Godefrooij Daniel A, Kandoussi Mustapha El, Soeters Nienke, Wisse Robert Pl
Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
Clin Ophthalmol. 2017 Oct 30;11:1931-1936. doi: 10.2147/OPTH.S139358. eCollection 2017.
The purpose of this study was to compare the effects of transepithelial crosslinking (trans-CXL) versus epithelium-off crosslinking (epi-off CXL) for progressive keratoconus with respect to the development of higher order aberrations (HOAs) and their effects on visual acuity.
A total of 61 patients were randomized and examined preoperatively and 1, 3, 6, and 12 months postoperatively in an academic referral center. Total corneal HOAs were compared between the two treatment groups using mixed linear modeling. Types of HOAs (coma, trefoil, and spherical aberration) that differed between groups were entered in a multivariable analysis to test their effect on uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA).
The epi-off CXL group had more flattening in maximal keratometry compared to the trans-CXL group (=0.02). UDVA did not differ significantly between the groups (=0.59); however, CDVA was significantly more improved in the trans-CXL group (=0.02). Horizontal trefoil improved more in the epi-off group compared to the trans-CXL group (=0.04), whereas the other HOAs were virtually unchanged in both groups. Differences in changes in HOAs between the two groups had no effect on either UCVA (=0.76) or CDVA (=0.96).
Although HOAs are clinically relevant determinants of vision quality in keratoconus patients, the change in total HOAs post treatment did not differ between the trans-CXL and epi-off CXL groups. Only horizontal trefoil differed significantly post treatment between the trans-CXL and epi-off CXL groups. However, this difference did not independently affect either UDVA or CDVA. Trans-CXL provides no benefit over epi-off CXL regarding visual relevant HOAs.
本研究旨在比较上皮下交联（trans-CXL）与去上皮交联（epi-off CXL）治疗进展性圆锥角膜对高阶像差（HOAs）的发展及其对视力的影响。
在一家学术转诊中心，共有61例患者被随机分组，并在术前以及术后1、3、6和12个月进行检查。使用混合线性模型比较两个治疗组之间的总角膜高阶像差。将组间存在差异的高阶像差类型（彗差、三叶草像差和球差）纳入多变量分析，以测试它们对未矫正远视力（UDVA）和矫正远视力（CDVA）的影响。
与trans-CXL组相比，epi-off CXL组的最大角膜曲率测量值更扁平（P = 0.02）。两组之间的UDVA无显著差异（P = 0.59）；然而，trans-CXL组的CDVA改善更为显著（P = 0.02）。与trans-CXL组相比，epi-off组的水平三叶草像差改善更多（P = 0.04），而其他高阶像差在两组中几乎没有变化。两组之间高阶像差变化的差异对UCVA（P = 0.76）或CDVA（P = 0.96）均无影响。
尽管高阶像差是圆锥角膜患者视力质量的临床相关决定因素，但trans-CXL组和epi-off CXL组治疗后总高阶像差的变化并无差异。仅水平三叶草像差在trans-CXL组和epi-off CXL组治疗后存在显著差异。然而，这种差异并未独立影响UDVA或CDVA。在与视力相关的高阶像差方面，trans-CXL与epi-off CXL相比并无优势。
