Akbar Bushra, Intisar-Ul-Haq Rana, Ishaq Mazhar, Arzoo Sabahat, Siddique Kashif
Dr. Bushra Akbar, MBBS. Department of Ophthalmology, Armed Forces Institute of Ophthalmology, AFIO, Rawalpindi, Pakistan.
Dr. Rana Intisar ul Haq, MBBS, DO, MCPS, FCPS. Department of Ophthalmology, Armed Forces Institute of Ophthalmology, AFIO, Rawalpindi, Pakistan.
Pak J Med Sci. 2017 May-Jun;33(3):570-575. doi: 10.12669/pjms.333.11907.
The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking (TE-CXL) with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking (CXL) in adult Pakistani population with progressive keratoconus.
This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel ((riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose) and vibeX Xtra (riboflavin 0.25%) (Avedro, USA)) were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities (UDVA, CDVA), spherical equivalent (SE), astigmatism, pachymetry at thinnest point (Pachy thin), apex keratometry (Kmax), simulated and steep keratometry (Sim K, steep K) were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm for 10 min (total dose 30 mW/cm).
The mean age of the patient was 24.54±5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points (=0.000, 0.004, 0.000, 0.004 respectively). Kmax and pachy thin were significantly reduced over baseline at 1 year (=0.000, 0.004 respectively). Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported.
Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus.
本研究旨在评估在巴基斯坦成年圆锥角膜患者中，使用改良核黄素和加速紫外线A照射进行经上皮角膜胶原交联（TE-CXL），对于最薄点角膜厚度小于400微米、无法采用去上皮角膜胶原交联（CXL）治疗的薄角膜的安全性和有效性。
本准实验研究纳入了26例圆锥角膜患者的26只眼，这些患者在武装部队眼科研究所接受了加速经上皮CXL治疗，并进行了12个月的随访。分两个阶段将改良核黄素（ParaCel，含0.25%核黄素、苯扎氯铵、乙二胺四乙酸、氨丁三醇、羟丙基甲基纤维素）和vibeX Xtra（含0.25%核黄素，美国Avedro公司）应用于角膜。在基线时以及术后3个月、6个月和12个月测量未矫正和矫正远视力（UDVA、CDVA）、球镜等效度（SE）、散光、最薄点角膜厚度（Pachy thin）、顶点角膜曲率（Kmax）、模拟角膜曲率和陡峭角膜曲率（Sim K、steep K）。然后将角膜暴露于9mW/cm的加速紫外线A照射下10分钟（总剂量30mW/cm）。
患者的平均年龄为24.54±5.16岁。在所有术后测试点，UDVA、CDVA、SE、散光均有显著改善（分别为P = 0.000、0.004、0.000、0.004）。1年后，Kmax和Pachy thin相较于基线有显著降低（分别为P = 0.000、0.004）。地形学指标Sim K和steep K未显示出显著变化。未报告术中或术后并发症。
使用改良核黄素进行经上皮加速CXL是一种安全有效的手术方法，可阻止进展性圆锥角膜薄角膜的疾病进展。
