Lin Tingting, Zhao Can, Feng Lijuan, Gao Hua, Li Suxia, Du Man, Sun Jijun, Zhong Xiaowei, Lu Xiuhai, Chow Vanissa W S, Shi Weiyun, Wang Ting
Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, 250021, China.
Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Province Key Laboratory of Eye Diseases, Qingdao, 266001, China.
Int Ophthalmol. 2025 Aug 28;45(1):361. doi: 10.1007/s10792-025-03615-1.
To compare the outcomes of corneal collagen cross-linking combined with lamellar keratoplasty (CXL-LK) versus LK alone in treating medically unresponsive acanthamoeba keratitis (AK).
This retrospective, non-randomized controlled clinical study included 11 eyes (CXL-LK group) and 16 eyes (LK group) at a tertiary ophthalmology center. Corneal infiltration, density of acanthamoeba cysts (AC) and pathological changes following CXL in AK patients were assessed. One-year post-operation, refractive outcomes, graft survival, corneal endothelial loss rates and AK recurrence were evaluated.
The area and depth of the infiltrates were reduced following CXL in AK patients, and the density of the AC decreased. Histopathological results indicated a reduction in AC volume after CXL, with the contents appearing wrinkled and degraded. At one year postoperatively, the corneal endothelial loss rate was 10.12% in the CXL-LK group, significantly lower than the 27.43% observed in the LK group (p = 0.031). None of the patients in the CXL-LK group experienced AK recurrence, with an average duration of anti-amoebic treatment of 62.20 ± 50.33 days, while a significant higher proportion of patients (31.25%) in the LK group experienced recurrence, with a significantly longer treatment duration of 182.75 ± 106.77 days (p = 0.009). The graft survival rate demonstrated statistically significant differences between the two groups one year after surgery (90.9% in the CXL-LK group vs. 68.75% in the LK group, P < 0.05).
CXL reduced AK infiltration, promoted AC degradation and effectively halted disease progression. CXL-LK significantly shortened the duration of anti-amoebic treatment, decreased AK recurrence and improved graft outcomes after LK.
ChiCTR1900026147 (2019-09-23).
比较角膜胶原交联联合板层角膜移植术（CXL-LK）与单纯板层角膜移植术（LK）治疗药物治疗无效的棘阿米巴角膜炎（AK）的效果。
这项回顾性、非随机对照临床研究纳入了一家三级眼科中心的11只眼（CXL-LK组）和16只眼（LK组）。评估了AK患者的角膜浸润、棘阿米巴囊肿（AC）密度以及CXL后的病理变化。术后一年，评估屈光结果、植片存活率、角膜内皮损失率和AK复发情况。
AK患者CXL后浸润面积和深度减小，AC密度降低。组织病理学结果显示CXL后AC体积减小，内容物出现皱缩和降解。术后一年，CXL-LK组角膜内皮损失率为10.12%，显著低于LK组的27.43%（p = 0.031）。CXL-LK组无一例患者发生AK复发，抗阿米巴治疗平均持续时间为62.20±50.33天，而LK组有显著更高比例的患者（31.25%）复发，治疗持续时间显著更长，为182.75±106.77天（p = 0.009）。两组术后一年的植片存活率差异有统计学意义（CXL-LK组为90.9%，LK组为68.75%，P < 0.05）。
CXL减少了AK浸润，促进了AC降解，并有效阻止了疾病进展。CXL-LK显著缩短了抗阿米巴治疗的持续时间，降低了AK复发率，并改善了LK后的植片效果。
ChiCTR1900026147（2019-09-23）
