Cehelyk Eli K, Syed Zeba A
Thomas Jefferson University.
Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Curr Opin Ophthalmol. 2024 Jul 1;35(4):315-321. doi: 10.1097/ICU.0000000000001054. Epub 2024 Apr 26.
This manuscript summarizes contemporary research from 2018 to 2023 evaluating long-term (≥2 years) outcomes of corneal crosslinking (CXL) for progressive keratoconus (KCN).
The standard Dresden protocol (SDP) has been utilized clinically since the early 2000 s to treat ectatic disorders, primarily progressive KCN and postrefractive ectasia. Various modifications have since been introduced including accelerated and transepithelial protocols, which are aimed at improving outcomes or reducing complications. This review summarizes data demonstrating that the SDP halts disease progression and improves various visual and topographic indices (UDVA, CDVA, Kmax, K1, K2) up to 13 years postoperatively. Accelerated and transepithelial protocols have been found to be well tolerated alternatives to SDP with similar efficacy profiles. Studies focusing on pediatric populations identified overall higher progression rates after CXL. All protocols reviewed had excellent safety outcomes in adults and children.
Recent studies revealed that SDP successfully stabilizes KCN long term, and a variety of newer protocols are also effective. Pediatric patients may exhibit higher progression rates after CXL. Further research is required to enhance the efficacy and ease of these protocols.
本手稿总结了2018年至2023年当代研究，评估角膜交联术（CXL）治疗进展性圆锥角膜（KCN）的长期（≥2年）疗效。
自21世纪初以来，标准德累斯顿方案（SDP）已在临床上用于治疗扩张性疾病，主要是进展性KCN和屈光术后扩张。此后引入了各种改良方案，包括加速和经上皮方案，旨在改善疗效或减少并发症。本综述总结的数据表明，SDP可阻止疾病进展，并在术后长达13年改善各种视觉和地形图指标（最佳矫正远视力、矫正视力、最大角膜曲率、K1、K2）。已发现加速和经上皮方案是SDP耐受性良好的替代方案，具有相似的疗效。针对儿科人群的研究发现，CXL术后总体进展率较高。所有审查的方案在成人和儿童中均具有出色的安全性。
最近的研究表明，SDP能成功长期稳定KCN，各种更新的方案也有效。儿科患者CXL术后可能有较高的进展率。需要进一步研究以提高这些方案的疗效和易用性。
