Anisimova N S, Anisimov S I, Shilova N F, Zemskaya A Yu, Gavrilova N A, Anisimova S Y
Eye Center Vostok-Prozrenie, Moscow, Russia.
A.I. Yevdokimov Moscow State University of Medicine and Dentristy, Moscow, Russia.
Vestn Oftalmol. 2020;136(2):99-106. doi: 10.17116/oftalma202013602199.
Corneal collagen cross-linking (CXL) is a procedure that aims to halt the progression of corneal ectasia in keratoconic eyes. It is achieved by inducing cross-links in the corneal stroma and extracellular matrix by exposing it to ultraviolet-A (370 nm) irradiation while it is filled with photosensitizer (riboflavin). According to the conventional protocol, the recommended de-epithelialized corneal thickness should be higher than 400 μm in order to avoid radiation damage to the corneal endothelium. However, in progressive keratoconus, corneal thickness is often close to or lower than this threshold of 400 μm, which limits the application of cross-linking for these patients. The present article reviews the different protocols of cross-linking for thin corneas, their advantages and disadvantages. At present, clinical research on modified cross-linking protocols is still limited due to the methodology and a low number of patients involved. Thus, comparative randomized controlled studies with long-term follow-up are necessary to confirm the safety and effectiveness of several CXL protocols and identify the most efficient one.
角膜胶原交联（CXL）是一种旨在阻止圆锥角膜患者角膜扩张进展的手术。它通过在角膜基质和细胞外基质中填充光敏剂（核黄素）的同时，将其暴露于紫外线A（370纳米）照射下，诱导交联来实现。根据传统方案，为避免对角膜内皮造成辐射损伤，推荐的去上皮角膜厚度应高于400微米。然而，在进行性圆锥角膜中，角膜厚度通常接近或低于400微米的这个阈值，这限制了交联在这些患者中的应用。本文综述了针对薄角膜的不同交联方案、它们的优缺点。目前，由于方法学和参与患者数量较少，关于改良交联方案的临床研究仍然有限。因此，需要进行长期随访的比较随机对照研究，以确认几种CXL方案的安全性和有效性，并确定最有效的方案。
