Eye Center at the University of Freiburg Medical Center, Albert Ludwig University Freiburg; Department of Ophthalmology, St. Johannes Hospital, Dortmund.
Dtsch Arztebl Int. 2019 Mar 8;116(11):184-190. doi: 10.3238/arztebl.2019.0184.
Keratoconus is a slowly progressive ectatic deformity of the cornea with a prevalence of 200 to 400 cases per 100 000 persons. The cornea is thinner than normal and irregularly warped; irregular astigmatism and myopia result. Riboflavin-UVA crosslinking (collagen cross-linking) makes corneal tissue more rigid through a photochemical effect and can stop the progression of the disease.
This review is based on relevant publications retrieved by a selective search in Medline, as well as on meta-analyses, Cochrane Reviews, and reports of national and international health care institutions.
Pertinent randomized controlled trials (RCTs) have shown that cross-linking prevents the progression of keratoconus to a statistically significant extent, as determined by measurement of topographic parameters. In the largest RCT to date (fol- low-up of 100 eyes for three years), the maximal corneal refractive power increased by 1.75 ± 0.38 diopters in the control group and decreased by -1.03 ± 0.19 diopters in the cross-linking group (p <0.001). This was also the only trial in which data were reported on the patient-relevant endpoint of uncorrected visual acuity, which mildly improved in the cross-linking group (-0.15 ± 0.06 logMAR, p = 0.009). Serious complications of cross-linking are known to date only from a few reports of individual cases. Cohort studies with follow-up times of up to ten years have shown that the condition can continue to progress after cross-linking, especially in younger patients.
Cross-linking is the first available treatment for keratoconus that can improve the natural course of the disease.
圆锥角膜是一种进行性扩张性角膜病变，每 10 万人中有 200 至 400 例。角膜比正常情况下更薄，且不规则地变形；不规则散光和近视随之产生。核黄素-UVA 交联（胶原交联）通过光化学作用使角膜组织更加坚硬，并能阻止疾病的进展。
本综述基于 Medline 中通过选择性搜索检索到的相关出版物，以及荟萃分析、Cochrane 综述和国家及国际卫生保健机构的报告。
相关的随机对照试验（RCT）表明，交联在统计学上显著阻止了圆锥角膜的进展，这是通过测量地形参数来确定的。在迄今为止最大的 RCT 中（三年随访 100 只眼），对照组的最大角膜屈光力增加了 1.75 ± 0.38 屈光度，交联组则降低了-1.03 ± 0.19 屈光度（p <0.001）。这也是唯一报告与患者相关的未矫正视力终点数据的试验，交联组的未矫正视力略有改善（-0.15 ± 0.06 logMAR，p = 0.009）。交联术的严重并发症目前仅从少数个别病例报告中得知。随访时间长达十年的队列研究表明，在交联后病情仍可能继续进展，尤其是在年轻患者中。
交联术是目前可改善疾病自然进程的圆锥角膜的第一种治疗方法。
