J Refract Surg. 2024 Sep;40(9):e583-e594. doi: 10.3928/1081597X-20240715-03. Epub 2024 Sep 1.
To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL.
This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units.
In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group ( < .001) and by 0.7 lines in the CXL group ( = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) ( < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) ( = .004). Corneal HOAs decreased in both groups but more in the CXL+PRK group.
Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. .
比较行组合加速角膜交联术（A-CXL）联合选择性波前引导角膜上皮下光性切削术（WG-transPRK）（不使用丝裂霉素 C）与单纯行 A-CXL 治疗的患者中的混浊和屈光结果。
本前瞻性研究分析了 2018 年 10 月至 2022 年 10 月期间 95 只眼（86 例）进行性圆锥角膜患者的资料。第一组行 CXL 联合角膜或眼部 WG-transPRK（CXL+PRK，n=52），以矫正高阶像差（HOAs）。第二组仅行 CXL（n=43），两组均在 SCHWIND Amaris 激光平台（SCHWIND eye-tech-solutions）上采用相同的无丝裂霉素 C 的加速 CXL 方案。基线和术后（1、3、6 和 12 个月）评估包括未矫正（UDVA）和矫正（CDVA）远视力、主观验光、断层扫描、角膜 HOAs 和光学相干断层扫描（OCT）扫描。一种专利的机器学习算法以灰度单位客观地检测和量化 OCT 扫描中的基质混浊。
两组患者在前角膜混浊反射率和上皮下混浊在术后 3 个月达到峰值，然后在 6 个月和 12 个月逐渐下降。两组患者在任何时间点的混浊程度均无差异。到 12 个月时，CXL+PRK 组的 CDVA 提高了 2.5 行（<0.001），CXL 组提高了 0.7 行（=0.10），最大角膜曲率从 51.70±5.10 降低至 47.90±7.90 屈光度（D）（CXL+PRK 组）（<0.001），从 51.20±5.10 降低至 50.30±4.60 D（CXL 组）（=0.004）。两组患者的角膜 HOAs 均降低，但 CXL+PRK 组降低更明显。
与单纯行 A-CXL 相比，联合应用 CXL 联合无丝裂霉素 C 的 WG-transPRK 并不会导致混浊增加。这种联合方法在视力、地形和像差参数方面的改善更显著。
