Gilevska Fanka, Biscevic Alma, Bohac Maja, Patel Sudi
Eye Clinic Sistina Oftalmologija, Skupi 5A, Skopje, Republic of North Macedonia.
Department of Cataract and Refractive Surgery, University Eye Hospital Svjetlost, 10000, Zagreb, Croatia.
Ophthalmol Ther. 2024 Oct;13(10):2599-2614. doi: 10.1007/s40123-024-00993-0. Epub 2024 Aug 7.
Objective markers describing corneal optical density (COD), thinnest corneal thickness (TCT), and anterior (ARC) and posterior (PRC) surface radii over the 3 mm thinnest region of the cornea were investigated to provide a model for estimating corrected distance visual acuity (CDVA) after corneal cross-linking (CXL) in keratoconus.
CDVA, COD, TCT, ARC, and PRC were monitored (using Pentacam™) over 1 year in patients with (1) keratoconus treated with routine CXL (2) relatively stable untreated keratoconus, and (3) age/gender-matched controls.
In group 1 (n = 77), the median logMAR CDVA (mode, interquartile range) improved significantly (p < 0.01) from 0.26 (0.22, 0.12-0.65) to 0.07 (0.00, 0.02-0.21). The mean (± standard deviation, 95% confidence interval) COD (in 0-100 grey scale units) in the 0-2 mm central anterior corneal region (0-2 ant), TCT (µm), ARC (mm), and PRC (mm) changed significantly (p < 0.01), from 21.2 (± 3.70, 20.4-22.0), 454 (± 40.0, 446-462), 6.49 (± 0.71, 6.33-6.65), and 4.81 (± 0.65, 4.66-4.96) to 31.5 (± 9.19, 29.5-33.6), 423 (± 49.3, 412-434), 6.78 (± 0.80, 6.60-6.98), and 4.74 (± 0.64, 4.59-4.88), respectively, but remained stable in groups 2 (n = 23) and 3 (n = 24). Significant relationships (p < 0.01) were uncovered between postop CDVA and preop values of COD, TCT, ARC, and PRC. Multilinear regression revealed significant correlations between CDVA at 1 year and preop COD, TCT, ARC, and PRC (r = 0.533, r = 0.126, r = 0.321, r = 0.506, r = 0.467). Including preop CDVA further enhanced this correlation (r = 0.637, r = 0.566).
CXL improved CDVA, increased COD and ARC, and reduced TCT and PRC. The chance of correctly estimating the CDVA at 1 year after CXL using preoperative markers of COD, TCT, ARC, and PRC is 53%, improving to 64% with the inclusion of preoperative CDVA. Objective measurements taken at the preoperative screening stage may be useful to estimate the likely postoperative CDVA when preoperative CDVA measures are unreliable or unobtainable.
ClinicalTrials.gov identifier, NCT06522789.
研究了描述角膜光学密度（COD）、最薄角膜厚度（TCT）以及角膜最薄区域3mm范围内前表面（ARC）和后表面（PRC）曲率半径的客观指标，以建立一个模型来估计圆锥角膜患者角膜交联术（CXL）后矫正远视力（CDVA）。
使用Pentacam™对以下三组患者进行为期1年的CDVA、COD、TCT、ARC和PRC监测：（1）接受常规CXL治疗的圆锥角膜患者；（2）相对稳定的未经治疗的圆锥角膜患者；（3）年龄/性别匹配的对照组。
在第1组（n = 77）中，logMAR CDVA中位数（众数，四分位间距）从0.26（0.22，0.12 - 0.65）显著改善（p < 0.01）至0.07（0.00，0.02 - 0.21）。0 - 2mm中央前角膜区域（0 - 2 ant）的平均（±标准差，95%置信区间）COD（0 - 100灰度单位）、TCT（μm）、ARC（mm）和PRC（mm）有显著变化（p < 0.01），分别从21.2（±3.70，20.4 - 22.0）、454（±40.0，446 - 462）、6.49（±0.71，6.33 - 6.65）和4.81（±0.65，4.66 - 4.96）变为31.5（±9.19，29.5 - 33.6）、423（±49.3，412 - 434）、6.78（±0. eighty，6.60 - 6.98）和4.74（±0.64，4.59 - 4.88），但在第2组（n = 23）和第3组（n = 24）中保持稳定。术后CDVA与术前COD、TCT、ARC和PRC值之间存在显著相关性（p < 0.01）。多元线性回归显示，1年时的CDVA与术前COD、TCT、ARC和PRC之间存在显著相关性（r = 0.533，r = 0.126，r = 0.321，r = 0.506，r = 0.467）。纳入术前CDVA可进一步增强这种相关性（r = 0.637，r = 0.566）。
CXL改善了CDVA，增加了COD和ARC，降低了TCT和PRC。使用术前COD、TCT、ARC和PRC指标正确估计CXL术后1年CDVA的概率为53%，纳入术前CDVA后提高到64%。当术前CDVA测量不可靠或无法获得时，术前筛查阶段的客观测量可能有助于估计术后可能的CDVA。
ClinicalTrials.gov标识符，NCT06522789。
