Knutsson Karl Anders, Paganoni Giorgio, Matuska Stanislav, Ambrosio Oriella, Ferrari Giulio, Zennato Arianna, Caccia Michela, Rama Paolo
Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Milan, Italy.
Br J Ophthalmol. 2018 Feb;102(2):248-252. doi: 10.1136/bjophthalmol-2016-310108. Epub 2017 Jun 27.
BACKGROUND/AIMS: To evaluate the effectiveness of corneal collagen cross-linking (CXL) in paediatric patients.
Fifty-two eyes of 43 paediatric patients with progressive keratoconus were enrolled in a prospective cohort study. Corneal CXL was performed using a conventional technique with instillation of 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase and during the 30 min ultraviolet A irradiation (3 mW/cm). Visual outcomes, topographic keratometry, maximum keratometry (K-max), refractive astigmatism, demarcation line and endothelial cell density were measured postoperatively.
A significant decrease of K-max from 59.30±7.08 to 57.07±6.46 (p<0.001) was observed 2 years after treatment. Uncorrected visual acuity improved from 0.59±0.41 LogMAR (logarithm of the minimum angle resolution) to 0.46±0.33 LogMAR (p=0.06) 2 years after the procedure, while best spectacle corrected visual acuity improved from 0.17±0.11 LogMAR to 0.15±0.12 LogMAR (p=0.17). Twenty-five eyes had K-max values of 60 dioptres (D) or greater. In this subgroup, K-max significantly decreased from 64.94±4.99 D to 62.25±4.42 D at 2 years (p<0.001). The demarcation line of the CXL treatment had a mean value of 249±74 µm and did not show a significant correlation with K-max flattening (Spearman r=0.019, p=0.899). Endothelial cell density remained stable 2 years after the procedure, changing from 2800±363 to 2736±659 cells/mm (p=0.90).
CXL is an effective treatment for avoiding keratoconus progression in paediatric patients. The procedure is safe and successful in stabilising keratoconus in eyes with more advanced forms of the disease, characterised by topographic K-max values greater than 60 D.
背景/目的：评估角膜胶原交联术（CXL）在儿科患者中的有效性。
43例患有进行性圆锥角膜的儿科患者的52只眼睛被纳入一项前瞻性队列研究。采用传统技术进行角膜CXL，在浸润阶段滴注含20%右旋糖酐的0.1%核黄素溶液30分钟，并在30分钟紫外线A照射（3 mW/cm）期间进行。术后测量视力、地形图角膜曲率、最大角膜曲率（K-max）、屈光性散光、分界线和内皮细胞密度。
治疗2年后，观察到K-max从59.30±7.08显著降至57.07±6.46（p<0.001）。术后2年，未矫正视力从0.59±0.41 LogMAR（最小分辨角对数）提高到0.46±0.33 LogMAR（p=0.06），而最佳眼镜矫正视力从0.17±0.11 LogMAR提高到0.15±0.12 LogMAR（p=0.17）。25只眼睛的K-max值为60屈光度（D）或更高。在该亚组中，2年时K-max从64.94±4.99 D显著降至62.25±4.42 D（p<0.001）。CXL治疗的分界线平均值为249±74 µm，与K-max变平无显著相关性（Spearman r=0.019，p=0.899）。术后2年内皮细胞密度保持稳定，从2800±363变为2736±659个细胞/mm²（p=0.90）。
CXL是避免儿科患者圆锥角膜进展的有效治疗方法。该手术在稳定疾病更晚期形式（以地形图K-max值大于60 D为特征）的圆锥角膜方面是安全且成功的。
