Sun Jijun, Li Fengjie, Wang Xinhai, Shi Weiyun, Wang Ting
Department of Ophthalmology, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.
Int Ophthalmol. 2025 Jun 3;45(1):221. doi: 10.1007/s10792-025-03592-5.
To analyze the clinical factors affecting corneal epithelial healing time after epithelium-off (epi-off) corneal collagen cross-linking (CXL) in patients with keratoconus (KC).
This prospective cohort study without blinding or randomization comprised 86 patients with KC (86 eyes) who underwent epi-off CXL. The tear film breakup time (TFBUT), corneal curvature, Schirmer's test, axial length, and corneal endothelial cell count may possibly affect corneal epithelial healing were recorded and analyzed by linear regression.
The corneal epithelium healing time was 2-12 (median, 4.5) days after surgery. The group with a shorter healing time had longer TFBUT (P < 0.001), thicker thinnest corneal thickness (P < 0.01), lower grading of KC (P < 0.01), and lower corneal curvature (all P < 0.05). The healing time of the corneal epithelium demonstrated significant negative correlations with TFBUT and thinnest corneal thickness (t = - 3.686, P < 0.001 and t = - 5.044, P < 0.001, respectively). Conversely, positive correlations were observed with maximum keratometry (Kmax), simulated keratometry 2 (SimK2), and average keratometry (Kavg) (Kmax: t = 2.695, P < 0.01; simK2: t = 3. 134, P < 0.01; Kavg: t = 3.020, P < 0.01). Multiple linear regression analysis indicated that simK2 was positively correlated with corneal healing. Meanwhile, the TFBUT and thinnest corneal thickness were negative correlated with corneal epithelial reconstruction.
Corneal thickness, corneal curvature (simK2), and the TFBUT may influence epithelial healing following epi-off CXL in patients with KC. Patients exhibiting steep simK2 and thinner cornea, which may correlate with lacrimal instability, should been closely monitor corneal epithelial healing after epi-off CXL and provide treatment to promote epithelial repair.
分析圆锥角膜（KC）患者在去上皮（epi-off）角膜交联（CXL）术后影响角膜上皮愈合时间的临床因素。
这项无盲法或随机分组的前瞻性队列研究纳入了86例接受epi-off CXL的KC患者（86只眼）。记录泪膜破裂时间（TFBUT）、角膜曲率、泪液分泌试验、眼轴长度和可能影响角膜上皮愈合的角膜内皮细胞计数，并通过线性回归进行分析。
术后角膜上皮愈合时间为2 - 12天（中位数为4.5天）。愈合时间较短的组具有更长的TFBUT（P < 0.001）、更厚的最薄角膜厚度（P < 0.01）、更低的KC分级（P < 0.01）以及更低的角膜曲率（均P < 0.05）。角膜上皮的愈合时间与TFBUT和最薄角膜厚度呈显著负相关（t = - 3.686，P < 0.001；t = - 5.044，P < 0.001）。相反，与最大角膜曲率（Kmax）、模拟角膜曲率2（SimK2）和平均角膜曲率（Kavg）呈正相关（Kmax：t = 2.695，P < 0.01；SimK2：t = 3.134，P < 0.01；Kavg：t = 3.020，P < 0.01）。多元线性回归分析表明，SimK2与角膜愈合呈正相关。同时，TFBUT和最薄角膜厚度与角膜上皮重建呈负相关。
角膜厚度、角膜曲率（SimK2）和TFBUT可能影响KC患者epi-off CXL术后的上皮愈合。表现为SimK2陡峭和角膜较薄（这可能与泪液稳定性相关）的患者，在epi-off CXL术后应密切监测角膜上皮愈合情况，并提供促进上皮修复的治疗。
