J Refract Surg. 2020 Dec 1;36(12):838-843. doi: 10.3928/1081597X-20201021-01.
To assess the long-term efficacy and safety of epithelium-off corneal cross-linking according to the Dresden protocol (S-CXL) in progressive keratoconus.
Patients treated with S-CXL from April 2006 to January 2010 at Humanitas Clinical and Research Center, Rozzano, Italy, who completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and corneal topography and tomography with Pentacam (OCULUS Optikgeräte GmbH) were evaluated at baseline and 10+ years after the procedure. The definition of progression after S-CXL was two of the following three criteria: increase of "A" value, increase of "B" value, or decrease of minimum thickness evaluated with the ABCD progression display above 95% CI for the post-CXL population.
Twenty-seven eyes of 22 patients were included. At a mean of 11 years of follow-up (maximum 13 years), S-CXL was able to maintain CDVA and induce significant regularization of the corneal surface as demonstrated by a significant decrease of the central keratoconus index (P = .035) and a decrease of anterior curvature ("A" value) starting from 2.54 ± 2.46, which reduced to 1.14 ± 1.60 (P = .005) at 10+ years of follow-up. Two of 27 eyes included showed significant progression after S-CXL (7.4%).
S-CXL was confirmed to be a safe and effective treatment for progressive keratoconus with a failure rate of 7.4% at up to 13 years of follow-up. The authors suggest the use of a combined progression system that evaluates anterior and posterior curvature and with thickness map together with the knowledge of the noise level of the testing system. [J Refract Surg. 2020;36(12):838-843.].
评估根据德累斯顿方案（S-CXL）对进行性圆锥角膜进行上皮下角膜交联的长期疗效和安全性。
纳入 2006 年 4 月至 2010 年 1 月在意大利罗扎诺的 Humanitas 临床和研究中心接受 S-CXL 治疗且随访时间至少 10 年的患者。在基线和治疗后 10 年以上，使用角膜地形图仪（OCULUS Optikgeräte GmbH）和 Pentacam 评估矫正远视力（CDVA）、屈光度和角膜地形图和断层扫描。S-CXL 后进展的定义为以下三个标准中的两个：“A”值增加、“B”值增加或在用于交联后人群的 ABCD 进展显示中，评估的最小厚度减少超过 95%置信区间。
纳入 22 例患者的 27 只眼。平均随访 11 年（最长 13 年），S-CXL 能够维持 CDVA 并诱导角膜表面显著规则化，表现为中央圆锥角膜指数显著降低（P =.035），前曲率（“A”值）从 2.54 ± 2.46 降低至 1.14 ± 1.60（P =.005）在 10 年以上的随访中。27 只眼中有 2 只（7.4%）显示 S-CXL 后有明显进展。
S-CXL 被证实是治疗进行性圆锥角膜的一种安全有效的方法，在长达 13 年的随访中失败率为 7.4%。作者建议使用一种联合进展系统，该系统结合了厚度图一起评估前、后曲率，并结合了测试系统的噪声水平知识。[J Refract Surg. 2020;36(12):838-843.]。
