Dai Zhihao, Liu Ziyuan, Zhang Yu, Yuan Yufei, Liu Yan, Wang Yuexin, Yu Shuo, Chen Yueguo
Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
Front Med (Lausanne). 2024 Aug 12;11:1420264. doi: 10.3389/fmed.2024.1420264. eCollection 2024.
To comprehensively compare the long-term outcome of the combined topography guided photorefractive keratectomy (TG-PRK) with accelerated corneal cross-linking (ACXL) and ACXL alone in eyes with progressive keratoconus. The analysis focused on the changes in the detailed corneal aberrometric values.
This single-center, prospective cohort study included 28 patients (30 eyes) of the TG-PRK plus ACXL group and 14 patients (15 eyes) of the ACXL alone group. The mean duration of the follow-up was 44 ± 10.18 months (ranged from 31 to 65 months). The preoperative data and the postoperative measurement data at the last follow-up visit, including demographic data, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, pachymetry, aberrometry and densitometry were analyzed.
The CDVA significantly improved in the TG-PRK plus ACXL group at the last follow-up visit ( = 0.006), while no significant improvement was found in the ACXL alone group ( = 0.432). The maximal keratometry of the anterior corneal surface (Kmax) of both groups significantly decreased at the last follow-up visit ( < 0.05). Compared with the ACXL alone group, the Kmax of the TG-PRK plus ACXL group showed a greater decline ( = 0.008). The total corneal aberrations, the corneal lower-order aberrations (LOAs), the corneal higher order aberrations (HOAs), the vertical coma and the spherical aberration (SA) at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group significantly decreased at the last follow-up visit (all < 0.05). The declines of the total corneal aberrations, the corneal LOAs, the corneal HOAs and the vertical coma at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group were significantly higher than those in the ACXL alone group ( < 0.001).
Compared with ACXL alone, combined TG-PRK with ACXL procedure had a significantly higher reduction in the corneal HOAs and better CDVA, while providing a similar long-term stability and safety. For progressive keratoconus patients with adequate corneal thickness, the combined procedure might be a recommended treatment option.
全面比较在进展性圆锥角膜眼中，联合地形引导准分子激光角膜切削术（TG-PRK）与加速角膜交联术（ACXL）以及单纯ACXL的长期疗效。分析聚焦于详细角膜像差测量值的变化。
这项单中心前瞻性队列研究纳入了28例患者（30只眼）的TG-PRK联合ACXL组以及14例患者（15只眼）的单纯ACXL组。平均随访时间为44±10.18个月（范围为31至65个月）。分析术前数据以及最后一次随访时的术后测量数据，包括人口统计学数据、未矫正远视力（UDVA）、矫正远视力（CDVA）、显然验光、角膜地形图、角膜厚度测量、像差测量和密度测量。
在最后一次随访时，TG-PRK联合ACXL组的CDVA显著改善（P = 0.006），而单纯ACXL组未发现显著改善（P = 0.432）。两组前角膜表面的最大角膜曲率（Kmax）在最后一次随访时均显著降低（P < 0.05）。与单纯ACXL组相比，TG-PRK联合ACXL组的Kmax下降幅度更大（P = 0.008）。TG-PRK联合ACXL组在最后一次随访时，4.0毫米和6.0毫米区域的总角膜像差、角膜低阶像差（LOAs）、角膜高阶像差（HOAs）、垂直彗差和球差（SA）均显著降低（均P < 0.05）。TG-PRK联合ACXL组在4.0毫米和6.0毫米区域的总角膜像差、角膜LOAs、角膜HOAs和垂直彗差的下降幅度显著高于单纯ACXL组（P < 0.001）。
与单纯ACXL相比，联合TG-PRK与ACXL手术在角膜高阶像差降低方面显著更高，且CDVA更好，同时提供了相似的长期稳定性和安全性。对于角膜厚度足够的进展性圆锥角膜患者，联合手术可能是一种推荐的治疗选择。
