant side effects. It seems to be a safe and promising procedure to stop the progression of post-LASIK keratectasia, thereby avoiding or delaying keratoplasty.
评估角膜交联术（CXL）预防准分子激光原位角膜磨镶术（LASIK）后角膜扩张进展的有效性和安全性。
在一项前瞻性、非随机、单中心研究中，对11例因近视散光接受LASIK手术并随后发生角膜扩张的患者的20只眼睛进行了CXL。该手术包括在紫外线A（UVA）照射前30分钟滴注0.1%核黄素-20%右旋糖酐溶液，并在照射期间每5分钟滴注一次，持续30分钟。在术前以及术后1个月、3个月、6个月和12个月对眼睛进行评估。完整的眼科检查包括裸眼视力、最佳矫正视力、内皮细胞计数、超声角膜测厚、角膜地形图和活体共聚焦显微镜检查。
在我们的队列中，CXL似乎稳定或部分逆转了LASIK术后角膜扩张的进展，且无明显并发症。术后12个月后，裸眼视力（UCVA）和最佳矫正视力（BCVA）的改善具有统计学意义（P<0.05）（1年时分别提高0.07和0.13对数最小分辨角（logMAR））。术后12个月时，平均基线最平坦子午线角膜曲率和平均最陡峭子午线角膜曲率降低（分别提高2.00和1.50屈光度（D））具有统计学意义（P<0.05）。CXL术后1年，平均内皮细胞计数未恶化。平均最薄角膜厚度显著增加。
研究结果表明，交联术后LASIK角膜扩张具有长期稳定性，且无相关副作用。这似乎是一种安全且有前景的方法，可阻止LASIK术后角膜扩张的进展，从而避免或延迟角膜移植术。
