三种不同方案角膜交联后角膜厚度减小量的比较

目的 评估三种不同方案角膜交联(corneal crosslinking,CXL)治疗进展期圆锥角膜后最薄角膜厚度(thinnest-point corneal thickness,TCT)减小量的差异.方法 回顾性临床病例研究.选取2010年8月至2015年11月在海军总医院眼科确诊并行CXL治疗的进展期圆锥角膜连续性病例85例(110眼).21例(25眼)行标准的去上皮CXL(standard epithelium-off corneal crosslinking,S-CXL)治疗;14例(22眼)行1g·L-1核黄素乳酸钠林格液离子导入CXL(iontophoresis-assisted CXL,I-CXLa)治疗;50例(63眼)行1g·L-1核黄素蒸馏水溶液离子导入CXL(iontophoresis-assisted CXL,I-CXLb)治疗.应用ALLEGRO眼前节分析仪测量术前、术后TCT,比较三种CXL方案术后TCT减小量的差异.结果 S-CXL术后3个月、6个月、12个月TCT与术前差值分别为(-14.93±27.16)μm、(-31.94±22.89)μm、(-27.71±26.01)μm;I-CXLa术后3个月、6个月、12个月TCT与术前差值分别为(-20.14±19.09)μm、(-10.10±24.28)μm、(-7.11±22.26)μm;I-CXLb术后3个月、6个月、12个月TCT与术前差值分别为(-28.08±26.14)μm、(-21.08±25.62)μm、(-15.91±19.19)μm.术后3个月时,三组TCT减小量差异没有统计学意义(P =0.188);术后6个月、12个月时,S-CXL组和I-CXLa组比较差异均有统计学意义(均为P＜0.05),I-CXLb组和S-CXL组、I-CXLb组和I-CXLa组比较差异均无统计学意义(均为P＞0.05).结论 三种CXL方案治疗术后6个月和12个月,TCT减小量与交联方案相关,反映了交联强度的大小.I-CXLb术后TCT减小量小于S-CXL,但差异不显著,两者交联强度差异亦不显著.

Comparison of corneal thickness reduction after corneal crosslinking in three different protocols

Objective To evaluate the differences of the thinnest-point corneal thickness (TCT) decrease after three different corneal crosslinking (CXL) protocols for progressive keratoconus.Methyds Retrospective clinical case study.From August 2010 to November 2015,consecutive 85 patients (110 eyes) with progressive keratoconus were enrolled and treated with CXL in Department of Opthalmology,Navy General Hospital.21 patients of 25 eyes underwent standard epithelium-off corneal crosslinking (S-CXL),14 patients of 22 eyes underwent 1 g · L-1 riboflavin-sodium lactate Ringer's solution iontophoresis-assisted CXL (I-CXLa),and 50 patients of 63 eyes underwent 0.1％ riboflavin-distilled water solution I-CXLb.Preoperative and postoperative TCT were measured by ALLEGRO oculyzer.The differences of TCT decrease after treatment were compared among the three CXL protocols.Results The differences of TCT from baseline after 3 months,6 months and 12 months in the S-CXL group were (-14.93 ±27.16) μm,(-31.94 ±22.89) μm,(-27.71 ±26.01) μm,respectively,the I-CXLa group were (-20.14 ± 19.09) μm,(-10.10 ± 24.28) μm,(-7.11 ± 22.26)μm,respectively,the I-CXLb group were (-28.08 ± 26.14) μm,(-21.08 ± 25.62) μm,(-15.91 ± 19.19)μm,respectively.Three months after treatment,the differences of TCT decrease in the three groups was not statistically significant (P =0.188);Six and 12 months after treatment,the differences between S-CXL and I-CXLa were statistically significant (all P ＜0.05),but the differences between S-CXL and I-CXLb,between I-CXLb and I-CXLa showed no significant difference (all P ＞ 0.05).Conclusion Six and 12 months after treatment,TCT decrease is related to the CXL protocol.TCT decrease degree may reflect the intensity of crossinking.TCT decrease in I-CXLb is smaller than that in S-CXL,but there is no statistical difference.