像差引导的准分子激光联合角膜胶原交联治疗早期圆锥角膜的临床观察

目的：观察像差引导的经上皮准分子激光屈光性角膜切削术（WG-TransPRK）联合快速角膜胶原交 联术（A-CXL）治疗早期圆锥角膜的临床疗效和安全性。方法：回顾性系列病例研究。收集在武汉爱 尔眼科医院汉口医院行WG-TransPRK同期联合A-CXL的早期圆锥角膜患者7例（12眼），并于术前， 术后1周、1个月、3个月、6个月、1年分别行裸眼视力（UCVA，LogMAR）、最佳矫正视力（BCVA， LogMAR）、屈光度、角膜地形图、共焦显微镜和角膜像差检查。数据采用配对t检验分析。结果： 术后1年，UCVA从0.77±0.25改善到0.34±0.26（P=0.001），BCVA从0.18±0.21改善到0.05±0.09 （P=0.034）；角膜前表面平坦曲率（K1）、角膜前表面陡峭曲率（K2）、角膜前表面最大角膜曲率（Kmax） 分别从（43.85±1.72）D、（46.64±2.36）D、（48.88±3.62）D降至（40.63±2.13）D（t=9.48，P=0.001）、 （42.27±1.89）D（t=8.29，P=0.001）、（45.43±1.54）D（t=3.02，P=0.014），差异均有统计学意义（均 P<0.05）。共聚焦显微镜观察上皮下神经纤维密度降低（P=0.001）；浅、中层基质细胞密度降低（均 P<0.05），深基质及内皮细胞密度变化差异无统计学意义。4 mm直径分析区域角膜总像差与角膜球 差降低，差异均有统计学意义（均P<0.05）。结论：WG-TransPRK联合A-CXL能安全有效治疗早期圆 锥角膜，提升患者视力。

Clinical Observation of Wavefront-Guided Transepithelial Photorefractive Keratectomy with Simultaneous Accelerated Corneal Collagen Cross-Linking in Early Keratoconic Patients

Objective: To observe the efficacy and safety of wavefront-guided transepithelial photorefractive keratectomy (WG-TransPRK) with simultaneous accelerated corneal collagen cross-linking (A-CXL) in early-stage keratoconus. Methods: In this retrospective study, twelve eyes of 7 patients with early keratoconus underwent simultaneous WG-TransPRK with A-CXL. Visual acuity, refractive status, topography, confocal microscopy and aberrations were examined before treatment and 1 week, 1 month,3 months, 6 months, and 12 months after surgery. Data were analyzed by paired t test. Results: Twelve months after the surgery, the average UCVA improved from 0.77±0.25 LogMAR to 0.34±0.26 LogMAR (P=0.001), the average BCVA improved from 0.18±0.21 LogMAR to 0.05±0.09 LogMAR (P=0.034). The K1, K2 spherical equivalent of the cornea were reduced from 43.85±1.72 D and 46.64±2.36 D to 40.63±2.13 D (t=9.48, P=0.001) and 42.27±1.89 D (t=8.29, P=0.001), respectively. And Kmax decreasing from 48.88±3.62 D to 45.43±1.54 D (t=3.02, P=0.014). Sub-basal nerve density decreased (P=0.001). The anterior and mid-stromal keratocyte density was reduced also (P<0.05). No significant change was detected in the deep stromal and endothelial cell density. The aberration parameters decreased in the 4 mm diameter analysis area (P<0.05). Conclusion: WG-TransPRK combined with simultaneous A-CXL is safe and effective for the treatment of early-stage keratoconus, with an improvement in visual acuity.