Bamdad Shahram, Zaheryani Seyed Mohammad Salar, Mohaghegh Sahar, Shirvani Mohammad
Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
School of Rehabilitation, Shahid Beheshti University of Medical Science, Tehran, Iran.
J Ophthalmic Vis Res. 2020 Feb 2;15(1):16-23. doi: 10.18502/jovr.v15i1.5934. eCollection 2020 Jan-Mar.
To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes.
In this double masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period.
Patients' mean age was 23.3 3.6 years. The preoperative thickness of the thinnest point was 459.20 37.40 µm and 455.80 32.70 µm in the epithelium-removal and epithelial-disruption CXL groups, respectively (P > 0.05). The corresponding figures were 433.50 33.50 µm and 451.90 39.70 µm, respectively, six months after the treatment (P = 0.0001). Irregularity component of the fourier analysis was 0.030 0.016 µm in the epithelium-removal group and 0.028 0.011 µm in the epithelium-disruption group preoperatively (P > 0.05). This measurement was 0.031 0.016 µm and 0.024 0.009 µm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P 0.05).
This study shows that epithelium-disruption CXL is superior to epithelium-removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques.
在角膜曲率数据的傅里叶分析及临床结果方面比较上皮去除和上皮破坏角膜交联（CXL）方法。
在这项双盲随机临床试验中，34例双眼圆锥角膜患者的每只眼睛被随机分配到上皮去除或上皮破坏CXL治疗组。在基线和六个月随访期进行眼部检查、验光、未矫正和最佳矫正视力（分别为UCVA和BSCVA）测量以及Pentacam成像（角膜曲率测量、角膜厚度测量和傅里叶分析）。
患者平均年龄为23.3±3.6岁。上皮去除和上皮破坏CXL组术前最薄点厚度分别为459.20±37.40μm和455.80±32.70μm（P>0.05）。治疗六个月后，相应数字分别为433.50±33.50μm和451.90±39.70μm（P = 0.0001）。傅里叶分析的不规则成分在术前上皮去除组为0.030±0.016μm，上皮破坏组为0.028±0.011μm（P>0.05）。该测量在第6个月时分别为0.031±0.016μm和0.024±0.009μm（P = 0.04）。与上皮去除组相比，上皮破坏CXL组在最薄点厚度和不规则成分方面有更好的结果。两个研究组在等效球镜度、平均角膜曲率、UCVA、BSCVA或其他傅里叶分析成分（球镜R最小值、球镜偏心率、中央、周边规则散光和最大偏心度）方面具有可比性（P>0.05）。
本研究表明，在上皮厚度和角膜不规则性的短期变化方面，上皮破坏CXL优于上皮去除CXL。两种技术之间其他评估参数具有可比性。
