Gil Pedro, Gil João Quadrado, Dias Margarida, Cunha Bruna, Alves Nuno, Rosa Andreia, Murta Joaquim
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
São José Local Health Unit, Lisbon, Portugal.
Cornea. 2024 Jul 31;44(8):983-991. doi: 10.1097/ICO.0000000000003653.
To perform a comparative analysis of visual, refractive, and tomographic outcomes of combined topography-guided photorefractive keratectomy (TG-PRK) and corneal crosslinking (CXL) in patients with progressive versus stable keratoconus.
Longitudinal retrospective case-control study. Patients with keratoconus submitted to simultaneous TG-PRK and CXL were included, with a minimum follow-up of 12 months up to 3 years. According to predefined disease progression criteria, patients were considered as progressive or stable.
A total of 101 eyes from 93 patients were included, 62 considered progressive and 39 stable keratoconus. All baseline characteristics were similar between groups, except for age at surgery (progressive: 23.40 ± 4.22 years; stable: 35.97 ± 9.09; P < 0.001). Logarithm of the minimum angle of resolution CDVA improved significantly in progressive (baseline: 0.48 ± 0.24; 12 months: 0.33 ± 0.29; P < 0.001) and stable (baseline: 0.51 ± 0.24; 12 months: 0.28 ± 0.21; P < 0.001) patients, with no differences between groups. Maximum keratometry decreased significantly in progressive (baseline: 59.18 ± 5.63 diopters; 12 months: 54.73 ± 5.95; P < 0.001) and stable (baseline: 57.77 ± 5.02; 12 months: 53.59 ± 4.20; P < 0.001) patients, with no differences between groups. Index of surface variance significantly improved in progressive (baseline: 109.18 ± 31.74 diopters; 12 months: 94.11 ± 34.11; P < 0.001) and stable (baseline: 102.87 ± 29.52; 12 months: 86.95 ± 27.21; P < 0.001) patients, with no differences between groups. Other tomographic outcomes were also similar between groups. Pachymetry significantly decreased after surgery but remained stable throughout the follow-up.
Combined TG-PRK and CXL is a safe and effective procedure for improving CDVA and regularizing the cornea, with comparable visual, refractive, and tomographic outcomes in both progressive and stable keratoconus. Combined TG-PRK and CXL may be added to the armamentarium of therapeutic tools for visual rehabilitation in patients with stable keratoconus.
对圆锥角膜进展期和稳定期患者行角膜地形图引导的准分子原位角膜磨镶术（TG-PRK）联合角膜交联术（CXL）后的视力、屈光及断层扫描结果进行对比分析。
纵向回顾性病例对照研究。纳入同时行TG-PRK和CXL的圆锥角膜患者，随访时间至少12个月，最长3年。根据预先定义的疾病进展标准，将患者分为进展期或稳定期。
共纳入93例患者的101只眼，其中62例为进展期圆锥角膜，39例为稳定期圆锥角膜。除手术年龄外（进展期：23.40±4.22岁；稳定期：35.97±9.09岁；P<0.001），两组所有基线特征相似。进展期（基线：0.48±0.24；12个月：0.33±0.29；P<0.001）和稳定期（基线：0.51±0.24；12个月：0.28±0.21；P<0.001）患者的最小分辨角对数视力（logMAR CDVA）均显著改善，两组间无差异。进展期（基线：59.18±5.63屈光度；12个月：54.73±5.95；P<0.001）和稳定期（基线：57.77±5.02；12个月：53.59±4.20；P<0.001）患者的最大角膜曲率均显著降低，两组间无差异。进展期（基线：109.18±31.74屈光度；12个月：94.11±34.11；P<0.001）和稳定期（基线：102.87±29.52；12个月：86.95±27.21；P<0.001）患者的表面方差指数均显著改善，两组间无差异。两组间其他断层扫描结果也相似。术后角膜厚度显著降低，但在整个随访过程中保持稳定。
TG-PRK联合CXL是一种安全有效的改善CDVA和使角膜规则化的手术，进展期和稳定期圆锥角膜患者的视力、屈光及断层扫描结果相当。TG-PRK联合CXL可作为稳定期圆锥角膜患者视觉康复治疗手段之一。
