Filippello Massimo, Stagni Edoardo, Buccoliero Donato, Bonfiglio Vincenza, Avitabile Teresio
Clinica Di Stefano-Velona, Catania, Italy.
Optom Vis Sci. 2012 Oct;89(10):e1-7. doi: 10.1097/OPX.0b013e318269c8e5.
To analyze the modifications of the corneal layers after transepithelial (TE) corneal cross-linking (CXL).
Twenty eyes of 20 patients with progressive keratoconus were treated with TE-CXL (without epithelium debridement), and their corneas analyzed at different times, up to 18 months, by confocal microscopy using a Nidek Confoscan 4.
The epithelial layer, after an initial disorganization due to the TE technique, returned to a normal state after 2 weeks. Keratocytes and nerve fibers in the stroma decreased in number (approximately 25%), to return to a normal density at about 6 months after the procedure. A demarcation dense line indicative of effective cross-linking could be observed after 6 months at a depth of around 60 μm below the Bowman membrane. The endothelium remained unaffected at all examination times.
The TE-CXL procedure appears to be safe and effective at least up to 18 months. The absence of epithelium debridement (necessary in the classical technique) makes the procedure more comfortable for the patient, and allows the treatment of thinner corneas (between 360 and 400 μm) and problematic patients.
分析经上皮（TE）角膜交联术（CXL）后角膜各层的变化。
对20例进行性圆锥角膜患者的20只眼行TE-CXL（不进行上皮清创），使用Nidek Confoscan 4共聚焦显微镜在不同时间点（最长18个月）对其角膜进行分析。
上皮层在因TE技术最初出现紊乱后，2周后恢复正常状态。基质中的角膜细胞和神经纤维数量减少（约25%），在术后约6个月恢复至正常密度。术后6个月可在Bowman膜下方约60μm深度处观察到一条指示有效交联的分界致密线。内皮细胞在所有检查时间均未受影响。
TE-CXL手术至少在18个月内似乎是安全有效的。无需上皮清创（传统技术所必需）使该手术对患者而言更舒适，并且允许治疗更薄的角膜（360至400μm之间）以及有问题的患者。
