Eraslan Muhsin, Toker Ebru, Cerman Eren, Ozarslan Deniz
Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
Eye Contact Lens. 2017 May;43(3):155-161. doi: 10.1097/ICL.0000000000000255.
To evaluate the efficacy of riboflavin/ultraviolet A epithelium-off (epi-off) and epithelium-on (epi-on) corneal collagen cross-linking (CXL) in progressive pediatric keratoconus.
Thirty-six eyes of 27 patients aged 18 years or younger (12-18 years) diagnosed with progressive keratoconus and treated with epi-off (n=18 eyes) or epi-on (n=18 eyes) CXL were included in this study. All patients were followed up for 24 months postoperatively.
At 24-month follow-up, the mean corrected distance visual acuity (CDVA) improved from 0.24±0.17 to 0.17±0.11 logMAR in the epi-off group (P=0.032). In the epi-on group, CDVA improved from 0.33±0.23 to 0.26±0.20 logMAR (P=0.012), but the improvement was not significantly different between groups (P>0.05). In the epi-off group, all mean K values improved: K1 (Δ=-0.63 D, P=0.024), K2 (Δ=-0.73 D, P=0.008), and Kmax (Δ=-1.4 D, P=0.035), whereas in the epi-on group, Kmax and K2 did not change significantly and K1 (Δ=0.68 D, P=0.029) significantly worsened. Postoperative mild corneal haze occurred in 5 eyes (28%) in the epi-off group. No postoperative complications were observed in the epi-on group. In 94.4% of the epi-off group, keratoconus regressed (44.4%) or stabilized (50.0%), whereas in the epi-on group, only 66.6% regressed (33.3%) or stabilized (33.3%), and the difference was significant (P=0.038).
The efficacy of the epi-on procedure in terms of its ability to halt keratoconus progression appears to be 0.70 of the efficacy of epi-off CXL.
评估核黄素/紫外线A上皮下（epi-off）和上皮内（epi-on）角膜胶原交联（CXL）治疗儿童进行性圆锥角膜的疗效。
本研究纳入27例18岁及以下（12 - 18岁）诊断为进行性圆锥角膜并接受epi-off（n = 18眼）或epi-on（n = 18眼）CXL治疗的患者的36只眼。所有患者术后随访24个月。
在24个月随访时，epi-off组平均矫正远视力（CDVA）从0.24±0.17 logMAR提高到0.17±0.11 logMAR（P = 0.032）。在epi-on组，CDVA从0.33±0.23 logMAR提高到0.26±0.20 logMAR（P = 0.012），但两组间改善无显著差异（P>0.05）。在epi-off组，所有平均角膜曲率值均改善：K1（Δ=-0.63 D，P = 0.024）、K2（Δ=-0.73 D，P = 0.008）和Kmax（Δ=-1.4 D，P = 0.035），而在epi-on组，Kmax和K2无显著变化，K1（Δ = 0.68 D，P = 0.029）显著恶化。epi-off组5只眼（28%）出现术后轻度角膜 haze。epi-on组未观察到术后并发症。在epi-off组94.4%的患者中，圆锥角膜病情缓解（44.4%）或稳定（50.0%），而在epi-on组，只有66.6%病情缓解（33.3%）或稳定（33.3%），差异有统计学意义（P = 0.038）。
就阻止圆锥角膜进展的能力而言，epi-on手术的疗效似乎是epi-off CXL疗效的0.70。
