Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
Cornea. 2023 Apr 1;42(4):423-428. doi: 10.1097/ICO.0000000000003165. Epub 2022 Nov 30.
Keratoconus is a progressive visually impairing disorder. Despite the beneficial effects of epithelial off-crosslinking (CXL) on the stabilization of keratoconus, progression may still occur. We report the efficacy and safety of a repeated CXL for significant progression of keratoconus after a single CXL procedure.
This retrospective study includes patients diagnosed with progressive keratoconus who were previously treated with CXL and underwent repeated CXL. Demographic, clinical, and surgical data were retrieved and analyzed.
Ten consecutive eyes of nine patients who developed progressive keratoconus after CXL were identified. The mean age at diagnosis of keratoconus was 20.2 ± 6.0 years. The post-repeated CXL follow-up period was 2.1 ± 1.3 years. The mean best corrected visual acuity (BCVA) remained stable throughout the follow-up period. The mean Kmax at baseline was 60.4 ± 3.6 D. Before the repeated CXL, Kmax progressed significantly ( P = 0.018) and was 62.2 ± 6.3 D, and at the last follow-up, the value decreased significantly ( P = 0.037) and was 60.3 ± 6.4 D. The mean minimal pachymetry was 464.0 ± 27.0 µ at base line. Before the repeated CXL, minimal pachymetry was significantly lower ( P = 0.018), and after the repeated CXL, the minimal pachymetry was stable ( P = 0.2). No intra- or postoperative complications were noted.
Repeated CXL is a safe and effective treatment option when failure of the initial CXL is diagnosed, even in young patients. This procedure may prevent visual deterioration and a potential need for keratoplasty.
圆锥角膜是一种进行性视力损害疾病。尽管上皮下交联（CXL）对圆锥角膜的稳定有有益的影响，但进展仍可能发生。我们报告了在单次 CXL 手术后，对圆锥角膜明显进展的患者进行重复 CXL 的疗效和安全性。
本回顾性研究纳入了先前接受过 CXL 治疗并接受重复 CXL 的进展性圆锥角膜患者。回顾性收集并分析了患者的人口统计学、临床和手术数据。
确定了 9 例患者的 10 只眼在 CXL 后发生进展性圆锥角膜。圆锥角膜诊断时的平均年龄为 20.2±6.0 岁。重复 CXL 后的随访时间为 2.1±1.3 年。整个随访期间最佳矫正视力（BCVA）保持稳定。基线时平均 Kmax 为 60.4±3.6D。在重复 CXL 之前，Kmax 显著进展（P=0.018），为 62.2±6.3D，在最后一次随访时，Kmax 值显著下降（P=0.037），为 60.3±6.4D。平均最小角膜厚度（pachymetry）基线值为 464.0±27.0µ。在重复 CXL 之前，最小角膜厚度显著降低（P=0.018），重复 CXL 后最小角膜厚度稳定（P=0.2）。未观察到术中或术后并发症。
当最初的 CXL 失败时，重复 CXL 是一种安全有效的治疗选择，即使是在年轻患者中。该手术可预防视力恶化和潜在的角膜移植需求。
