From the Centro Polispecialistico Mediterraneo, Sellia Marina, Italy (Rechichi, Ferrise); Siena Crosslinking Center, Siena University Hospital, Ophthalmology Unit, Siena, Italy (Mazzotta, Bagaglia); Departement of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy (Oliverio, Meduri); Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom (Romano); Department of Ophthalmology, Riga Stradins University, Riga, Latvia (Borroni); Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India (Jacob).
J Cataract Refract Surg. 2021 Nov 1;47(11):1403-1410. doi: 10.1097/j.jcrs.0000000000000640.
To evaluate the changes in refractive outcomes and corneal aberrations in central and paracentral keratoconus after selective transepithelial topography-guided photorefractive keratectomy combined with accelerated corneal crosslinking (STARE-X).
Centro Polispecialistico Mediterraneo, Siena Crosslinking Center, and University of Messina, Italy.
Prospective, interventional, multicentric study.
Patients were subdivided into 2 groups: Group 1 with cone located within the central 3 mm zone (50 eyes) and Group 2 (50 eyes) with cone located outside the central 3 mm zone. Follow-up was 2 years at least for all eyes. Outcome parameters included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Corneal tomography and corneal wavefront aberrations were assessed and compared before and 2 years after the treatment.
100 eyes of 100 patients underwent STARE-X protocol. At 2 years, UDVA and CDVA improved, and sphere, cylinder, and Kmax reduced after treatment in both groups (P < .001, respectively). Moreover, a statistically significant reduction was observed of total higher-order aberrations root main square (RMS), coma RMS, and spherical aberration RMS in both groups (P < .001, respectively). However, CDVA improved more in Group 1 than in Group 2 (P < .02).
The STARE-X protocol demonstrated effective results in halting keratoconus progression and improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration at 2 years. Longer follow-up studies are warranted to observe further long-term CXL flattening effect on the cone.
评估经上皮角膜地形图引导光性角膜切削术联合加速角膜交联术（STARE-X）治疗中心和旁中心圆锥角膜后屈光度和角膜像差的变化。
意大利锡耶纳交联中心 Centro Polispecialistico Mediterraneo 和墨西拿大学。
前瞻性、干预性、多中心研究。
患者分为 2 组：第 1 组圆锥位于中央 3mm 区域内（50 只眼），第 2 组圆锥位于中央 3mm 区域外（50 只眼）。所有患者随访至少 2 年。观察指标包括未矫正远视力（UDVA）和矫正远视力（CDVA）。治疗前后评估并比较角膜地形图和角膜波前像差。
共有 100 例（100 只眼）患者接受了 STARE-X 治疗。2 年后，两组患者 UDVA 和 CDVA 均提高，球镜、柱镜和 Kmax 均降低（P<0.001）。此外，两组患者总高阶像差均方根（RMS）、彗差 RMS 和球差 RMS 均显著降低（P<0.001）。然而，第 1 组的 CDVA 改善程度大于第 2 组（P<0.02）。
STARE-X 方案在阻止圆锥角膜进展和改善角膜规则性方面具有显著疗效，同时具有安全有效的特性。STARE-X 可在 2 年内提高视力和角膜像差。需要进行更长时间的随访研究，以观察 CXL 对圆锥的进一步长期变平效果。
