Nassaralla Belquiz Amaral, Vieira Diogo Mafia, Machado Márcia Leite, Figueiredo Marisa Novaes Faleiro Chaves de, Nassaralla João Jorge
Goiania Eye Institute, Goiânia (GO), Brazil.
Arq Bras Oftalmol. 2013 May-Jun;76(3):155-8. doi: 10.1590/s0004-27492013000300005.
To evaluate the thinnest corneal thickness changes during and after corneal collagen cross-linking treatment with ultraviolet-A irradiation, using hypo-osmolar riboflavin solution in thin corneas.
Eighteen eyes of 18 patients were included in this study. After epithelium removal, iso-osmolar 0.1% riboflavin solution was instilled to the cornea every 3 minutes for 30 minutes. Hypo-osmolar 0.1% riboflavin solution was then applied every 20 seconds for 5 minutes or until the thinnest corneal thickness reached 400 µm. Ultraviolet-A irradiation was performed for 30 minutes. During irradiation, iso-osmolar 0.1% riboflavin drops were applied every 5 minutes. Ultrasound pachymetry was performed at approximately the thinnest point of the cornea preoperatively, after epithelial removal, after iso-osmolar riboflavin instillation, after hypo-osmolar riboflavin instillation, after ultraviolet-A irradiation, and at 1, 6 and 12 months after treatment.
Mean preoperative thinnest corneal thickness was 380 ± 11 µm. After epithelial removal it decreased to 341 ± 11 µm, and after 30 minutes of iso-osmolar 0.1% riboflavin drops, to 330 ± 7.6 µm. After hypo-osmolar 0.1% riboflavin drops, mean thinnest corneal thickness increased to 418 ± 11 µm. After UVA irradiation, it was 384 ± 10 µm. At 1, 6 and 12 months after treatment, it was 372 ± 10 µm, 381 ± 12.7, and 379 ± 15 µm, respectively. No intraoperative, early postoperative, or late postoperative complications were noted.
Hypo-osmolar 0.1% riboflavin solution seems to be effective for swelling thin corneas. The swelling effect is transient and short acting. Corneal thickness should be monitored throughout the procedure. Larger sample sizes and longer follow-up are required in order to make meaningful conclusions regarding safety.
使用低渗核黄素溶液评估薄角膜在紫外线A照射角膜胶原交联治疗期间及之后最薄角膜厚度的变化。
本研究纳入了18例患者的18只眼。去除上皮后，每3分钟向角膜滴注等渗0.1%核黄素溶液，持续30分钟。然后每20秒应用低渗0.1%核黄素溶液，持续5分钟或直至最薄角膜厚度达到400µm。进行30分钟的紫外线A照射。照射期间，每5分钟滴注等渗0.1%核黄素滴眼液。术前、上皮去除后、等渗核黄素滴注后、低渗核黄素滴注后、紫外线A照射后以及治疗后1、6和12个月，在角膜最薄点附近进行超声测厚。
术前平均最薄角膜厚度为380±11µm。上皮去除后降至341±11µm，等渗0.1%核黄素滴眼液滴注30分钟后降至330±7.6µm。低渗0.1%核黄素滴眼液滴注后，平均最薄角膜厚度增至418±11µm。紫外线A照射后为384±10µm。治疗后1、6和12个月分别为372±10µm、381±12.7µm和379±15µm。未观察到术中、术后早期或晚期并发症。
低渗0.1%核黄素溶液似乎对薄角膜肿胀有效。肿胀效果是短暂且作用时间短的。在整个过程中应监测角膜厚度。为了得出关于安全性的有意义结论，需要更大的样本量和更长的随访时间。
