Cifariello F, Minicucci M, Di Renzo F, Di Taranto D, Coclite G, Zaccaria S, De Turris S, Costagliola C
Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
Casa di Cura "Villa Maria", Campobasso, Italy.
J Ophthalmol. 2018 Jul 29;2018:4947983. doi: 10.1155/2018/4947983. eCollection 2018.
To evaluate two different techniques of cross-linking: standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus.
Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3 mW/cm.
In both groups, a significant improvement in visual function (Group 1: baseline 0.36 ± 0.16 logMAR, two-year follow-up 0.22 ± 0.17 logMAR, =0.01; Group 2: baseline 0.32 ± 0.18 logMAR, 2-year follow-up 0.27 ± 0.19 logMAR, =0.01) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness: -55 micron and -71 micron, resp.). One-month after treatment, OSDI reached 13.56 ± 2.15 in Group 1 (=0.03) and 11.26 ± 2.12 in Group 2 (=0.04). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), with =0.668 and 0.356, respectively.
Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.
评估两种不同的交联技术：标准上皮去除（上皮下交联，CXL epi-off）与经上皮（上皮交联，CXL epi-on）交联技术在进行性圆锥角膜患者中的应用。
2014年6月至2015年6月，在这项非盲、随机对照研究中，前瞻性纳入了32例进行性圆锥角膜患者的40只眼。20只眼接受上皮下交联治疗，20只眼接受经上皮交联治疗，随机分组，并随访2年。所有患者均接受了全面的眼科检查，包括未矫正和最佳矫正视力、中央和周边角膜厚度、角膜散光、模拟最大、最小和平均角膜曲率、角膜共焦显微镜检查、Schirmer I试验和泪膜破裂时间（BUT）试验，以及眼表疾病指数。记录术中及术后并发症。上皮下交联使用的溶液为0.1%核黄素和20.0%右旋糖酐（Ricrolin），而经上皮交联（Ricrolin TE）使用溶液为0.1%核黄素、15.0%右旋糖酐、氨丁三醇（Tris）和乙二胺四乙酸。使用UV-X系统以3 mW/cm²进行紫外线A治疗。
两组患者的视功能均有显著改善（第1组：基线时logMAR为0.36±0.16，两年随访时为0.22±0.17，P = 0.01；第2组：基线时logMAR为0.32±0.18，两年随访时为0.27±0.19，P = 0.01）。两组的角膜曲率均保持不变。平均角膜厚度均有显著降低（角膜厚度平均差异分别为-55微米和-71微米）。治疗1个月后，第1组的眼表疾病指数为13.56±2.15（P = 0.03），第2组为11.26±2.12（P = 0.04）。在共焦显微镜检查中，两组均发现角膜神经异常改变。第1组比第2组更常见纤维化反应（43.75%）和活化角膜细胞（62.6%）（分别为25.0%和18.75%），P值分别为0.668和0.356。
我们的研究结果表明，两种方法均能减缓圆锥角膜的进展。两种治疗方式在结果和相关并发症方面相当。经上皮交联技术优于上皮下交联技术，因为它能保留角膜厚度、提高视力，还能在研究期间减轻术后眼部不适。
