Liao Kai, Hu Min, Chen Fen, Li Pei, Song Peng, Zeng Qing-Yan
Aier School of Ophthalmology, Central South University, Changsha 410000, Hunan Province, China.
Hankou Aier Eye Hospital, Wuhan 430000, Hubei Province, China.
Int J Ophthalmol. 2019 Feb 18;12(2):219-225. doi: 10.18240/ijo.2019.02.06. eCollection 2019.
To compare the clinical and microstructural changes induced by different transepithelial iontophoresis-assisted corneal cross-linking (I-CXL) methods for keratoconus.
A total of 42 eyes of 42 patients with progressive keratoconus were divided into two groups. Group A received I-CXL for 5min, while group B received I-CXL for 10min. Visual acuity, optical coherence tomography (OCT), specular microscopy and confocal microscopy were evaluated preoperatively and at 1, 3, 6, and 12mo postoperatively.
Twelve months after the operation, uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were improved in both groups, with a better outcome in the I-CXL 10min group (=0.025, 0.021, respectively). Kmax values decreased by 0.94±3.00 D in the I-CXL 10min group (=0.033) but increased by 1.87±3.29 D in the I-CXL 5min group (=0.012). OCT scans showed that the demarcation line was most visible and substantially deeper in the I-CXL 10min group. Confocal microscopy showed greater anterior stromal keratocyte decreases in the I-CXL 10min group than in the I-CXL 5min group at 3 and 6mo postoperatively (<0.001); however, anterior stromal keratocytes and subbasal nerve density were not significantly different between the two groups at 12mo postoperatively.
I-CXL for 10min more effectively halts the progression of keratoconus than I-CXL for 5min after 12mo of follow-up. However, long-term studies are needed to evaluate the efficacy and safety of I-CXL.
比较不同经上皮离子导入辅助角膜交联（I-CXL）方法治疗圆锥角膜所引起的临床和微观结构变化。
42例进展期圆锥角膜患者的42只眼被分为两组。A组接受5分钟的I-CXL治疗，而B组接受10分钟的I-CXL治疗。在术前以及术后1、3、6和12个月评估视力、光学相干断层扫描（OCT）、镜面反射显微镜检查和共聚焦显微镜检查结果。
术后12个月，两组的未矫正视力（UCVA）和矫正远视力（CDVA）均有所改善，I-CXL 10分钟组效果更佳（分别为P = 0.025，0.021）。I-CXL 10分钟组的最大角膜曲率（Kmax）值下降了0.94±3.00 D（P = 0.033），而I-CXL 5分钟组则增加了1.87±3.29 D（P = 0.012）。OCT扫描显示，I-CXL 10分钟组的分界线最明显且更深。共聚焦显微镜检查显示，术后3个月和6个月时，I-CXL 10分钟组的前基质角膜细胞减少比I-CXL 5分钟组更明显（P<0.001）；然而，术后12个月时，两组的前基质角膜细胞和基底神经密度无显著差异。
随访12个月后，10分钟的I-CXL比5分钟的I-CXL更有效地阻止圆锥角膜的进展。然而，需要长期研究来评估I-CXL的疗效和安全性。
