Nieuwsma Abigail, Vander Zee Brandon L, Berdahl John P, Ibach Mitch, Ferguson Tanner J, Terveen Daniel
University of Texas Health, San Antonio, TX, USA.
University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
Ther Adv Ophthalmol. 2023 Sep 15;15:25158414231197064. doi: 10.1177/25158414231197064. eCollection 2023 Jan-Dec.
Corneal cross-linking (CXL) is a safe and effective procedure for slowing keratectasia progression in eyes with a corneal thickness of at least 400 µm. Limited research has evaluated the safety and efficacy of epi-off CXL in corneas thinner than 400 µm.
To evaluate the safety and efficacy of CXL to slow keratectasia progression in eyes with <400 µm preoperative corneal thickness.
Retrospective chart review.
This retrospective chart review included 37 eyes who underwent epi-off, iso-osmolar riboflavin corneal CXL with a preoperative thinnest point of the cornea <400 µm and had at least 6-12 months of follow-up. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity (BCVA), thinnest point of the cornea, flat keratometry, steep keratometry, maximum keratometry (K), need for penetrating keratoplasty, and cases of endothelial failure were recorded. Data were collected at baseline and months 3, 6, 9, and 12 post-CXL.
Following cross-linking, 18 eyes (47%) had improved BCVA, 13 (35%) had an unchanged BCVA, and 6 eyes (16%) had a worse BCVA ( = 0.05). The mean postoperative BCVA was 20/81 (0.61 LogMAR) compared to 20/121 (0.78 LogMAR) preoperatively ( = 0.06). K decreased an average of 1.1 D at 3-month ( = 0.53) and 3.4 D at the furthest follow-up ( = 0.10). At the farthest follow-up, 22.7% of eyes had >1 D of K steepening. No patients required keratoplasty and there were no cases of endothelial failure in the follow-up period.
This research supports the safety and efficacy of epi-off, iso-osmolar CXL in eyes with <400 μm baseline corneal thickness with no patients requiring penetrating or endothelial keratoplasty, a trend toward improvement in BCVA, and K flattening. In the future, prospective studies would be helpful to confirm these findings.
角膜交联术（CXL）是一种安全有效的手术，可减缓角膜厚度至少为400μm的眼睛中圆锥角膜的进展。有限的研究评估了上皮移除CXL在厚度小于400μm的角膜中的安全性和有效性。
评估CXL对减缓术前角膜厚度<400μm的眼睛中圆锥角膜进展的安全性和有效性。
回顾性病历审查。
这项回顾性病历审查纳入了37只眼睛，这些眼睛接受了上皮移除、等渗核黄素角膜CXL，术前角膜最薄点<400μm，且至少随访了6至12个月。记录术前和术后的未矫正视力、最佳矫正视力（BCVA）、角膜最薄点、平坦角膜曲率、陡峭角膜曲率、最大角膜曲率（K）、穿透性角膜移植术的需求以及内皮功能衰竭的病例。在基线以及CXL术后3、6、9和12个月收集数据。
交联术后，18只眼睛（47%）的BCVA有所改善，13只眼睛（35%）的BCVA不变，6只眼睛（16%）的BCVA变差（P = 0.05）。术后平均BCVA为20/81（0.61 LogMAR），术前为20/121（0.78 LogMAR）（P = 0.06）。K在3个月时平均下降1.1D（P = 0.53），在最远随访时下降3.4D（P = 0.10）。在最远随访时，22.7%的眼睛K增加>1D。随访期间没有患者需要角膜移植术，也没有内皮功能衰竭的病例。
本研究支持上皮移除、等渗CXL在基线角膜厚度<400μm的眼睛中的安全性和有效性，没有患者需要穿透性或内皮角膜移植术，BCVA有改善趋势，且K变平。未来，前瞻性研究将有助于证实这些发现。
