Celik-Buyuktepe Tuna, Ucakhan Omur O
Department of Ophthalmology, Unye State Hospital, Ordu, Turkey.
Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey.
Curr Eye Res. 2025 Jan;50(1):32-40. doi: 10.1080/02713683.2024.2385441. Epub 2024 Aug 1.
To comparatively evaluate the influence of different riboflavin formulations and soaking durations on the anterior segment optical coherence tomography (AS-OCT) findings following accelerated corneal crosslinking (ACXL) at 9 mW/cm for in progressive keratoconus.
In this prospective study, consecutive patients with progressive keratoconus were randomized into 4 groups. Group 1: hydroxypropyl methylcellulose (HPMC)-based riboflavin for 10 min; Group 2: HPMC-based riboflavin for 20 min; Group 3: dextran-based riboflavin (0.1%) for 30 min. Riboflavin soaking was followed by ultraviolet-A irradiation at 9 mW/cm for 10 min in all three groups. Group 4 underwent conventional CXL (CCXL) using Dresden protocol. The AS-OCT features of the crosslinked cornea were evaluated at postoperative month 1 and correlated to the clinical outcomes at postoperative month 12.
The study enrolled 26 eyes of 26 patients in each group. In groups 1 and 2, the AS-OCT findings were similar ( > .05) and the demarcation lines depth (DLD) were deep as obtained following CCXL. The DLD was significantly shallower in group 3 compared to the other groups ( < .01). There were no between-group differences in regards to the visual, refractive, keratometric, and tomographic outcomes at postoperative month 12. No significant endothelial cell loss or any other clinically significant adverse event was encountered in any patient's eye at 12 months follow-up.
Although structural variations were noted in the crosslinked cornea, DLDs observed following ACXL (9 mW/cm) using HPMC-based solution for 10 or 20 min were similar to those observed following CCXL. Whereas, ACXL (9 mW/cm) using dextran-based solution for 30 min resulted in the shallowest DLD. Despite these remodeling differences, the visual, refractive and tomographic outcomes of all groups were comparable at postoperative 1-year follow-up. Studies with a greater number of patients and longer follow-ups are required to establish any relation between AS-OCT characteristics of crosslinked cornea and ACXL efficacy.
比较评估不同核黄素制剂和浸泡时间对进行性圆锥角膜患者在9 mW/cm加速角膜交联（ACXL）后眼前节光学相干断层扫描（AS-OCT）结果的影响。
在这项前瞻性研究中，将连续的进行性圆锥角膜患者随机分为4组。第1组：基于羟丙基甲基纤维素（HPMC）的核黄素浸泡10分钟；第2组：基于HPMC的核黄素浸泡20分钟；第3组：基于右旋糖酐的核黄素（0.1%）浸泡30分钟。三组在核黄素浸泡后均接受9 mW/cm的紫外线A照射10分钟。第4组采用德累斯顿方案进行传统角膜交联（CCXL）。在术后1个月评估交联角膜的AS-OCT特征，并与术后12个月的临床结果相关联。
每组纳入26例患者的26只眼。第1组和第2组的AS-OCT结果相似（P>0.05），分界线深度（DLD）与CCXL后获得的深度相同。与其他组相比，第3组的DLD明显更浅（P<0.01）。术后12个月时，各组在视力、屈光、角膜曲率和断层扫描结果方面无组间差异。在12个月的随访中，任何患者的眼睛均未出现明显的内皮细胞丢失或任何其他具有临床意义的不良事件。
尽管交联角膜存在结构差异，但使用基于HPMC的溶液进行10或20分钟的ACXL（9 mW/cm）后观察到的DLD与CCXL后观察到的相似。而使用基于右旋糖酐的溶液进行30分钟的ACXL（9 mW/cm）导致DLD最浅。尽管存在这些重塑差异，但所有组在术后1年随访时的视力、屈光和断层扫描结果相当。需要进行更多患者和更长随访时间的研究，以确定交联角膜的AS-OCT特征与ACXL疗效之间的任何关系。
