使用更高能量密度和加速治疗时间的角膜交联术后上皮重塑。

Epithelial remodeling after corneal crosslinking using higher fluence and accelerated treatment time.

机构信息

From the Department of Ophthalmology (Haberman), New York University Langone Health, New York, New York, the Keck School of Medicine of the University of Southern California (Lang, Hafezi, Randleman), and the Roski Eye Institute (Hafezi, Randleman), University of Southern California, Los Angeles, California, USA; the Department of Cornea, Cataract & Refractive Surgery (Broncano), El Brillante Clinic, Córdoba, Spain; the Department of Ophthalmology (Kim), Ulsan University of College of Medicine, Ulsan, South Korea; the Faculty of Medicine (Hafezi), University of Geneva, Geneva and ELZA Institute (Hafezi), Dietikon/Zurich, Switzerland; the Department of Ophthalmology (Hafezi), Wenzhou Medical University, Wenzhou, China.

出版信息

J Cataract Refract Surg. 2018 Mar;44(3):306-312. doi: 10.1016/j.jcrs.2017.12.021. Epub 2018 Mar 30.

DOI:10.1016/j.jcrs.2017.12.021

PMID:29610026

Abstract

PURPOSE

To evaluate changes in regional corneal epithelial thickness after corneal crosslinking (CXL) using higher fluence (7.2 J/cm) and accelerated treatment time (4 minutes) in eyes with progressive keratoconus using spectral-domain optical coherence tomography (SD-OCT) and to correlate focal epithelial and focal anterior curvature changes.

SETTING

Academic medical center in the United States.

DESIGN

Prospective case series.

METHODS

Patients had anterior segment SD-OCT (RTVue-100) with focal stromal and epithelial measurements and Scheimpflug imaging before and 1, 3, 6, and 12 months after accelerated CXL.

RESULTS

Twenty-seven eyes from 20 patients were evaluated. Before the accelerated CXL, the epithelium was thinnest in the inferior inner and outer temporal regions, whereas at 12 months postoperatively, the epithelium was significantly thinned in multiple inferior and nasal regions by 1.1 to 3.2 μm (P < .05, all measurements), with no significant changes from 6 to 12 months. Epithelial thickness standard deviation across the central 6.0 mm was significantly reduced by 3 months (1.4 μm, P = .09) and remained stable at 12 months (P = .009). Change in epithelial thickness was poorly correlated to change in anterior curvature (r = -0.035).

CONCLUSIONS

Significant epithelial remodeling occurred after accelerated CXL in eyes with progressive keratoconus, with improved regularity across the central 6.0 mm, by 6 months after treatment. There was poor correlation between focal epithelial thickness and anterior curvature changes, with wide variability between patients. Establishing the pattern of epithelial remodeling after CXL might help optimize future custom treatment protocols.

摘要

目的

使用更高的光密度（7.2 J/cm）和加速治疗时间（4 分钟）对进行性圆锥角膜进行角膜交联（CXL），并用光谱域光学相干断层扫描（SD-OCT）评估区域角膜上皮厚度的变化，并与焦点上皮和焦点前曲率变化相关联。

设置

美国学术医疗中心。

设计

前瞻性病例系列。

方法

患者接受眼前节 SD-OCT（RTVue-100），并进行焦点基质和上皮测量以及 Scheimpflug 成像，在加速 CXL 之前以及之后 1、3、6 和 12 个月进行。

结果

评估了 20 例 27 只眼。在加速 CXL 之前，上皮在下方的内、外颞区最薄，而在术后 12 个月，在下侧和鼻侧的多个区域上皮厚度明显变薄 1.1 至 3.2 μm（所有测量值，P <.05），从 6 个月到 12 个月没有明显变化。中央 6.0mm 上皮厚度标准偏差在 3 个月时明显降低（1.4 μm，P =.09），在 12 个月时保持稳定（P =.009）。上皮厚度变化与前曲率变化相关性较差（r = -0.035）。