Department of Ophthalmology, State University of Campinas, São Paulo, Brazil.
Cornea. 2020 Feb;39(2):186-191. doi: 10.1097/ICO.0000000000002130.
The goal of this study was to compare the effect of early corneal collagen cross-linking (CXL) intervention (before 17 years of age) with that of late intervention (after 17 years of age) on the characteristics and progression of keratoconus.
One hundred five eyes of 94 patients with keratoconus undergoing treatment with CXL were included. The patients were divided into 2 groups by age: group 1 (mean age of 13.8 yrs; range 10-16) and group 2 (mean age of 21.5 yrs; range 17-36). Eyes were evaluated regarding best-corrected visual acuity (BCVA), refractive error, corneal endothelial cell density, and central corneal thickness, as well as using slit-lamp biomicroscopy, Goldmann tonometry, and the keratometry (Kmax, Ksteep, and Kflat parameters) test before CXL and at 1, 3, 6, and 12 months thereafter.
The mean (SD) BCVA of group 1 was 0.45 (±0.25) before CXL and 0.56 (±0.29) 1 year after CXL (P = 0.030); mean (SD) Kmax, Ksteep, and Kflat were 58.47 (±7.2), 52.93 (±5.4), 47.22 (±4.2) before CXL respectively, and 58.21 (±7.7), 52.25 (±5.5), and 46.56 (±4.6) 1 year after CXL, respectively (P = 0.897, 0.481, and 0.491). The mean (SD) BCVA of group 2 was 0.50 (±0.30) before CXL and 0.56 (±0.32) 1 year thereafter (P = 0.346); mean (SD) Kmax, Ksteep, and Kflat were, respectively, 57.64 (±7.1), 54.02 (±6.2), and 48.60 (±4.1) before CXL and 56.46 (±8.0), 52.46 (±5.8), and 47.85 (±4.9) 1 year after CXL, respectively (P = 0.553, 0.258, and 0.640).
The study showed no statistical differences between younger and older patients. These findings support the indication of CXL treatment in pediatric patients for early stabilization of the disease and better progress regarding BCVA and keratometry parameters.
本研究旨在比较早期角膜胶原交联（CXL）干预（17 岁前）与晚期干预（17 岁后）对圆锥角膜特征和进展的影响。
纳入 94 例接受 CXL 治疗的圆锥角膜患者的 105 只眼。根据年龄将患者分为两组：组 1（平均年龄 13.8 岁；范围 10-16 岁）和组 2（平均年龄 21.5 岁；范围 17-36 岁）。在 CXL 之前以及之后 1、3、6 和 12 个月，使用最佳矫正视力（BCVA）、屈光不正、角膜内皮细胞密度和中央角膜厚度、裂隙灯生物显微镜、眼压计和角膜曲率计（Kmax、Ksteep 和 Kflat 参数）对眼睛进行评估。
组 1 的平均（SD）BCVA 在 CXL 前为 0.45（±0.25），CXL 后 1 年为 0.56（±0.29）（P=0.030）；平均（SD）Kmax、Ksteep 和 Kflat 分别为 58.47（±7.2）、52.93（±5.4）和 47.22（±4.2），CXL 后 1 年分别为 58.21（±7.7）、52.25（±5.5）和 46.56（±4.6）（P=0.897、0.481 和 0.491）。组 2 的平均（SD）BCVA 在 CXL 前为 0.50（±0.30），CXL 后 1 年为 0.56（±0.32）（P=0.346）；平均（SD）Kmax、Ksteep 和 Kflat 分别为 57.64（±7.1）、54.02（±6.2）和 48.60（±4.1），CXL 后 1 年分别为 56.46（±8.0）、52.46（±5.8）和 47.85（±4.9）（P=0.553、0.258 和 0.640）。
研究结果显示，年轻患者和年长患者之间无统计学差异。这些发现支持对儿科患者进行 CXL 治疗，以早期稳定疾病，并在 BCVA 和角膜曲率参数方面取得更好的进展。
