Li Gavin, Di Meglio Laura, Wang Jiangxia, Woreta Fasika A, Bower Kraig S, Jhanji Vishal, Srikumaran Divya, Soiberman Uri S
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
J Ophthalmol. 2022 Jun 1;2022:4661392. doi: 10.1155/2022/4661392. eCollection 2022.
To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC).
Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up.
Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, =0.026). Group 1 eyes had higher baseline K1 (=0.026), K2 (=0.006), Km (=0.01), and Kmax (=0.002) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax ( < 0.01); progressors also had thinner pachymetry at the pupil, apex, and thinnest point ( < 0.01). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, K > 47.9D, astigmatism > 1.4D, pachymetry at the pupil <475 m, and thinnest pachymetry <478 m were tentative predictors of progression in the naïve fellow eye.
Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.
评估对于圆锥角膜（KC）患者，单眼交联术（CXL）联合对侧眼保守随访是否为一种可接受的治疗策略。
纳入79例最初接受单眼CXL的KC患者的对侧眼。30例对侧眼最终接受了CXL（第1组），而49例对侧眼进行了随访（第2组）。在所有眼睛术前及最后一次随访时收集最佳矫正视力（BSCVA）和角膜断层扫描参数。
对侧眼接受CXL的患者（第1组）比未接受的患者（第2组，P = 0.026）更年轻。与第2组眼睛相比，第1组眼睛的基线K1（P = 0.026）、K2（P = 0.006）、Km（P = 0.01）和Kmax（P = 0.002）更高。在49只未治疗的对侧眼（第2组）中，19只眼有进展迹象。进展的未治疗眼有更高的基线K1、K2、Km和Kmax（P < 0.01）；进展者在瞳孔、顶点和最薄点处的角膜厚度也更薄（P < 0.01）。基线值K1≥43.5屈光度（D）、K2 > 45.1D、Km > 44.3D、K > 47.9D、散光> 1.4D、瞳孔处角膜厚度< 475μm和最薄角膜厚度< 478μm是未治疗对侧眼进展的初步预测指标。
对于一部分KC眼，单眼CXL联合对侧眼的密切随访可能是一种可接受的治疗策略。
