J Refract Surg. 2021 Feb 1;37(2):83-90. doi: 10.3928/1081597X-20201124-01.
To evaluate and compare corneal haze as determined by optical coherence tomography (OCT) after corneal cross-linking (CXL) for the treatment of mild to moderate keratoconus with or without mitomycin C (MMC) application.
This was a retrospective analysis of 87 eyes of 72 patients with mild to moderate keratoconus. The first group (n = 44 eyes) underwent CXL between June 2013 and January 2015 and the second group (n = 43 eyes) underwent CXL with MMC (CXL+MMC) between February and December 2015, both following the Dresden protocol. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. Main outcome measures were corneal reflectivity and haze reflectivity measured by a specially developed OCT image analysis software.
Anterior corneal reflectivity at 1 month and 1 year postoperatively was 14.79 ± 4.68 and 25.97 ± 15.01 (P < .001), and 13.88 ± 4.39 and 18.41 ± 9.25 (P = .025) for the CXL and CXL+MMC groups, respectively. The reflectivity of the anterior stromal haze region at 1 month and 1 year postoperatively was 23.15 ± 5.91 and 33.14 ± 16.58 (P = .005), and 20.58 ± 7.88 and 27.14 ± 12.80 (P = .049) for both groups, respectively. The changes in simulated keratometry from preoperatively to postoperatively were similar in both groups. The CXL+MMC group showed larger maximum keratometry flattening: 53.41 ± 6.88 diopters (D) preoperatively and 49.44 ± 5.66 D 1 year postoperatively versus 52.27 ± 5.78 and 50.91 ± 4.25 D for CXL alone (P = .008).
MMC application following CXL significantly increases corneal haze. Similar studies need to be performed on simultaneous CXL and photorefractive keratectomy to evaluate the role of MMC in haze formation in such procedures. [J Refract Surg. 2021;37(2):83-90.].
利用光学相干断层扫描（OCT）评估并比较行角膜交联术（CXL）治疗轻、中度圆锥角膜时是否联合应用丝裂霉素 C（MMC）后角膜混浊的情况。
本研究为回顾性病例系列研究。纳入 72 例（87 只眼）轻、中度圆锥角膜患者，根据术中是否联合应用丝裂霉素 C 将患者分为 CXL 组（n=44 只眼）和 CXL+MMC 组（n=43 只眼）。CXL 组于 2013 年 6 月至 2015 年 1 月行 CXL 治疗，CXL+MMC 组于 2015 年 2 月至 12 月行 CXL+MMC 治疗，两组均采用德累斯顿方案。患者分别于术前及术后 1、3、6、12 个月接受随访。主要观察指标为使用特制的 OCT 图像分析软件测量角膜反射率和角膜混浊反射率。
术后 1 个月和 1 年时，CXL 组和 CXL+MMC 组患者的角膜前表面反射率分别为 14.79±4.68 和 25.97±15.01（P<0.001）、13.88±4.39 和 18.41±9.25（P=0.025）；术后 1 个月和 1 年时，两组患者角膜前基质混浊区反射率分别为 23.15±5.91 和 33.14±16.58（P=0.005）、20.58±7.88 和 27.14±12.80（P=0.049）。两组术后模拟角膜曲率值变化情况相似。与 CXL 组相比，CXL+MMC 组术后最大角膜屈光度变平程度更大：术前分别为 53.41±6.88 屈光度（D）和 52.27±5.78 D，术后 1 年分别为 49.44±5.66 D 和 50.91±4.25 D（P=0.008）。
CXL 术后联合应用丝裂霉素 C 可显著增加角膜混浊程度。有必要对同时行 CXL 和光性折射角膜切除术的患者进行类似研究，以评估丝裂霉素 C 在这些手术中引起混浊形成的作用。
