Department of Cataract, Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Indian J Ophthalmol. 2013 Aug;61(8):422-4. doi: 10.4103/0301-4738.116073.
Collagen cross-linking (CXL) has become the standard of care for progressive keratoconus, after numerous clinical studies have established its efficacy and safety in suitably selected eyes. The standard protocol is applicable in eyes which have a minimum corneal thickness of 400 μm after epithelial debridement. This prerequisite was stipulated to protect the corneal endothelium and intraocular tissues from the deleterious effect of ultraviolet-A (UVA) radiation. However, patients with keratoconus often present with corneal thickness of less than 400 μm and could have otherwise benefited from this procedure. A few modifications of the standard procedure have been suggested to benefit these patients without a compromise in safety. Transepithelial cross-linking, pachymetry-guided epithelial debridement before cross-linking, and the use of hypoosmolar riboflavin are some of the techniques that have been attempted. Although clinical data is limited at the present time, these techniques are worth considering in patients with thin corneas. Further studies are needed to scientifically establish their efficacy and safety.
胶原交联 (CXL) 已成为进行性圆锥角膜的标准治疗方法，因为多项临床研究已经证实其在合适选择的眼中具有疗效和安全性。该标准方案适用于上皮清创后角膜厚度至少为 400μm 的眼睛。这一前提规定是为了保护角膜内皮和眼内组织免受紫外线-A (UVA) 辐射的有害影响。然而，圆锥角膜患者的角膜厚度通常小于 400μm，本可以从该程序中受益。已经提出了一些对标准程序的修改，以在不影响安全性的情况下使这些患者受益。经上皮交联、交联前角膜厚度引导性上皮清创和低渗核黄素的使用是一些已经尝试过的技术。尽管目前临床数据有限，但对于薄角膜患者，这些技术值得考虑。需要进一步的研究来科学地确定它们的疗效和安全性。
