Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA.
Cornea. 2022 Apr 1;41(4):408-416. doi: 10.1097/ICO.0000000000002730.
The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus.
A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively.
Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of -0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and -1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable.
Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.
本研究旨在评估角膜交联术对进展性圆锥角膜儿童和年轻患者视力和角膜曲率的影响。
对 2013 年 1 月至 2019 年 11 月在斯坦福大学拜尔斯眼科研究所接受角膜交联术的年龄在 22 岁或以下的圆锥角膜患者的病历进行回顾性分析。主要观察指标包括矫正距离视力的最小分辨角对数(logMAR)；角膜曲率计，包括最大角膜曲率(Kmax)；角膜厚度；以及总波前像差。在基线时以及术后 12 个月和 24 个月时进行测量。
共评估了 49 例 57 只眼 12 至 22 岁患者。术前平均 logMAR 视力为 0.38 ± 0.32（20/48），术后 12 个月和 24 个月时的平均 logMAR 视力分别为 0.29 ± 0.31（20/39）和 0.31 ± 0.31（20/41）。与术前平均 Kmax 相比，术后 12 个月时 Kmax 改善了-0.8 屈光度（D），平均为 59.1 ± 9.1 D，术后 24 个月时改善了-1.3 D，平均为 59.7 ± 8.8 D。排除接受双眼交联术患者的第二只眼的亚组分析显示出类似的结果。线性混合模型显示术后 12 个月和 24 个月时 Kmax 均有显著改善。交联术后角膜中央最小厚度最初下降，但在术后 24 个月时稳定。总波前像差保持稳定。
角膜交联术可稳定并在某些情况下改善儿童和年轻成人圆锥角膜患者的视力和角膜参数。该手术安全且耐受性良好，可能有助于阻止年轻患者的圆锥角膜进展。
