Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Cornea. 2013 Jul;32(7):903-6. doi: 10.1097/ICO.0b013e31828321dd.
Collagen cross-linking (CXL) is a safe and effective procedure to stop progression of keratoconus. However, corneas with a maxK of more than 55 to 58 diopters (D) have been suggested to have an increased failure rate. We report results of CXL for progressive keratoconus in corneas with a maxK of 55 D or more.
Retrospective follow-up. Twenty-eight eyes of 22 patients from 12 to 38 years were treated with CXL for progressive keratoconus. All patients had a preoperative maxK of at least 55 D. Patients were examined on 2 or more occasions after treatment, with a mean follow-up of 22 months. At all visits, patients received routine clinical examination with slit-lamp biomicroscopy, determination of corrected distance visual acuity (CDVA), and Pentacam tomography.
The average preoperative maxK was 61.2 ± 3.7 D. After CXL, maxK significantly decreased to 59.5 ± 3.7 D at the last recorded visit. In 27 eyes, keratoconic progression seemed to have stopped, and in 14 eyes maxK improved with more than 2.0 D decrease, whereas 1 eye showed an increase in maxK of more than 2.0 D. The average CDVA remained unchanged after CXL treatment, although 11 eyes improved and 2 eyes had an unexplained loss of CDVA.
CXL treatment in eyes with advanced progressive keratoconus prevented further progression in 27 of 28 eyes. Progression in cases with advanced keratoconus should not exclude CXL as a treatment to preserve visual acuity or as a supplement to other treatment modalities to delay or avoid keratoplasty.
胶原交联（CXL）是一种安全有效的方法，可以阻止圆锥角膜的进展。然而，已经有研究表明，最大角膜曲率（maxK）超过 55 至 58 屈光度（D）的角膜失败率会增加。我们报告了 maxK 为 55 D 或更高的进展性圆锥角膜患者行 CXL 治疗的结果。
回顾性随访研究。22 名患者的 28 只眼，年龄在 12 至 38 岁之间，因进展性圆锥角膜接受 CXL 治疗。所有患者术前 maxK 至少为 55 D。患者在治疗后至少随访 2 次，平均随访时间为 22 个月。所有随访中，患者均接受常规临床检查，包括裂隙灯生物显微镜检查、矫正远视力（CDVA）和 Pentacam 断层扫描。
平均术前 maxK 为 61.2±3.7 D。CXL 后，末次随访时 maxK 显著下降至 59.5±3.7 D。在 27 只眼中，圆锥角膜进展似乎已停止，在 14 只眼中 maxK 降低超过 2.0 D，而 1 只眼的 maxK 增加超过 2.0 D。CXL 治疗后平均 CDVA 保持不变，尽管 11 只眼改善，2 只眼出现无法解释的 CDVA 损失。
在 28 只眼中，有 27 只眼的进展性晚期圆锥角膜接受 CXL 治疗后阻止了进一步进展。在进展性晚期圆锥角膜患者中，不应排除 CXL 作为保持视力的治疗方法，或作为其他治疗方式的补充，以延迟或避免角膜移植。
