Vounotrypidis Efstathios, Athanasiou Alexis, Kortüm Karsten, Kook Daniel, Shajari Mehdi, Priglinger Siegfried, Mayer Wolfgang J
Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, D-80336, Munich, Germany.
Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany.
Graefes Arch Clin Exp Ophthalmol. 2018 Jun;256(6):1165-1172. doi: 10.1007/s00417-018-3955-3. Epub 2018 Mar 10.
To investigate the long-term efficacy of accelerated corneal collagen cross-linking (CXL) in a large mid-European cohort with progressive keratoconus.
Four hundred thirteen eyes of 316 patients with progressive keratoconus were enrolled and treated with conventional (group A) or accelerated (group B) CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), slit lamp, and Pentacam® examinations were performed before and 12, 24, and 36 months after surgery. Maximum and mean anterior keratometry (Kmax, Kmf), corneal topography indices, and corneal pachymetry (TCT) were examined within each group and between groups. Further subgroup analysis of mild and moderate keratoconic eyes was performed.
One hundred thirty-one eyes of 101 patients were treated in group A, 282 eyes of 215 patients in group B. (UDVA, CDVA) and Kmax improved within each group, but not statistically significantly between groups after 36 months (p = 0.081, p = 0.344, p = 0.113, respectively). Kmf remained stable in both groups. TCT decreased significantly in group A (p = 0.014), but remained stable in group B (p = 0.063). Subgroup analysis showed similar results with improvement in visual acuity and keratometry and decrease of TCT. Corneal topography indices showed no differences between the groups after 36 months, but developed differently in the subgroup analysis. No correlation was detected between the change of corneal topography indices and TCT with regard to preoperative Kmax.
In a large mid-European study population including subgroup analysis of mild and moderate keratoconus, accelerated CXL showed similar results to conventional CXL regarding keratometry, corneal topography indices, and CDVA, but further improvement of UDVA. Preoperative Kmax did not affect the postoperative course of corneal topography indices and TCT.
在欧洲中部一个患有进行性圆锥角膜的大型队列中研究加速角膜胶原交联（CXL）的长期疗效。
纳入316例进行性圆锥角膜患者的413只眼，采用传统（A组）或加速（B组）CXL治疗。在手术前以及术后12、24和36个月进行裸眼远视力（UDVA）、矫正远视力（CDVA）、裂隙灯和Pentacam®检查。在每组内以及组间检查最大和平均角膜曲率（Kmax、Kmf）、角膜地形图指数和角膜厚度测量（TCT）。对轻度和中度圆锥角膜眼进行进一步的亚组分析。
A组治疗101例患者的131只眼，B组治疗215例患者的282只眼。每组内（UDVA、CDVA）和Kmax均有改善，但36个月后组间差异无统计学意义（分别为p = 0.081、p = 0.344、p = 0.113）。两组的Kmf均保持稳定。A组的TCT显著降低（p = 0.014），而B组保持稳定（p = 0.063）。亚组分析显示视力和角膜曲率改善以及TCT降低的结果相似。36个月后两组间角膜地形图指数无差异，但在亚组分析中变化不同。关于术前Kmax，未检测到角膜地形图指数变化与TCT之间的相关性。
在一项包括轻度和中度圆锥角膜亚组分析的大型欧洲中部研究人群中，加速CXL在角膜曲率、角膜地形图指数和CDVA方面显示出与传统CXL相似的结果，但UDVA有进一步改善。术前Kmax不影响角膜地形图指数和TCT的术后进程。
