Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt.
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Acta Ophthalmol. 2019 Jun;97(4):e623-e631. doi: 10.1111/aos.13986. Epub 2018 Nov 29.
To compare the safety and efficacy of standard 30 min epithelium-off cross-linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium-off cross-linking (AXL) for the treatment of progressive keratoconus (CXL-Plus).
This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow-up.
In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D.
Surprisingly, standard CXL showed close results to CXL-Plus at the 24th follow-up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL-Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long-term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.
比较标准 30 分钟去上皮层光交联（CXL）与光折射角膜切削术（PRK）联合加速去上皮层光交联（AXL）治疗进展性圆锥角膜（CXL-Plus）的安全性和疗效。
这是一项前瞻性多中心对照临床研究。共有 75 例 1 级圆锥角膜且有进展记录的患者的 125 只眼被分为两组。A 组 58 只眼接受标准 CXL 治疗，B 组 67 只眼接受 PRK 联合 AXL 治疗。记录的数据包括术前和术后 3、6、12 和 24 个月的角膜地形图检查的未矫正远视力（UDVA）、最佳矫正视力（CDVA）、主观和客观屈光度、角膜曲率和角膜厚度。
在 A 组中，24 个月时 UDVA 和 CDVA 从 1.12±0.38 和 0.58±0.42 提高到 0.66±0.20 和 0.20±0.12（LogMAR±SD）。球镜等效从 4.03±1.18 减少到 1.78±1.04 D。柱镜减少了 0.32±0.19 D。在 B 组中，24 个月时 UDVA 和 CDVA 从 1.26±0.52 和 0.68±0.36 提高到 0.58±0.28 和 0.20±0.16（LogMAR±SD）。球镜等效从 4.23±0.95 减少到 1.92±0.74 D。柱镜减少了±1.76 D。
令人惊讶的是，标准 CXL 在第 24 个月的随访中与 CXL-Plus 显示出接近的结果。标准 CXL 作为一种稳定程序，与近视成分减少有关。CXL-Plus 作为一种屈光和稳定程序，对近视和散光成分均有早期影响，但无后期改善。标准 CXL 在其长期效果上似乎比 AXL 更有效。因此，在未来，我们希望测试 PRK 与标准 CXL 的联合应用。
