Saad Sami, Saad Rana, Goemaere Isabelle, Cuyaubere Roxane, Borderie Marie, Borderie Vincent, Bouheraoua Nacim
CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France.
Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France.
J Clin Med. 2023 Apr 18;12(8):2931. doi: 10.3390/jcm12082931.
To investigate the outcomes of accelerated (A-CXL) and iontophoresis (I-CXL) corneal crosslinking in a large retrospective cohort with progressive keratoconus.
This retrospective observational cohort study included consecutive patients treated by A-CXL (9 mW/5.4 J/cm) or I-CXL with a minimal follow-up of 12 months. Visual acuity, manifest refraction, topography, specular microscopy, and corneal optical coherence tomography (OCT) were evaluated at baseline and at the last visit. Progression was defined as an increase in the maximum topographic keratometry (Kmax) of 1D.
302 eyes of 241 patients with a mean age of 25.2 ± 7.5 years were included from 2012 to 2019: 231 and 71 eyes in the A-CXL and I-CXL groups, respectively. The mean follow-up was 27.2 ± 13.2 months (maximum: 85.7 months). Preoperatively, the mean Kmax was 51.8 ± 4.0D, with no differences between groups. Mean topographic measurements and spherical equivalent remained stable during the follow-up. At the last visit, CXL failure was reported in 60 eyes (19.9%): 40 (14.7%) versus 20 (28.2%) in A-CXL versus I-CXL, respectively, = 0.005. The likelihood of progression after CXL was significantly higher following I-CXL: RR = 1.62, CI95 = [1.02 to 2.59], = 0.04. Demarcation line presence at 1 month was positively correlated with higher efficacy of CXL, = 0.03. No endothelial damage was reported, especially in 51 thin corneas (range = 342-399 µm).
A-CXL seems more effective than I-CXL in stabilizing keratoconus; this is to be taken into account when a therapeutic indication is posed according to the aggressiveness of the keratoconus.
在一个大型回顾性队列中研究加速角膜交联术（A-CXL）和离子导入角膜交联术（I-CXL）治疗进行性圆锥角膜的效果。
这项回顾性观察性队列研究纳入了接受A-CXL（9 mW/5.4 J/cm）或I-CXL治疗且随访至少12个月的连续患者。在基线和最后一次随访时评估视力、显验光、角膜地形图、角膜内皮显微镜检查以及角膜光学相干断层扫描（OCT）。进展定义为最大角膜地形图角膜曲率（Kmax）增加1D。
2012年至2019年纳入了241例平均年龄为25.2±7.5岁患者的302只眼：A-CXL组和I-CXL组分别为231只眼和71只眼。平均随访时间为27.2±13.2个月（最长：85.7个月）。术前，平均Kmax为51.8±4.0D，两组之间无差异。随访期间平均角膜地形图测量值和等效球镜度保持稳定。在最后一次随访时，报告有60只眼（19.9%）CXL失败：A-CXL组为40只眼（14.7%），I-CXL组为20只眼（28.2%），P = 0.005。I-CXL后CXL进展的可能性显著更高：风险比（RR）= 1.62，95%置信区间（CI）=[1.02至2.59]，P = 0.04。1个月时出现分界线与CXL更高的疗效呈正相关，P = 0.03。未报告有内皮损伤，尤其是在51只薄角膜（范围= 342 - 399 µm）中。
在稳定圆锥角膜方面，A-CXL似乎比I-CXL更有效；根据圆锥角膜的严重程度提出治疗指征时应考虑这一点。
