Mazharian Adrien, Flamant Roxane, Elahi Sina, Panthier Christophe, Rampat Radhika, Gatinel Damien
Centre d'Explorations et de Recherche en Optique Visuelle (CEROV), Hôpital Fondation Rothschild, Paris, France.
Front Med (Lausanne). 2023 May 24;10:1152266. doi: 10.3389/fmed.2023.1152266. eCollection 2023.
To study the progression of keratoconus after cessation of eye rubbing with a minimum follow up of three-years.
Retrospective, monocentric, longitudinal cohort study of keratoconus patients with a minimum of 3 years follow-up.
One hundred fifty three eyes of seventy-seven consecutive patients with keratoconus were included.
Initial examination consisted of anterior and posterior segment evaluation using slit-lamp biomicroscopy. At the initial visit, patients were thoroughly informed of their pathology and instructed to stop rubbing their eyes. Eye rubbing cessation was assessed at all the follow-up visits at 6 months, 1 year, 2 years, 3 years, and yearly afterward. Corneal topography using the Pentacam® (Oculus®, Wetzlar, Germany) was used to obtain maximum and average anterior keratometry readings (Kmax and Kmean), as well as thinnest pachymetry (Pachymin, μm) in both eyes.
The main outcomes measured were maximum keratometry (Kmax), mean keratometry (Kmean), and thinnest pachymetry (Pachymin) values at various time points to assess for keratoconus progression. Keratoconus progression was defined as a significant augmentation of Kmax (>1D), Kmean (>1D), or significant diminution of Pachymin (>5%) throughout the total follow-up duration.
One hundred fifty three eyes of seventy-seven patients (75.3% males) aged 26.4 years old, were followed for an average of 53 months. Over the course of the follow-up, there was no statistically significant variation of ∆Kmax (+0.04 ± 0.87; = 0.34), ∆ Kmean (+0.30 ± 0.67; = 0.27) nor ∆Pachymin (-4.36 ± 11.88; = 0.64). Among the 26 of the 153 eyes which had at least one criterion of KC progression, 25 admitted continuing eye rubbing, or other at-risk behaviors.
This study suggests that a significant proportion of keratoconus patients are likely to remain stable if close monitoring and strict ARB cessation are achieved, without the need for further intervention.
研究圆锥角膜患者停止揉眼后至少三年的病情进展情况。
对圆锥角膜患者进行回顾性、单中心、纵向队列研究，随访时间至少3年。
纳入77例连续圆锥角膜患者的153只眼。
初始检查包括使用裂隙灯生物显微镜对眼前段和后段进行评估。在初次就诊时，向患者详细告知其病情，并指导他们停止揉眼。在所有随访中，即6个月、1年、2年、3年时以及之后每年，评估是否停止揉眼。使用Pentacam®（德国韦茨拉尔奥culus公司）进行角膜地形图检查，以获取双眼的最大和平均前表面角膜曲率读数（Kmax和Kmean）以及最薄角膜厚度（Pachymin，μm）。
测量的主要结果是不同时间点的最大角膜曲率（Kmax）、平均角膜曲率（Kmean）和最薄角膜厚度（Pachymin）值，以评估圆锥角膜的进展情况。圆锥角膜进展定义为在整个随访期间Kmax（>1D）、Kmean（>1D）显著增加，或Pachymin显著减少（>5%）。
77例患者（75.3%为男性）的153只眼，年龄26.4岁，平均随访53个月。在随访过程中，∆Kmax（+0.04±0.87；P = 0.34）、∆Kmean（+0.30±0.67；P = 0.27）和∆Pachymin（-4.36±11.88；P = 0.64）均无统计学显著变化。在153只眼中，有26只至少有一项圆锥角膜进展标准，其中25只承认继续揉眼或有其他高危行为。
本研究表明，如果实现密切监测并严格停止高危行为，很大一部分圆锥角膜患者可能保持病情稳定，无需进一步干预。
