跨上皮角膜胶原交联术治疗进展期圆锥角膜

目的 观察跨上皮紫外线核黄素角膜胶原交联治疗进展期圆锥角膜的临床效果。方法 前瞻性病例研究。对36例（54眼）的进展期圆锥角膜患者行跨上皮角膜胶原交联手术治疗。表面麻醉下采用意大利SOOFT跨上皮角膜胶原交联仪将0.25%的核黄素导入角膜10 min（电流1.0 mA），370 nm的紫外线照射9 min（能量10 mW/cm2）。平均随诊（14.1±2.3）个月。术后1 d观察角膜上皮愈合情况，术后1、3、6、12个月复诊。检查指标包括UCVA、BCVA、眼压、角膜曲率、角膜厚度、角膜地形图、角膜内皮细胞计数、角膜生物力学、角膜活体激光共聚焦显微镜检查。对手术前后的各项指标行配对t检验。结果 术后1 d裂隙灯显微镜下发现角膜上皮点状混浊、水肿，次日好转。未出现角膜溃疡、角膜溶解、haze、剧烈眼痛等并发症。术后12个月，患者UCVA从4.27±0.23提高到4.41±0.20（t=3.962，P<0.01），BCVA从4.69±0.23提高到4.82±0.14（t=3.507，P<0.01）；Kmax下降（1.25±0.68）D（t=9.351，P<0.01）；散光值下降（0.30±0.21）D（t=7.227，P<0.01）。角膜最大压陷深度从（1.21±0.11）mm下降为（1.16±0.12）mm（t=4.131，P<0.01）。眼压、角膜内皮细胞密度、角膜厚度治疗前后差异无统计学意义。结论 跨上皮角膜胶原交联法可以有效控制进展期圆锥角膜的发展且未出现类似传统去上皮法导致的多种并发症。跨上皮角膜胶原交联方法是安全、有效的，有望取代去上皮法成为进展期圆锥角膜首选的治疗方式

Transepithelial corneal collagen cross-linking in the treatment of progressive keratoconus

Objective To observe the therapeutic effects of riboflavin-ultraviolet A（UVA） corneal collagen cross-linking （CXL） performed with a transepithelial method for progressive keratoconus. Methods This was a prospective case series study. Thirty-six patients （54 eyes） with progressive keratoconus who underwent transepithelial corneal collagen cross-linking surgery were reviewed. The procedure was performed under topical anesthesia using a transepithelial corneal collagen cross-linking instrument （SOFT， Italy）. riboflavin （0.25%） was imported into the cornea for 10 minutes （current 1.0 mA）. The irradiation was performed for 9 minutes using a solid-state UVA illuminator at 370 nm and an irradiance of 10 mW/cm2. The average follow-up time was 14.1±2.3 months. Corneal epithelium healing was observed 1 day after surgery. There were no complications such as corneal ulcer， corneal dissolution， corneal epithelium mist opacity （haze） or severe pain. Uncorrected visual acuity （UCVA）； best corrected visual acuity （BCVA）； intraocular pressure； corneal curvature； corneal thickness； corneal topography； endothelial cell count； corneal biomechanical properties and in vivo confocal microscopy were evaluated at baseline and at 1， 3， 6， 12 months postoperatively. Data were analyzed using a paired samples t test. Results The day after surgery， the corneal epithelium had opaque spots due to edema but the condition improved by the second day. Postoperative 12 months， UCVA and BCVA increased from 4.27±0.23 to 4.41±0.20 （t=3.962， P<0.01） and from 4.69±0.23 to 4.82±0.14 （t=3.507， P<0.01）， respectively. Interim analysis of treated eyes showed a flattening of the steepest simulated keratometry value （K-max） and astigmatism by an average of 1.25±0.68 diopters （t=9.351， P<0.01） and 0.30±0.21 diopters （t=7.227， P<0.01）. The deformation amplitude decreased from 1.21±0.11 mm to 1.16±0.12 mm（t=4.131， P<0.01）. Intraocular pressure， endothelial cell count and central corneal thickness did not change significantly. Conclusion Transepithelial cornea