上皮光折射性角膜切削术与机械性上皮去除联合角膜交联术治疗圆锥角膜：特拉维夫方案。
Epithelial photorefractive keratectomy vs mechanical epithelial removal followed by corneal crosslinking for keratoconus: the Tel-Aviv Protocol.
机构信息
From the Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University (Rabina), Tel Aviv, Department of Ophthalmology, Rambam Health Care Campus (Mimouni), Haifa, Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology (Mimouni), Haifa, Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev (Kaiserman), Beer Sheba, and Care-Vision Laser Centers (Kaiserman), Tel-Aviv, Israel.
出版信息
J Cataract Refract Surg. 2020 May;46(5):749-755. doi: 10.1097/j.jcrs.0000000000000122.
PURPOSE
To compare the Tel-Aviv Protocol, epithelial photorefractive keratectomy (ePRK) combined with corneal crosslinking (CXL), to CXL with alcohol-assisted epithelial removal (Alc-CXL) for progressive keratoconus.
SETTING
Care-Vision Laser Centers, Tel Aviv, Israel.
DESIGN
Retrospective study.
METHODS
All patients underwent Alc-CXL or ePRK, a 50 μm laser ablation of the epithelium with a myopic spherical component and an astigmatic component, followed by CXL. All patients completed at least 1 year of follow-up.
RESULTS
A total of 131 eyes of 131 patients were included in the study. Fifty patients (38%) were included in the Tel-Aviv Protocol group, and 81 patients (62%) were included in the Alc-CXL group. There was a significant improvement in uncorrected distance visual acuity (UDVA) (from 1.22 ± 0.75 logarithm of the minimum angle of resolution [logMAR] to 0.49 ± 0.44 logMAR, P < .001), corrected distance visual acuity (CDVA) (from 0.29 ± 0.17 logMAR to 0.16 ± 0.12 logMAR, P < .001), Kmax (from 48.50 ± 3.00 diopters [D] to 46.50 ± 3.00 D, P < .001), and cylinder (from -3.31 ± 1.70 D to -2.32 ± 1.66 D, P < .001) in the Tel-Aviv Protocol group in comparison with nonsignificant changes in the Alc-CXL group in UDVA (from 0.89 ± 0.62 logMAR to 0.81 ± 0.65 logMAR, P = .23), CDVA (from 0.25 ± 0.21 logMAR to 0.21 ± 0.17 logMAR, P = .10), Kmax (from 46.50 ± 4.50 D to 46.00 ± 4.40 D, P = .08), and cylinder (from -2.99 ± 2.05 D to -2.80 ± 1.75 D, P = .39) at the end of the follow-up period.
CONCLUSIONS
The Tel-Aviv Protocol for progressive keratoconus patients provided good improvement in visual acuity and astigmatism while halting the progression of keratoconus.
目的
比较泰尔阿维夫方案（Tel-Aviv Protocol）、上皮光折射性角膜切削术（epithelial photorefractive keratectomy，ePRK）联合角膜交联术（corneal crosslinking，CXL）与酒精辅助上皮去除的 CXL（Alc-CXL）治疗进行性圆锥角膜的效果。
地点
以色列特拉维夫 Care-Vision Laser 中心。
设计
回顾性研究。
方法
所有患者均接受 Alc-CXL 或 ePRK 治疗，前者为 50μm 激光消融术，治疗近视性球镜成分和散光性成分，随后行 CXL。所有患者均完成至少 1 年的随访。
结果
本研究共纳入 131 例（131 只眼）患者。50 例（38%）患者纳入泰尔阿维夫方案组，81 例（62%）患者纳入 Alc-CXL 组。在未经矫正的远视力（uncorrected distance visual acuity，UDVA）（从 1.22±0.75 最小角分辨率对数[logMAR]改善至 0.49±0.44 logMAR，P＜0.001）、矫正的远视力（corrected distance visual acuity，CDVA）（从 0.29±0.17 logMAR 改善至 0.16±0.12 logMAR，P＜0.001）、最大角膜曲率（Kmax）（从 48.50±3.00 屈光度[D]改善至 46.50±3.00 D，P＜0.001）和散光（从 -3.31±1.70 D 改善至 -2.32±1.66 D，P＜0.001）方面，泰尔阿维夫方案组均有显著改善，而 Alc-CXL 组在 UDVA（从 0.89±0.62 logMAR 改善至 0.81±0.65 logMAR，P＝0.23）、CDVA（从 0.25±0.21 logMAR 改善至 0.21±0.17 logMAR，P＝0.10）、Kmax（从 46.50±4.50 D 改善至 46.00±4.40 D，P＝0.08）和散光（从 -2.99±2.05 D 改善至 -2.80±1.75 D，P＝0.39）方面的变化均无统计学意义。
结论
泰尔阿维夫方案治疗进行性圆锥角膜患者可显著改善视力和散光，同时阻止圆锥角膜进展。
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