Corneal and Refractive Surgery, HDR Vision Research Center, Hoopes Vision, Draper, UT.
Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT.
Cornea. 2024 Sep 1;43(9):1184-1197. doi: 10.1097/ICO.0000000000003536. Epub 2024 May 17.
The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events.
A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL.
Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen's D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively.
Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.
本综述旨在总结不同的手术方法，即将光折射性角膜切削术（PRK）与角膜交联术（CXL）相结合，以简单的格式呈现每个方案模板，并概述主要结果和不良事件。
按照系统评价和荟萃分析指南的要求进行文献回顾。共检索了 8 个不同的数据库。如果 PRK 后立即进行 CXL，则纳入研究。
37 篇论文符合纳入标准，总产率为 823 篇。最近的研究表明，同时进行 PRK 和 CXL 不仅可以稳定角膜，防止圆锥角膜进展，还可以提高患者的视力。考虑到所有方案，未矫正远视力和（眼镜）矫正远视力的改善均具有显著意义。在 K1、K2、平均 K、Kmax、球镜、柱镜和等效球镜方面也有显著降低。随机效应分析证实了这些趋势。校正远视力平均提高了 0.18 ± 1.49 logMAR（Cohen's D [CD] 0.12；P <0.02）。Kmax 也显著降低了 2.57 ± 0.45 D（CD 5.74；P <0.001）。柱镜和等效球镜也分别降低了 1.36 ± 0.26 D（CD 5.25；P <0.001）和 2.61 ± 0.38 D（CD 6.73；P <0.001）。
联合这两种手术似乎具有净效益，可稳定和改善扩张性疾病，同时提高视力。由于个性化 PRK 和 CXL 方法似乎更优越，因此将这两种方法结合起来可能对患者最有利。
