Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Germany; and.
Imaging, Biomechanics and Mathematical Modeling Solutions Lab, Narayana Nethralaya Foundation, Bangalore, India.
Cornea. 2023 Nov 1;42(11):1365-1376. doi: 10.1097/ICO.0000000000003219. Epub 2023 Jan 19.
The aim of this study was to analyze the biomechanical effect of accelerated corneal cross-linking (9*10) in progressive keratoconus (KC) in comparison to untreated fellow eyes using Scheimpflug-based tonometry (Corvis ST, CVS).
Forty-three eyes of 43 patients with KC showed progressive KC and were treated using accelerated corneal cross-linking. Twenty-five untreated fellow eyes were used as the control group. All eyes were examined biomechanically (CVS) and tomographically (Pentacam) at baseline, after 1-month, 6-month, and 12-month follow-up. Statistical analysis was performed using a linear mixed model. A logistic regression was performed to attribute the effects of changes in each parameter to treatment status (treated or untreated).
Maximum keratometry values decreased statistically significantly at 12 months by -1.1 D (95 confidence interval: -2.0 to -0.1, P = 0.025) compared with baseline. Thinnest corneal thickness decreased significantly after 1 month ( P < 0.001) and recovered to baseline after 12 months ( P = 0.752). In the corneal cross-linking (CXL) group, biomechanical changes were observed by an increased bIOP, a shorter A2 time, and a lower integrated radius after 1 month (all P < 0.05). No biomechanical and tomographical changes were observed in the control group (all P > 0.05). Logistic regression pointed out that treated eyes can be separated from untreated eyes by differences in bIOP, corneal thickness, A1 velocity, integrated radius, and Kc mean at 1, 6, and 12 months.
The alterations in biomechanical parameters indicated a corneal stiffening effect after CXL treatment, which was mostly detectable 1 month after treatment, although corneal thickness was reduced. The logistic regression model showed an adequate separation between CXL-treated and untreated eyes.
本研究旨在分析使用基于Scheimpflug 的眼压测量（Corvis ST，CVS）比较未经治疗的对侧眼，在进展性圆锥角膜（KC）中加速角膜交联（9*10）的生物力学效应。
43 名 KC 患者的 43 只眼表现出进展性 KC，使用加速角膜交联进行治疗。25 只未经治疗的对侧眼作为对照组。所有眼均在基线、治疗后 1 个月、6 个月和 12 个月进行生物力学（CVS）和断层扫描（Pentacam）检查。使用线性混合模型进行统计分析。进行逻辑回归以将各参数变化的影响归因于治疗状态（治疗或未治疗）。
与基线相比，12 个月时最大角膜曲率值统计学上显著降低-1.1 D（95%置信区间：-2.0 至-0.1，P = 0.025）。1 个月后角膜最薄厚度显著降低（P < 0.001），12 个月后恢复至基线（P = 0.752）。在角膜交联（CXL）组中，1 个月时观察到生物力学变化，包括 bIOP 增加、A2 时间缩短和整合半径降低（均 P < 0.05）。对照组未观察到生物力学和断层扫描变化（均 P > 0.05）。逻辑回归指出，在 1、6 和 12 个月时，bIOP、角膜厚度、A1 速度、整合半径和 Kc 平均值的差异可将治疗眼与未治疗眼区分开来。
CXL 治疗后生物力学参数的变化表明角膜变硬效应，尽管角膜厚度降低，但在治疗后 1 个月即可检测到。逻辑回归模型显示 CXL 治疗与未治疗眼之间有足够的分离。
