From Woolfson Eye Institute (Stulting, Woolfson), Atlanta, Georgia, Center for Excellence in Eye Care (Trattler), Miami, Florida, and Re:Vision, Georgetown University Medical Center and Washington Hospital Center (Rubinfeld), Washington, DC, USA.
From Woolfson Eye Institute (Stulting, Woolfson), Atlanta, Georgia, Center for Excellence in Eye Care (Trattler), Miami, Florida, and Re:Vision, Georgetown University Medical Center and Washington Hospital Center (Rubinfeld), Washington, DC, USA.
J Cataract Refract Surg. 2018 Nov;44(11):1363-1370. doi: 10.1016/j.jcrs.2018.07.029. Epub 2018 Sep 15.
To evaluate the effect of riboflavin-ultraviolet (UV)-A corneal crosslinking (CXL) without epithelial removal on ectatic corneal disease.
Woolfson Eye Institute, Atlanta, Georgia, USA.
Prospective observational study.
Patients were treated with a new riboflavin formulation without epithelial removal, then exposed to UV light (365 nm) at 4 mW/cm with on-off cycling for 30 minutes. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, maximum corneal curvature (maximum keratometry [Kmax]), total higher-order aberrations (HOAs), and coma were measured at 3, 6, 12, and 24 months postoperatively. Progression was defined as an increase of more than 1 diopter (D) in Kmax and loss of more than 1 line of CDVA.
Five hundred twelve eyes of 308 patients with keratoconus or forme fruste keratoconus and 80 eyes of 55 patients with ectasia after laser in situ keratomileusis (LASIK) were treated with the new riboflavin formulation without epithelial removal; 229 patients received bilateral treatments, 95 of which were simultaneous. The mean UDVA and CDVA improved by 1 to 1.5 Snellen lines at 1 and 2 years postoperatively (P < .0001). Mean Kmax decreased by 0.48 D at 2 years postoperatively (P = .0002). Mean total HOAs and coma decreased by 36% (P < .0001) and 37% (P = .0002), respectively, at 2 years postoperatively. Kmax decreased more than 1 D in three times as many eyes as it increased more than 1 D (P < .0001). No eyes progressed, and there was no loss of effect between 1 and 2 years postoperatively. No vision-threatening events were observed. Pain typically resolved within 24 hours, and visual acuity returned to preoperative levels in 1 to 2 days.
Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.
评估不进行上皮去除的核黄素-紫外线（UV）-A 角膜交联（CXL）对扩张性角膜疾病的疗效。
美国佐治亚州亚特兰大市 Woolfson 眼科研究所。
前瞻性观察性研究。
患者接受新的核黄素制剂治疗，不进行上皮去除，然后用 365nm 的紫外线（4mW/cm，开-关循环 30 分钟）照射。术后 3、6、12 和 24 个月测量未矫正（UDVA）和矫正（CDVA）远距视力、最大角膜曲率（最大角膜曲率计 [Kmax]）、总高阶像差（HOAs）和彗差。进展定义为 Kmax 增加超过 1 屈光度（D）和 CDVA 损失超过 1 行。
308 例圆锥角膜或准分子激光原位角膜磨镶术（LASIK）后扩张性角膜疾病患者的 512 只眼和 80 只 LASIK 后扩张性角膜疾病患者的 80 只眼接受了新的核黄素制剂治疗，不进行上皮去除；229 例患者接受了双侧治疗，其中 95 例为同时治疗。术后 1 年和 2 年，UDVA 和 CDVA 平均提高 1 至 1.5 行 Snellen 线（P<.0001）。术后 2 年 Kmax 平均降低 0.48D（P=0.0002）。术后 2 年，总 HOAs 和彗差分别降低 36%（P<.0001）和 37%（P=0.0002）。Kmax 增加超过 1 D 的眼数是减少超过 1 D 的眼数的三倍（P<.0001）。术后 1 至 2 年无眼进展，无疗效丧失。未观察到视力威胁性事件。疼痛通常在 24 小时内消退，视力在 1 至 2 天内恢复术前水平。
使用这种新方案的上皮保留 CXL 阻止了 LASIK 后圆锥角膜和扩张性角膜疾病的进展。与上皮去除的 CXL 相比，它更安全，恢复更快，允许常规双侧同时治疗。
