Abbondanza Eye Centres, Rome and Milan, Italy.
St. Luke's International University, Tokyo, Japan.
Semin Ophthalmol. 2023 Oct;38(7):630-637. doi: 10.1080/08820538.2023.2179407. Epub 2023 Mar 7.
This study aims to determine whether customised peripheral corneal cross-linking (P-CXL) can halt keratoconus progression in ultrathin corneas with stage 3 and 4 keratoconus, with thinnest pachymetry well below 400 μm and therefore excluded from most treatment protocols.
This retrospective study included 21 eyes with progressive keratoconus and thinnest pachymetry ranging from 97 to 399 μm (mean 315 μm), who underwent P-CXL between 2007 and 2020. The procedure involved preoperative NSAIDs therapy, tomography-guided customized epithelial debridement, the use of both hypo-osmolar and iso-osmolar riboflavin solutions, and 9.0 mW/cm UV-A irradiation for 10 minutes. The outcome measures were best spectacle-corrected visual acuity (BSCVA), mean keratometry, maximum keratometry, and thinnest pachymetry.
After a minimum follow-up period of 12 months, P-CXL stabilized or improved mean keratometry and maximum keratometry in 85.7% of eyes (Kavg from 57.48 ± 9.38 to 56.43 ± 8.96 D, < 0.001; Kmax from 72.77 ± 12.74 to 70.00 ± 11.50 D, < 0.001), BSCVA in 90.5% of eyes (from 4.48 ± 2.85 to 5.72 ± 3.34 decimals, < 0.001), and thinnest pachymetry in 81% of eyes (from 315.81 ± 90.05 to 342.33 ± 74.22 μm, = 0.08). No adverse events and no loss of endothelial cell density occurred.
Customised peripheral corneal cross-linking (P-CXL) treated very severe keratoconus with a success rate of 85.7% and improved visual acuity and tomographic indicators in most cases. While a longer follow-up and a larger sample would help to support such conclusions to a greater extent, these results allow to broaden the treatment spectrum for patients with stage 3 and 4 keratoconus and contact lens tolerance.
本研究旨在确定定制化周边角膜交联术（P-CXL）是否可以阻止处于 3 期和 4 期的超薄角膜圆锥角膜的进展，这些角膜的最薄角膜厚度低于 400μm，因此不符合大多数治疗方案的要求。
这是一项回顾性研究，纳入了 21 只患有进展性圆锥角膜且最薄角膜厚度在 97μm 至 399μm 之间（平均 315μm）的眼。这些眼在 2007 年至 2020 年间接受了 P-CXL 治疗。该手术包括术前 NSAIDs 治疗、基于断层扫描的定制化上皮清创术、使用低渗和等渗核黄素溶液以及 9.0mW/cm 的 UV-A 照射 10 分钟。主要观察指标包括最佳矫正视力（BSCVA）、平均角膜曲率、最大角膜曲率和最薄角膜厚度。
在 12 个月的最短随访期后，85.7%的眼的 P-CXL 稳定或改善了平均角膜曲率和最大角膜曲率（Kavg 从 57.48±9.38 降至 56.43±8.96D， <0.001；Kmax 从 72.77±12.74 降至 70.00±11.50D， <0.001）、90.5%的眼的 BSCVA（从 4.48±2.85 提高至 5.72±3.34 小数， <0.001）和 81%的眼的最薄角膜厚度（从 315.81±90.05 提高至 342.33±74.22μm， =0.08）。没有发生不良事件和内皮细胞密度损失。
定制化周边角膜交联术（P-CXL）治疗非常严重的圆锥角膜成功率为 85.7%，并在大多数情况下改善了视力和断层扫描指标。虽然更长的随访和更大的样本量将有助于更大程度地支持这些结论，但这些结果使我们能够为 3 期和 4 期圆锥角膜患者拓宽治疗范围，并提高他们对接触镜的耐受性。
