圆锥角膜的治疗管理：基于角膜地形图引导的矫正技术联合高光强交联技术的稳定性（雅典协议）。
Keratoconus management: long-term stability of topography-guided normalization combined with high-fluence CXL stabilization (the Athens Protocol).
出版信息
J Refract Surg. 2014 Feb;30(2):88-93. doi: 10.3928/1081597X-20140120-03.
PURPOSE
To investigate refractive, topometric, pachymetric, and visual rehabilitation changes induced by anterior surface normalization for keratoconus by partial topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking.
METHODS
Two hundred thirty-one keratoconic cases subjected to the Athens Protocol procedure were studied for visual acuity, keratometry, pachymetry, and anterior surface irregularity indices up to 3 years postoperatively by Scheimpflug imaging (Oculus Optikgeräte GmbH, Wetzlar, Germany).
RESULTS
Mean visual acuity changes at 3 years postoperatively were +0.38 ± 0.31 (range: -0.34 to +1.10) for uncorrected distance visual acuity and +0.20 ± 0.21 (range: -0.32 to +0.90) for corrected distance visual acuity. Mean K1 (flat meridian) keratometric values were 46.56 ± 3.83 diopters (D) (range: 39.75 to 58.30 D) preoperatively, 44.44 ± 3.97 D (range: 36.10 to 55.50 D) 1 month postoperatively, and 43.22 ± 3.80 D (range: 36.00 to 53.70 D) up to 3 years postoperatively. The average Index of Surface Variance was 98.48 ± 43.47 (range: 17 to 208) pre-operatively and 76.80 ± 38.41 (range: 7 to 190) up to 3 years postoperatively. The average Index of Height Decentration was 0.091 ± 0.053 μm (range: 0.006 to 0.275 μm) preoperatively and 0.057 ± 0.040 μm (range: 0.001 to 0.208 μm) up to 3 years postoperatively. Mean thinnest corneal thickness was 451.91 ± 40.02 μm (range: 297 to 547 μm) preoperatively, 353.95 ± 53.90 μm (range: 196 to 480 μm) 1 month postoperatively, and 370.52 ± 58.21 μm (range: 218 to 500 μm) up to 3 years postoperatively.
CONCLUSIONS
The Athens Protocol to arrest keratectasia progression and improve corneal regularity demonstrates safe and effective results as a keratoconus management option. Progressive potential for long-term flattening validates using caution in the surface normalization to avoid overcorrection.
目的
研究通过部分地形引导的准分子激光消融联合加速、高剂量交联术对圆锥角膜进行前表面正常化后引起的屈光、地形学、角膜厚度和视觉康复变化。
方法
对 231 例接受雅典方案手术的圆锥角膜患者，通过 Scheimpflug 成像（德国韦茨拉尔的 Oculus Optikgeräte GmbH）在术后长达 3 年的时间内研究视力、角膜曲率、角膜厚度和前表面不规则指数。
结果
术后 3 年，未矫正远视力的平均视力变化为+0.38 ± 0.31（范围：-0.34 至+1.10），矫正远视力的平均视力变化为+0.20 ± 0.21（范围：-0.32 至+0.90）。术前平均 K1（平坦子午线）角膜曲率值为 46.56 ± 3.83 屈光度（D）（范围：39.75 至 58.30 D），术后 1 个月为 44.44 ± 3.97 D（范围：36.10 至 55.50 D），术后 3 年为 43.22 ± 3.80 D（范围：36.00 至 53.70 D）。术前平均表面变异指数为 98.48 ± 43.47（范围：17 至 208），术后 3 年为 76.80 ± 38.41（范围：7 至 190）。术前平均高度偏心指数为 0.091 ± 0.053μm（范围：0.006 至 0.275μm），术后 3 年为 0.057 ± 0.040μm（范围：0.001 至 0.208μm）。术前平均最薄角膜厚度为 451.91 ± 40.02μm（范围：297 至 547μm），术后 1 个月为 353.95 ± 53.90μm（范围：196 至 480μm），术后 3 年为 370.52 ± 58.21μm（范围：218 至 500μm）。
结论
阻止圆锥角膜进展和改善角膜规则性的雅典方案作为圆锥角膜管理的一种选择，显示出安全有效的结果。长期潜在的扁平化表明，在表面正常化时要谨慎使用，以避免过度矫正。
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