Hernandez-Camarena Julio C, Graue-Hernandez Enrique O, Loya-García Denise, Ruiz-Lozano Raul E, Valdez-García Jorge E
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL 64710, Mexico.
Department of Cornea and Refractive Surgery, Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico.
Clin Ophthalmol. 2019 Aug 30;13:1665-1673. doi: 10.2147/OPTH.S206103. eCollection 2019.
To report the visual and topographic outcomes of two pulsed-light-accelerated CXL (A-CXL) protocols at a 12-month follow-up and their correlation with the corneal stromal demarcation line (DL) depth.
Retrospective comparative cohort of patients with documented progressive keratoconus were included. Two epi-off pulsed-light [1s on-1s off] A-CXL protocols were compared: irradiance 308 and 455:20 (fluence 7.2 J/cm). UDVA, CDVA, spherical equivalent (SE), topographic astigmatism, K, K, K, central corneal thickness (CCT), thinnest pachymetry (TCT) and endothelial cell density (ECD) were measured preoperatively and months 1, 3, 6 and 12 postoperative. Corneal DL was measured 1 month postoperatively using anterior segment optical coherence tomography.
Fifty eyes (27 patients): 22 eyes in group A-CXL (308), 28 eyes in group A-CXL (455:20). Mean age (years) was 19.04±4.71 and 20.32±4.57. DL depth (µm) at month 1 was 200.63±10.01 µm and 184.53±19.68 µm for group A-CXL (308) and group A-CXL (455:20), respectively (<0.001). Significant improvement in CDVA, topographic astigmatism, K, K and K was observed in both groups (no significant difference between groups) and no significant changes were observed in CCT, TCT and ECD with regard to baseline. Over 85% of the eyes in both protocols achieved stabilization or improvement in maximum K at the end of the follow-up. No significant correlations between DL and any visual or topographic outcomes were observed at 12 months.
No correlation between DL depth and visual or topographic outcomes was observed on either protocol. Although significant improvement on CDVA, topographic astigmatism, K, K and K was observed in both groups at 12 months, further research is needed to assure safety and effectiveness at stabilizing keratoconus progression.
报告两种脉冲光加速角膜交联术（A-CXL）方案在12个月随访时的视力和地形图结果，以及它们与角膜基质分界线（DL）深度的相关性。
纳入有记录的进行性圆锥角膜患者的回顾性比较队列。比较两种表层剥离脉冲光[1秒开-1秒关]A-CXL方案：辐照度308和455:20（能量密度7.2 J/cm）。术前以及术后1、3、6和12个月测量最佳矫正远视力（UDVA）、矫正视力（CDVA）、等效球镜度（SE）、地形图散光、角膜曲率（K）、K、K、中央角膜厚度（CCT）、最薄角膜厚度（TCT）和内皮细胞密度（ECD）。术后1个月使用眼前节光学相干断层扫描测量角膜DL。
50只眼（27例患者）：A-CXL（308）组22只眼，A-CXL（455:20）组28只眼。平均年龄（岁）分别为19.04±4.71和20.32±4.57。A-CXL（308）组和A-CXL（455:20）组术后1个月时DL深度（μm）分别为200.63±10.01和184.53±19.68（<0.001）。两组的CDVA地形图散光、K、K和K均有显著改善（两组间无显著差异），CCT、TCT和ECD与基线相比无显著变化。两种方案中超过85%的眼在随访结束时最大K值达到稳定或改善。12个月时未观察到DL与任何视力或地形图结果之间存在显著相关性。
两种方案中均未观察到DL深度与视力或地形图结果之间存在相关性。尽管两组在12个月时CDVA、地形图散光、K、K和K均有显著改善，但仍需要进一步研究以确保稳定圆锥角膜进展的安全性和有效性。
