Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TUM, Munich, Germany.
Technische Universität München, Munich, Germany.
Graefes Arch Clin Exp Ophthalmol. 2024 Mar;262(3):871-877. doi: 10.1007/s00417-023-06225-8. Epub 2023 Sep 6.
To evaluate long-term results of accelerated corneal cross-linking (ACXL) in patients with progressive keratoconus, seventy-four eyes of 53 patients with progressive keratoconus (documented Kmax progression > 1D/a) who underwent ACXL (18mW/cm2 for 5 min) were included in a retrospective observational clinical study. The investigation focused on tomographic and keratometric parameters, refractive data, and visual outcomes at 5 years follow-ups.
Corrected distance visual acuity (CDVA), slit lamp, and Pentacam® examinations were conducted, including assessments of thinnest corneal point (TP), minimum radius (Rmin), corneal astigmatism, and maximum anterior keratometry (Kmax). These examinations were performed two weeks before the surgery and, on average, 56 months after the surgery. In a subgroup of 24 eyes, Pentacam® examination data from an intermediate visit at 12 months until the final visit was evaluated to confirm continuous stability. The ACXL protocol included corneal abrasion, hydroxypropylmethylcellulose (HPMC)-riboflavin eye drops administered every 5 min for a total duration of 30 min, and irradiation with 18mW/cm2 for 5 min using riboflavin eye drops applied every minute during the irradiation process. Intraoperatively, minimal corneal pachymetry of > 400 µm was ensured in every patient.
After 56 months, all values exhibited statistically significant changes (paired t-test; CDVA p = 0.002; Kmax p < 0.001; Rmin p < 0.001; astigmatism p = 0.03; TP p < 0.001). In the subgroup analysis of 24 eyes, which included tomographical and keratometric parameters, no statistically significant changes were observed during the last 12 months of observation (paired t-test; Kmax p = 0.72; Rmin p = 0.67; astigmatism p = 0.72). Treatment failure was strictly defined as an increase in Kmax (> 1D) during the 5-year follow-up and was observed in only 3 eyes (4%).
ACXL is an effective and safe treatment for patients with progressive keratoconus. Our results demonstrate improvements in functional and tomographical outcomes even after high-energy ACXL (18mW/cm2 for 5 min) over a long-term period of 56 months. Our analysis indicates stable conditions in previously progressive keratoconus, particularly during the final year of the observation period. The treatment failure rate was 4%.
评估渐进性圆锥角膜患者接受加速角膜交联术（ACXL）的长期疗效。本研究回顾性观察了 53 例（74 只眼）接受 ACXL（18mW/cm2 照射 5 分钟）治疗的进展性圆锥角膜患者，这些患者的最大角膜曲率（Kmax）进展>1D/年。研究重点关注了术后 5 年随访时的角膜地形图和角膜曲率参数、屈光数据和视力结果。
在术前两周和术后平均 56 个月时进行了视力、裂隙灯和 Pentacam®检查，包括测量角膜最薄点（TP）、最小曲率半径（Rmin）、角膜散光和最大角膜前曲率（Kmax）。在 24 只眼中的亚组中，评估了从术后 12 个月至最后一次随访的中间随访期间的 Pentacam®检查数据，以确认持续稳定性。ACXL 方案包括角膜表面刮除、羟丙基甲基纤维素（HPMC）-核黄素滴眼剂，每 5 分钟滴眼一次，共 30 分钟，然后使用核黄素滴眼剂以 18mW/cm2 照射 5 分钟，在照射过程中每 1 分钟滴一次。术中确保每位患者的角膜最小厚度>400μm。
术后 56 个月，所有值均表现出统计学显著变化（配对 t 检验；视力 p=0.002；Kmax p<0.001；Rmin p<0.001；散光 p=0.03；TP p<0.001）。在 24 只眼的亚组分析中，包括角膜地形图和角膜曲率参数，在最后 12 个月的观察期间未观察到统计学显著变化（配对 t 检验；Kmax p=0.72；Rmin p=0.67；散光 p=0.72）。治疗失败严格定义为在 5 年随访期间 Kmax 增加（>1D），仅在 3 只眼中（4%）观察到。
ACXL 是治疗进展性圆锥角膜的有效且安全的方法。我们的结果表明，即使在 56 个月的长期随访中使用高能量 ACXL（18mW/cm2 照射 5 分钟），也能改善功能和角膜地形图结果。我们的分析表明，先前进展性圆锥角膜的情况稳定，特别是在观察期的最后一年。治疗失败率为 4%。
