Iqbal Mohammed, Elmassry Ahmed, Tawfik Ahmed, Elgharieb Mervat Elshabrawy, El Deen Al Nahrawy Osama Mohiey, Soliman Ashraf Hassan, Saad Hisham A, Ibrahim Elzembely Hosam A, Saeed Ahmed Mohamed, Mohammed Osama Ali, Kamel Ahmed Gad, El Saman Islam Saad
Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt.
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Cornea. 2018 Sep;37(9):1143-1150. doi: 10.1097/ICO.0000000000001663.
To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus.
Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up.
The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus.
CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.
评估上皮移除联合角膜交联术（CXL）与准分子激光角膜切削术（CXL Plus）矫正圆锥角膜近视和散光成分的有效性和安全性。
本回顾性、多中心、非对照临床研究纳入了46例行CXL Plus手术的患者的79只眼。记录术前以及随访期间3、6、12和18个月时的裸眼远视力、矫正远视力、验光、角膜曲率测量和角膜厚度测量结果。
术前平均（±标准差）裸眼远视力和矫正远视力分别为1.00±0.22最小分辨角对数（logMAR）和0.62±0.38 logMAR，术后分别改善至0.71±0.36 logMAR和0.32±0.18 logMAR。平均角膜曲率值、最薄处平均角膜厚度以及平均近视和散光成分在随访期间分别从术前的46.58±0.97 D、473±29μm、3.65±1.72 D和1.83±0.69 D降至43.79±1.17 D、431±38μm、1.02±0.78 D和1.15±0.26 D。11只眼上皮愈合延迟，2只眼出现基质混浊，1只眼发生原发性单纯疱疹性角膜炎，5只眼圆锥角膜进展。
尽管CXL Plus术后早期可能存在上皮愈合延迟和角膜混浊等并发症，但在18个月的随访期间改善了圆锥角膜的屈光状态。CXL Plus降低圆锥角膜近视成分的效果优于散光成分。然而，该手术的安全性和稳定性被术后长期并发症以及圆锥角膜较高的术后进展率所抵消。
