Koç Mustafa, Uzel Mehmet Murat, Koban Yaran, Durukan Irfan, Tekin Kemal, Ylmazbaş Pelin
*Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey; †Department of Ophthalmology, Kafkas University, Kars, Turkey; and ‡Department of Ophthalmology, Kayserigöz Hospital, Kayseri, Turkey.
Cornea. 2016 Feb;35(2):151-6. doi: 10.1097/ICO.0000000000000709.
To evaluate the effect of accelerated corneal cross-linking (CXL) according to corneal thickness in keratoconus.
Patients undergoing corneal CXL (9 mW/cm(2)) with hypo-osmolar riboflavin solution were included in this study. The patients were divided into 2 groups. Group 1 included patients with corneal thickness below 400 μm (50 eyes from 45 patients), and group 2 included patients with corneal thickness above 400 μm (50 eyes from 47 patients). Visual acuity (VA), refraction, topographic values, and higher-order aberrations were evaluated in the preoperative term and postoperatively at months 1, 3, and 6.
The improvements in VA were significant and similar in both groups [0.25/0.19 logMAR, P = 0.130]. In group 1, the rate of decrease in spherical refraction [0.85/0.27 diopters (D), P = 0.012] and maximum keratometry (Kmax, 2.49/0.68 D, P < 0.001) was significantly higher than that in group 2. The cylindrical change was similar (0.43/0.29 D P = 0.173). Corneal thinning was higher in group 2 (25/40.4 μm P < 0.001). Anterior elevation values decreased at higher rates in group 1 (3.73/0.24 μm P < 0.001); neither group showed a significant difference in posterior elevation (-0.14/-0.4 μm P > 0.05). In group 1, all aberration values except trefoil significantly decreased, whereas in group 2 none of the aberrations decreased except the total root mean square. All higher-order aberration values decreased at significantly higher rates in group 1 (P < 0.05).
In thin corneas, accelerated corneal CXL provides better anatomical changes; however, the improvement in VA is similar to that in thick corneas.
评估圆锥角膜中根据角膜厚度进行加速角膜交联（CXL）的效果。
本研究纳入接受低渗核黄素溶液角膜CXL（9 mW/cm²）的患者。患者分为2组。第1组包括角膜厚度低于400μm的患者（45例患者的50只眼），第2组包括角膜厚度高于400μm的患者（47例患者的50只眼）。在术前以及术后1、3和6个月评估视力（VA）、屈光、地形图值和高阶像差。
两组的VA改善均显著且相似[0.25/0.19 logMAR，P = 0.130]。在第1组中，球镜屈光度数下降率[0.85/0.27屈光度（D），P = 0.012]和最大角膜曲率（Kmax，2.49/0.68 D，P < 0.001）显著高于第2组。柱镜变化相似（0.43/0.29 D，P = 0.173）。第2组角膜变薄更明显（25/40.4μm，P < 0.001）。第1组前表面高度值下降率更高（3.73/0.24μm，P < 0.001）；两组后表面高度均无显著差异（-0.14/-0.4μm，P > 0.05）。在第1组中，除三叶草像差外所有像差值均显著下降，而在第2组中，除总均方根外所有像差均未下降。第1组所有高阶像差值下降率均显著更高（P < 0.05）。
在薄角膜中，加速角膜CXL可提供更好的解剖学改变；然而，VA的改善与厚角膜相似。
