From the Cornea Eye Institute, Beverly Hills, California (Gaster, Margines, Canedo, Rabinowitz); Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation, and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, California (Li).
J Cataract Refract Surg. 2021 Oct 1;47(10):1333-1337. doi: 10.1097/j.jcrs.0000000000000617.
To evaluate the safety and efficacy of epithelium-off (epi-off) corneal crosslinking (CXL) in adolescents with progressive keratoconus (KC).
Private clinical practice.
Nonrandomized prospective clinical trial.
230 adolescent patients aged 10 to 19 years with progressive KC (increasing maximum keratometry [Kmax] or astigmatism of 1.00 diopter or greater associated with decreased corrected distance visual acuity [CDVA]) underwent CXL. Exclusion criteria were age at time of CXL younger than 10 years or older than 19 years, corneas that were thinner than 400 μm or demonstrated central corneal scarring, history of herpetic eye disease, or pregnancy or nursing. Follow-up examinations of uncorrected distance visual acuity (UDVA), CDVA, Kmax, and minimum pachymetry occurred on 130 eyes at 1 year, 77 eyes at 2 years, and 55 eyes at 3 years post-CXL.
In this study, 230 eyes of adolescent patients were evaluated. UDVA significantly improved from preoperatively to 1 year, 2 years, and 3 years post-CXL. CDVA values significantly improved from preoperatively to 1 year, 2 years, and 3 years post-CXL. Kmax values significantly reduced (improved) from preoperatively to 1 year and 3 years post-CXL and reduced (improved) (P = .22) from preoperatively to 2 years post-CXL. Minimum pachymetry decreased significantly from preoperatively to 1 year, 2 years, and 3 years post-CXL.
CXL in patients aged 10 to 19 years was safe and efficacious, halted progression of KC and could improve UCVA, CDVA, and Kmax. Minimum pachymetry decreased and stabilized post-CXL. Ophthalmologists should encourage adolescent patients with KC to obtain prompt evaluation and possible CXL to halt progression of the disease.
评估去上皮（epi-off）角膜交联（CXL）在进展性圆锥角膜（KC）青少年患者中的安全性和有效性。
私人临床实践。
非随机前瞻性临床试验。
230 名年龄在 10 至 19 岁之间的进展性 KC 青少年患者（最大角膜曲率 [Kmax] 增加 1.00 屈光度或散光增加 1.00 屈光度，同时伴有矫正远视力 [CDVA] 下降）接受 CXL。排除标准为 CXL 时年龄小于 10 岁或大于 19 岁、角膜厚度小于 400μm 或存在中央角膜瘢痕、疱疹性眼病史或妊娠或哺乳期。CXL 后 1 年、2 年和 3 年分别对 130 只眼、77 只眼和 55 只眼进行未矫正远视力（UDVA）、CDVA、Kmax 和最小角膜厚度检查。
本研究共评估了 230 只青少年患者的眼睛。UDVA 从术前到 CXL 后 1 年、2 年和 3 年显著提高。CDVA 值从术前到 CXL 后 1 年、2 年和 3 年显著提高。Kmax 值从术前到 CXL 后 1 年和 3 年显著降低（改善），从术前到 CXL 后 2 年降低（改善）（P =.22）。最小角膜厚度从术前到 CXL 后 1 年、2 年和 3 年显著降低。
10 至 19 岁患者的 CXL 安全有效，可阻止 KC 进展，并可提高 UCVA、CDVA 和 Kmax。CXL 后最小角膜厚度降低并稳定。眼科医生应鼓励患有 KC 的青少年患者尽快进行评估并可能进行 CXL，以阻止疾病进展。
