圆锥角膜患者行定制化与加速角膜交联术的角膜生物力学及角膜地形图比较。

Nagoya Eye Clinic, Nagoya, Japan; and.

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

Cornea. 2021 Jul 1;40(7):851-858. doi: 10.1097/ICO.0000000000002572.

PURPOSE

To compare the changes in corneal biomechanical properties and corneal tomography between transepithelial customized corneal crosslinking (C-CXL) and epithelium-off accelerated corneal crosslinking (A-CXL) in eyes with keratoconus.

METHODS

Twenty eyes in 20 consecutive patients who underwent C-CXL (C-CXL group) and 20 eyes in 20 patients who underwent A-CXL (A-CXL group) were included in this retrospective comparative study. The corneal biomechanical properties were analyzed using a Scheimpflug-based tonometer, and all corneas were examined by anterior segment optical coherence tomography (AS-OCT) before and 3 months after surgery. The corneal biomechanical parameters analyzed were the maximum inverse radius, deformation amplitude (DA) ratio max (2 mm), stiffness parameter at applanation 1, and integrated radius. The AS-OCT parameters analyzed included average keratometry, corneal astigmatism, maximum keratometry reading (Kmax), higher-order irregularity, and asymmetry.

RESULTS

In the C-CXL group, there were significant improvements in biomechanical parameters, including the maximum inverse radius, the DA ratio max (2 mm), and the integrated radius after surgery (P = 0.037, P = 0.002, and P = 0.003, respectively). In the C-CXL group, there was a significant decrease in the Kmax, higher-order irregularity, and asymmetry components (P = 0.014, P = 0.008, and P = 0.016, respectively). The biomechanical properties and AS-OCT parameters did not change significantly in the A-CXL group after surgery. According to multiple regression analyses, C-CXL had a greater effect than A-CXL in improving the maximum inverse radius, DA ratio max (2 mm), integrated radius, Kmax, asymmetry component, and higher-order irregularity component.

CONCLUSIONS

C-CXL might improve the biomechanical properties and irregular shape of the cornea from the early postoperative period to a greater extent than A-CXL.

目的

比较经上皮定制角膜交联（C-CXL）和上皮下加速角膜交联（A-CXL）治疗圆锥角膜患者的角膜生物力学和角膜断层参数的变化。

方法

本回顾性对照研究纳入 20 例（20 只眼）接受 C-CXL（C-CXL 组）和 20 例（20 只眼）接受 A-CXL（A-CXL 组）的患者。使用基于 Scheimpflug 的眼压计分析角膜生物力学特性，所有角膜均在术前和术后 3 个月行眼前节光学相干断层扫描（AS-OCT）检查。分析的角膜生物力学参数包括最大反转半径、变形幅度比 max（2mm）、压平 1 时的刚性参数和整合半径。分析的 AS-OCT 参数包括平均角膜曲率、角膜散光、最大角膜曲率读数（Kmax）、高阶像差和不对称性。

结果

C-CXL 组术后生物力学参数，包括最大反转半径、变形幅度比 max（2mm）和整合半径均显著改善（P = 0.037、P = 0.002 和 P = 0.003）。C-CXL 组的 Kmax、高阶像差和不对称性成分均显著降低（P = 0.014、P = 0.008 和 P = 0.016）。A-CXL 组术后生物力学参数和 AS-OCT 参数无显著变化。根据多元回归分析，C-CXL 在改善最大反转半径、变形幅度比 max（2mm）、整合半径、Kmax、不对称性成分和高阶像差成分方面的效果大于 A-CXL。