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使用传统设备进行局部角膜交联治疗圆锥角膜进展期的疗效

Outcomes of localized corneal collagen crosslinking with a conventional device in progressive keratoconus.

作者信息

Vorobichik Berar Ofri, Shemesh Rachel, Gomel Nir, Berger Yoav, Barequet Irina S

机构信息

Goldschleger Eye Institute, Faculty of Medical and Health Sciences, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.

Division of Ophthalmology, Faculty of Medical and Health Sciences, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2025 Mar 27. doi: 10.1007/s00417-025-06803-y.

DOI:10.1007/s00417-025-06803-y
PMID:40146322
Abstract

PURPOSE

To evaluate the outcomes of localized crosslinking (L-CXL) for progressive keratoconus utilizing a standard CXL device.

DESIGN

This retrospective cohort study.

METHODS

included patients diagnosed with progressive keratoconus and treated with a localized cone-centered CXL (based on corneal topography) using the accelerated CXL protocol with a standard CXL device.

RESULTS

We Identified 24consecutive eyes. The average BDVA before CXL was 0.282 ± 0.35 LogMar, remained overall stable at 12-month post-surgery at 0.204 ± 0.173 LogMar (P = 0.395). Ten eyes (of eight patients) (42%) demonstrated an improvement in BDVA at 12 months of 1-4 lines and none of the other eyes lost BDVA. These eyes had significantly lower pre-operative BDVA than the stable eyes (P = 0.034). Ten eyes (of eight patients) (42%) demonstrated an improvement in K-max at 12 months post-operatively, of at least 1D; six of these eyes had improvement in both BDVA and Kmax. None of the eyes developed an increase in Kmax throughout the follow-up.

CONCLUSION

In this series, cone-centered L-CXL, using a conventional CXL device resulted in significant stabilization and even improvements in BDVA and Kmax in almost half of the eyes, without significant adverse events. Addressing the CXL application onto the affected area results in beneficial results.

摘要

目的

利用标准的角膜交联(CXL)设备评估局部交联(L-CXL)治疗进展性圆锥角膜的效果。

设计

这项回顾性队列研究。

方法

纳入被诊断为进展性圆锥角膜并使用标准CXL设备通过加速CXL方案进行以圆锥为中心的局部CXL治疗的患者。

结果

我们连续纳入了24只眼。CXL术前平均最佳矫正视力(BDVA)为0.282±0.35 LogMar,术后12个月总体保持稳定,为0.204±0.173 LogMar(P = 0.395)。10只眼(8例患者)(42%)在12个月时BDVA提高了1-4行,其他眼均未出现BDVA下降。这些眼术前BDVA显著低于视力稳定的眼(P = 0.034)。10只眼(8例患者)(42%)术后12个月角膜最大曲率(K-max)改善至少1D;其中6只眼的BDVA和K-max均有改善。随访期间所有眼的K-max均未增加。

结论

在本系列研究中,使用传统CXL设备进行以圆锥为中心的L-CXL,在近半数眼中导致了显著的稳定,甚至BDVA和K-max有所改善,且无明显不良事件。将CXL应用于患区可产生有益效果。

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本文引用的文献

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Am J Ophthalmol. 2023 Jun;250:95-102. doi: 10.1016/j.ajo.2023.01.022. Epub 2023 Feb 1.
2
Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen.经上皮角膜交联术治疗进行性圆锥角膜:补充氧的联合应用的临床和 OCT 结果
J Cataract Refract Surg. 2020 Dec;46(12):1582-1587. doi: 10.1097/j.jcrs.0000000000000347.
3
Biomechanical Impact of Localized Corneal Cross-linking Beyond the Irradiated Treatment Area.
局部角膜交联在照射治疗区域之外的生物力学影响。
J Refract Surg. 2019 Apr 1;35(4):253-260. doi: 10.3928/1081597X-20190304-01.
4
Corneal Cross-Linking: Current USA Status: Report From the Cornea Society.角膜交联:美国现状:来自角膜协会的报告
Cornea. 2018 Oct;37(10):1218-1225. doi: 10.1097/ICO.0000000000001707.
5
Comparative evaluation of progression rate in keratoconus before and after collagen crosslinking.交联手术后圆锥角膜进展速率的对比评估。
Br J Ophthalmol. 2018 Aug;102(8):1109-1113. doi: 10.1136/bjophthalmol-2017-311017. Epub 2017 Nov 9.
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Customized Corneal Cross-linking Using Different UVA Beam Profiles.使用不同紫外线A光束轮廓的定制角膜交联术。
J Refract Surg. 2017 Oct 1;33(10):676-682. doi: 10.3928/1081597X-20170621-07.
7
Recent advances in corneal collagen cross-linking.角膜胶原交联的最新进展。
Indian J Ophthalmol. 2017 Sep;65(9):787-796. doi: 10.4103/ijo.IJO_648_17.
8
Pediatric keratoconus: a review of the literature.儿童圆锥角膜:文献综述
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9
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J Ophthalmic Vis Res. 2017 Jul-Sep;12(3):260-264. doi: 10.4103/jovr.jovr_30_16.
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