Mazzotta Cosimo, Traversi Claudio, Baiocchi Stefano, Bagaglia Simone, Caporossi Orsola, Villano Antonio, Caporossi Aldo
Department of Medicine, Surgery and Neurosciences, Ophthalmogy Unit, Siena University, Siena, Italy.
Siena Crosslinking Center, Siena, Italy.
Cornea. 2018 May;37(5):560-566. doi: 10.1097/ICO.0000000000001505.
To assess the 10-year follow-up efficacy and safety of riboflavin ultraviolet A-induced cross-linking (CXL) in a population of pediatric patients aged 18 years and younger with progressive keratoconus (KC).
The prospective longitudinal cohort study included 62 eyes of 47 keratoconic patients undergoing epithelium-off CXL who completed 10-year follow-up. The surgical procedure was performed in all patients according to the Siena (Dresden modified) protocol. Evaluation included uncorrected distance visual acuity, corrected distance visual acuity, Scheimpflug corneal tomography, and optical coherence tomography demarcation line measurement. Follow-up measurements taken up to 10 years after treatment were compared with baseline values, and statistical analysis was performed using a 2-tailed paired sample Student t test.
Uncorrected distance visual acuity and corrected distance visual acuity improved from 0.45 to 0.23 logarithm of the minimum angle resolution (P = 0.0001) and from 0.14 to 0.1 logarithm of the minimum angle resolution (P = 0.019). KC stability was recorded after 10 years of follow-up in nearly 80% of the patients. The overall 10-year follow-up progression rate was 24% including 13 eyes of 9 patients with Kmax progression over 1 diopter and 2 eyes of 2 patients who underwent corneal grafting.
The study demonstrates the ability of CXL to slow down KC progression in pediatric patients, improving functional performance. Long-term stability may be correlated with CXL-induced delay in corneal collagen turnover and with spontaneous age-related KC stabilization. A 24% regression rate could be contemplated in the patients who were aged 15 years and younger at the time of inclusion in the treatment protocol.
评估核黄素紫外线A诱导交联（CXL）对18岁及以下患有进行性圆锥角膜（KC）的儿科患者的10年随访疗效和安全性。
这项前瞻性纵向队列研究纳入了47例接受去上皮CXL的圆锥角膜患者的62只眼睛，这些患者完成了10年随访。所有患者均按照锡耶纳（德累斯顿改良）方案进行手术。评估包括未矫正远视力、矫正远视力、Scheimpflug角膜断层扫描和光学相干断层扫描分界线测量。将治疗后长达10年的随访测量值与基线值进行比较，并使用双尾配对样本Student t检验进行统计分析。
未矫正远视力从最小分辨角对数0.45提高到0.23（P = 0.0001），矫正远视力从最小分辨角对数0.14提高到0.1（P = 0.019）。近80%的患者在10年随访后记录到KC稳定。总体10年随访进展率为24%，包括9例患者的13只眼睛Kmax进展超过1屈光度，以及2例患者的2只眼睛接受了角膜移植。
该研究证明了CXL能够减缓儿科患者KC的进展，改善功能表现。长期稳定性可能与CXL诱导的角膜胶原周转延迟以及与年龄相关的KC自发稳定有关。在纳入治疗方案时年龄在15岁及以下的患者中，可考虑24%的退行率。
