Zhang Jia, Chen Tong, Wang Junjie, Bao Fangjun, Chen Wen, Stojanovic Aleksandar, Wang Qinmei, Chen Shihao
Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
Ophthalmol Ther. 2022 Aug;11(4):1423-1439. doi: 10.1007/s40123-022-00510-1. Epub 2022 May 9.
This study evaluated the outcomes of laser in situ keratomileusis (LASIK) combined with prophylactic corneal collagen cross-linking (CXL) in correcting myopia in cases with increased estimated risk of postoperative corneal ectasia, detected by regional analysis of corneal morphology.
The retrospective study included 180 eyes of 99 patients. Group 1 (94 eyes of 49 patients) with increased risk of postoperative corneal ectasia, as detected by "Ectasia Risk Factor Score System for LASIK", underwent femtosecond laser-assisted LASIK (FS-LASIK) combined with prophylactic CXL, using short riboflavin soaking time and low UV energy. Group 2 (86 eyes of 50 patients) with normal corneal topography, who underwent FS-LASIK alone, were used as controls. Refractive and visual outcomes and Scheimpflug topo/tomography were analyzed preoperatively and 1 week, 1 month, and 12 months postoperatively. Mean regional corneal curvature (M) values for three subregions (the central 3.0 mm region, the paracentral 3.0-6.0 mm region, and the peripheral 6.0-9.0 mm region) of both anterior and posterior surfaces were calculated.
An increase in flattening of the peripheral anterior region and more steepening of the posterior paracentral region were shown at 12 months compared to 1 month postoperatively in group 1. The findings were significantly more pronounced than in group 2 (P < 0.001 and P = 0.035, respectively). The refractive and visual outcomes were comparable in the two groups.
Prophylactic CXL seems to influence corneal regional reshaping after surgery, while not affecting the 1-year visual and refractive results.
本研究评估了在通过角膜形态区域分析检测出术后角膜扩张估计风险增加的病例中，准分子原位角膜磨镶术（LASIK）联合预防性角膜胶原交联（CXL）矫正近视的效果。
这项回顾性研究纳入了99例患者的180只眼。第1组（49例患者的94只眼），根据“LASIK角膜扩张危险因素评分系统”检测出术后角膜扩张风险增加，接受了飞秒激光辅助LASIK（FS-LASIK）联合预防性CXL，采用短核黄素浸泡时间和低紫外线能量。第2组（50例患者的86只眼）角膜地形图正常，仅接受FS-LASIK，作为对照组。术前以及术后1周、1个月和12个月分析屈光和视觉效果以及Scheimpflug地形图/断层扫描。计算前后表面三个子区域（中央3.0毫米区域、旁中央3.0 - 6.0毫米区域和周边6.0 - 9.0毫米区域）的平均区域角膜曲率（M）值。
与术后1个月相比，第1组术后12个月时周边前表面变平增加，后旁中央区域变陡更明显。这些结果比第2组显著更明显（分别为P < 0.001和P = 0.035）。两组的屈光和视觉效果相当。
预防性CXL似乎会影响术后角膜区域重塑，而不影响1年的视觉和屈光结果。
