From the Department of Ophthalmology (Hagem, Thorsrud, Sandvik, Råen, Drolsum), Oslo University Hospital and the Center for Eye Research (Thorsrud, Drolsum), University of Oslo, Oslo, Norway.
From the Department of Ophthalmology (Hagem, Thorsrud, Sandvik, Råen, Drolsum), Oslo University Hospital and the Center for Eye Research (Thorsrud, Drolsum), University of Oslo, Oslo, Norway.
J Cataract Refract Surg. 2017 Apr;43(4):511-517. doi: 10.1016/j.jcrs.2017.01.013.
To evaluate corneal collagen crosslinking (CXL) with conventional and accelerated ultraviolet-A (UVA) irradiation using riboflavin with methylcellulose.
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
Prospective randomized case series.
Patients with keratoconus were randomized to have CXL using conventional 3 mW/cm UVA irradiation for 30 minutes (CXL30) or accelerated 9 mW/cm UVA irradiation for 10 minutes (CXL10). In both groups, a solution of riboflavin 0.1% with hydroxypropyl methylcellulose 1.1% (methylcellulose-riboflavin) was used. The endothelial cell density (ECD), visual acuity, and tomography were measured at baseline and after 12 months. Anterior segment optical coherence tomography and in vivo confocal microscopy (IVCM) were performed after 1 month.
The study comprised 40 patients (40 eyes). A complete absence of keratocytes in all eyes at 100 μm depths was found on IVCM. At 300 μm, 400 μm, and preendothelial levels, the differences were 83.3% versus 31.3% (P = .02), 64.7% versus 20.0% (P = .01), and 42.1% versus 5.9% (P = .02) in the CXL30 and CXL10 groups. No statistically significant differences were found in the change in visual acuity or maximum keratometry between the groups after 12 months. There was no relationship between the depth of keratocyte absence and the ECD change after 12 months.
Marked deep structural changes with an absence of keratocytes occurred when CXL was used with conventional or accelerated UVA irradiation; however, the changes were more pronounced with the use of conventional UVA irradiation. The use of methylcellulose-riboflavin might explain the deep alterations and raises a long-term safety concern.
使用含有甲基纤维素的核黄素对常规和加速紫外线-A（UVA）照射进行角膜胶原交联（CXL）。
挪威奥斯陆大学医院眼科。
前瞻性随机病例系列。
随机将圆锥角膜患者分为使用常规 3 mW/cm UVA 照射 30 分钟（CXL30）或加速 9 mW/cm UVA 照射 10 分钟（CXL10）的两组。在两组中，均使用 0.1%核黄素和 1.1%羟丙基甲基纤维素（甲基纤维素-核黄素）溶液。在基线和 12 个月时测量内皮细胞密度（ECD）、视力和断层扫描。在 1 个月后进行眼前段光学相干断层扫描和体内共聚焦显微镜（IVCM）检查。
本研究包括 40 例患者（40 只眼）。在 IVCM 上，在所有眼睛的 100 μm 深度处均发现完全没有角膜细胞。在 300 μm、400 μm 和前内皮层水平，CXL30 组和 CXL10 组的差异分别为 83.3%比 31.3%（P =.02）、64.7%比 20.0%（P =.01）和 42.1%比 5.9%（P =.02）。12 个月后，两组之间视力变化或最大角膜曲率无统计学差异。角膜细胞缺失深度与 12 个月后 ECD 变化之间无相关性。
当使用常规或加速 UVA 照射进行 CXL 时，会出现明显的深层结构变化，伴有角膜细胞缺失，但使用常规 UVA 照射时，变化更为明显。使用甲基纤维素-核黄素可能解释了深层改变，并引起了长期的安全性担忧。
