Kocak I, Aydin A, Kaya F, Koc H
Service d'ophtalmologie, hôpital de Nisa, Istanbul, Turkey.
Service d'ophtalmologie, hôpital de Nisa, Istanbul, Turkey; Clinique universitaire d'ophtalmologie, faculté de médecine, université d'Istanbul Medipol, Istanbul, Turkey.
J Fr Ophtalmol. 2014 May;37(5):371-6. doi: 10.1016/j.jfo.2013.11.012. Epub 2014 Mar 26.
To evaluate the safety and efficacy of transepithelial corneal collagen crosslinking (TE-CXL) as compared to epithelium-off crosslinking (epi-off CXL) in progressive keratoconus.
Records of keratoconus patients treated with TE-CXL or epi-off CXL were reviewed retrospectively. Patients were included if they had at least 12months follow-up. Pre- and postoperative measurements of visual acuity, refractive errors, keratometry, corneal topography and pachymetry were assessed and compared.
There was no statistically significant difference between two groups at baseline in terms of demographic, refractive and corneal parameters. Mean maximum cone apex curvature (apical K) increased from 51.62±5. Eighty-four diopters (D) to 53.70±5.49 D in the TE-CXL group (n=17), and decreased from 52.02±4.07 D to 51.22±3.51 in the epi-off CXL group (n=19) at the end of the follow-up period. The difference between two groups was statistically significant (P=0.0002). An increase of≥1D in apical K was observed in two of 19 eyes (11%) in the epi-off CXL group, and 11 of 17 eyes (65%) in TE-CXL group at the last follow-up visit, compared to baseline (P<0.0001). Fourteen patients in the epi-off CXL group exhibited corneal edema that resolved without haze with topical corticosteroid treatment by 4months. No postoperative corneal edema was observed in TE-CXL group.
Although it is safe and well tolerated, TE-CXL does not effectively halt the progression of keratoconus. Epi-off CXL appears to be effective in stopping progression and even improves corneal parameters.
评估经上皮角膜胶原交联术（TE-CXL）与去上皮交联术（epi-off CXL）相比在进展性圆锥角膜治疗中的安全性和有效性。
回顾性分析接受TE-CXL或epi-off CXL治疗的圆锥角膜患者的记录。纳入至少随访12个月的患者。评估并比较术前和术后的视力、屈光不正、角膜曲率测量、角膜地形图和角膜厚度测量结果。
两组在基线时的人口统计学、屈光和角膜参数方面无统计学显著差异。TE-CXL组（n = 17）的平均最大圆锥顶点曲率（顶点K）从51.62±5.84屈光度（D）增加到53.70±5.49 D，而epi-off CXL组（n = 19）在随访期末从52.02±4.07 D降至51.22±3.51 D。两组之间的差异具有统计学显著性（P = 0.0002）。与基线相比，在最后一次随访时，epi-off CXL组19眼中有2眼（11%）的顶点K增加≥1 D，TE-CXL组17眼中有11眼（65%）出现这种情况（P<0.0001）。epi-off CXL组有14例患者出现角膜水肿，经局部皮质类固醇治疗4个月后水肿消退且无 haze。TE-CXL组未观察到术后角膜水肿。
尽管TE-CXL安全且耐受性良好，但它不能有效阻止圆锥角膜的进展。去上皮交联术似乎在阻止进展方面有效，甚至能改善角膜参数。
