Amer Ibrahim, Elaskary Abdelhakeem, Mostafa Ali, Hazem Hazem A, Omar Ahmed, Abdou Ahmed
Ophthalmology Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt.
Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Clin Ophthalmol. 2020 Nov 3;14:3747-3754. doi: 10.2147/OPTH.S275797. eCollection 2020.
To compare the visual, refractive and topographic outcomes of standard and accelerated corneal collagen cross-linking (CXL) in pediatric keratoconus patients.
Prospective, comparative observational study on 68 eyes of 35 pediatric keratoconus patients (<18 years). Patients were classified into two groups, group (I) included 34 eyes and received standard "Epi-Off" CXL (3 mW/cm, 30 min.) and group (II) included 34 eyes and received accelerated "Epi-Off" CXL (9 mW/cm, 10 min.). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), simulated keratometry (Sim K-1, Sim K-2, K-max, K-mean), cylindrical (CYL), pachymetry and Q-value were evaluated preoperatively and for 3 years postoperatively.
Postoperative UDVA and CDVA did not significantly change in both groups after 3 years. Postoperative SE was increased significantly in accelerated CXL (p=0.012) with no significant change in the postoperative cylinder in both procedures. Standard CXL had greater "significant" effect in decreasing Sim K-1, K-max and K-mean. The mean reduction in postoperative corneal pachymetry (at thinnest location) was significant in standard CXL (18.4 μm) (p=0.001). No significant change was noticed in postoperative Q-value.
Standard and accelerated CXL protocols are efficient in pediatric keratoconus management with better outcomes in the standard procedure.
比较标准和加速角膜胶原交联（CXL）在儿童圆锥角膜患者中的视力、屈光和地形图结果。
对35例儿童圆锥角膜患者（<18岁）的68只眼进行前瞻性、对比观察研究。患者分为两组，第一组包括34只眼，接受标准的“去上皮”CXL（3 mW/cm，30分钟），第二组包括34只眼，接受加速的“去上皮”CXL（9 mW/cm，10分钟）。术前及术后3年评估未矫正远视力（UDVA）、矫正远视力（CDVA）、等效球镜度（SE）、模拟角膜曲率（Sim K-1、Sim K-2、K-max、K-mean）、柱镜度（CYL）、角膜厚度测量和Q值。
3年后两组患者术后UDVA和CDVA均无显著变化。加速CXL术后SE显著增加（p=0.012），两种手术术后柱镜度均无显著变化。标准CXL在降低Sim K-1、K-max和K-mean方面有更大的“显著”效果。标准CXL术后角膜最薄处平均厚度减少显著（18.4μm）（p=0.001）。术后Q值无显著变化。
标准和加速CXL方案在儿童圆锥角膜治疗中均有效，标准手术效果更佳。
