Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Cont Lens Anterior Eye. 2020 Oct;43(5):458-464. doi: 10.1016/j.clae.2020.03.004. Epub 2020 Mar 22.
To compare the corneal densitometry changes after transepithelial pulsed (t-ACXL), epithelium-off continuous (c-ACXL) and epithelium-off pulsed (p-ACXL), accelerated corneal crosslinking for patients with progressive keratoconus.
Prospective, interventional case series at a university hospital tertiary referral center. Forty eyes received t-ACXL, 40 eyes received c-ACXL, and 40 eyes received p-ACXL. Corneal tomography, densitometry and visual acuity were evaluated preoperatively and at 1, 3, 6, 12 and 24 months postoperatively.
Total densitometry values of the total layer over the annular diameters 0-12 mm expressed in grayscale units (GSU) showed no significant change after t-ACXL and p-ACXL but increased significantly after c-ACXL at 1 month (16.76 ± 2.38, P value < 0.01) and 3 months (16.12 ± 2.22, P value 0.04), returning to baseline levels at month 6 (14.97 ± 2.13, P value 0.99) and remained stable until final follow-up. At 1 month, the mean change in total densitometry value of the t-ACXL group (-0.53 ± 2.08) was significantly lower than the p-ACXL (0.70 ± 1.96 P value 0.04) and c-ACXL (1.97 ± 2.65 P value < 0.01). There was no statistical difference in the mean change in total densitometry between the three groups from 6 to 24 months. In the c-ACXL group, a higher degree of CXL-induced corneal haze at 1 month was observed in patients with steeper preoperative keratometry readings and in individuals where a greater flattening effect was achieved at 24 months.
Continuous epithelium-off accelerated cornea crosslinking appears to induce more corneal haze than pulsed epithelium-off and transepithelial pulsed cornea crosslinking in the early postoperative period. Differences resolve by six-months.
比较经上皮脉冲（t-ACXL）、上皮下连续（c-ACXL）和上皮下脉冲（p-ACXL）加速角膜交联治疗进展性圆锥角膜患者的角膜密度变化。
在大学医院的三级转诊中心进行前瞻性、干预性病例系列研究。40 只眼接受 t-ACXL，40 只眼接受 c-ACXL，40 只眼接受 p-ACXL。术前及术后 1、3、6、12 和 24 个月评估角膜断层扫描、密度和视力。
以灰度单位（GSU）表示的环形直径 0-12mm 总层的总密度值在 t-ACXL 和 p-ACXL 后无明显变化，但 c-ACXL 后 1 个月（16.76±2.38，P 值<0.01）和 3 个月（16.12±2.22，P 值 0.04）明显增加，6 个月时恢复至基线水平（14.97±2.13，P 值 0.99），并保持稳定直至最终随访。术后 1 个月，t-ACXL 组总密度值的平均变化（-0.53±2.08）明显低于 p-ACXL（0.70±1.96，P 值 0.04）和 c-ACXL（1.97±2.65，P 值<0.01）。从 6 个月到 24 个月，三组间总密度值的平均变化无统计学差异。在 c-ACXL 组中，术前角膜曲率读数较高和术后 24 个月角膜平坦化效果较大的患者，术后 1 个月观察到更高程度的 CXL 诱导性角膜混浊。
在术后早期，连续上皮下加速角膜交联似乎比脉冲上皮下和经上皮脉冲角膜交联引起更多的角膜混浊。差异在 6 个月时得到解决。
