Vilares-Morgado Rodrigo, Ferreira Ana Margarida, Cunha Ana Maria, Moreira Raúl, Torrão Luís, Neves-Cardoso Pedro, Pinheiro-Costa João
Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal.
Clin Ophthalmol. 2024 Feb 8;18:393-407. doi: 10.2147/OPTH.S450916. eCollection 2024.
To report the 4-year outcomes of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) in the treatment of eyes with progressive keratoconus (KC).
Eyes of patients who underwent TE-ACXL (6mW/cm for 15 minutes) for progressive KC and presented 48 months of follow-up were included. Corrected distance visual acuity (CDVA), keratometry measurements (Kmax, maximum keratometry, Kmean, mean keratometry and Astg, corneal astigmatism), thinnest corneal thickness (PachyMin), and topographic, and tomographic indices (specifically the posterior radius of curvature from the 3.0 mm centered on the thinnest point of the cornea (PRC), and the D-index) were analysed preoperatively and every 12 months after TE-ACXL, up to 48 months. Progression after TE-ACXL was considered when eyes presented ≥1 criteria: (1) increase of ≥1D in Kmax or increase of ≥0.75D in Kmean or increase of ≥1D in Astg; (2) reduction of ≥0.085 mm in PRC; (3) decrease ≥5% in PachyMin.
41 eyes from 30 patients were included, with a mean age at crosslinking of 20.90±4.69 years. There was a significant increase in Kmean (+0.64±1.04 D, <0.001; +0.98 ± 1.49 D, <0.001; +1.27±2.01 D, <0.001; +1.13±2.00 D, =0.006) and a significant decrease in PRC throughout follow-up (-0.12±0.22, p=0.002; -0.15±0.24, <0.001; -0.17±0.43, =0.021; -0.16±0.43, =0.027). PachyMin decreased significantly at 36 and 48 months (-8.50±15.93 μm, =0.004; -7.82±18.37, =0.033). According to our progression criteria, there was a major progression rate throughout follow-up (57.1%, 61.1%, 58.8%, and 67.9%, respectively). Surgery and follow-up were uneventful in all subjects. Eleven eyes (26.8%) required further procedures, ≥36 months after the initial TE-ACXL, due to persistent progressive disease.
TE-ACXL proved to be a safe therapeutic option for progressive KC. However, its efficacy is deemed unsatisfactory, as a notable proportion of affected eyes may continue to advance within a 4-year timeframe, necessitating additional procedures to halt the disease's course.
报告经上皮加速角膜胶原交联术（TE-ACXL）治疗进展性圆锥角膜（KC）4年的疗效。
纳入接受TE-ACXL（6mW/cm，持续15分钟）治疗进展性KC且随访48个月的患者的眼睛。在术前以及TE-ACXL术后每12个月直至48个月，分析矫正远视力（CDVA）、角膜曲率测量值（Kmax，最大角膜曲率；Kmean，平均角膜曲率；Astg，角膜散光）、最薄角膜厚度（PachyMin）以及地形图和断层扫描指标（特别是以角膜最薄点为中心的3.0mm处的后表面曲率半径（PRC）和D指数）。当眼睛出现以下≥1条标准时，考虑为TE-ACXL术后病情进展：（1）Kmax增加≥1D或Kmean增加≥0.75D或Astg增加≥1D；（2）PRC减少≥0.085mm；（3）PachyMin减少≥5%。
纳入30例患者的41只眼睛，交联时的平均年龄为20.90±4.69岁。在整个随访期间，Kmean显著增加（+0.64±1.04D，<0.001；+0.98±1.49D，<0.001；+1.27±2.01D，<0.001；+1.13±2.00D，=0.006），PRC显著降低（-0.12±0.22，p=0.002；-0.15±0.24，<0.001；-0.17±0.43，=0.021；-0.16±0.43，=0.027）。PachyMin在36个月和48个月时显著降低（-8.50±15.93μm，=0.004；-7.82±18.37，=0.033）。根据我们的病情进展标准，在整个随访期间有较高的病情进展率（分别为57.1%、61.1%、58.8%和67.9%）。所有受试者的手术和随访过程均顺利。11只眼睛（26.8%）在初次TE-ACXL术后≥36个月因疾病持续进展需要进一步治疗。
TE-ACXL被证明是治疗进展性KC的一种安全的治疗选择。然而，其疗效被认为不令人满意，因为相当一部分患眼在4年时间内可能会继续进展，需要额外的治疗来阻止疾病的进程。
