离子导入辅助跨上皮角膜胶原交联治疗进展期圆锥角膜2a随访分析

目的：报道离子导入辅助跨上皮角膜胶原交联(iontophoresis-assited transepithelial corneal collagen cross-linking, I-CXL)治疗进展期圆锥角膜的2a 观察结果。
　　方法：选取进展期圆锥角膜患者24例34眼,应用1g/ L 核黄素蒸馏水溶液,离子导入(1mA 电流)辅助跨上皮给药5min 后,紫外线 A(370nm,3mW/ cm2)照射30min。观察术前和术后2a 最佳矫正视力(best corrected distance visual acuity, BCVA)、角膜散光度数、K1、K2、Kmean、Kmax、眼压、角膜内皮细胞密度、角膜顶点厚度、角膜最薄厚度变化。
　　结果：术后2a,BCVA(LogMAR)从0.32依0.25提高到0.25依0.19,差异具有统计学意义(t =2.849,P =0.015),K1从47.12依4.33下降到46.06依4.77,差异具有统计学意义(t =2.652,P =0.015), K2从51.36依5.59下降到50.40依6.16,差异具有统计学意义(t =2.121,P =0.047),Kmean从49.12依4.76下降到48.10依5.25,差异具有统计学意义(t =2.663,P=0.015),Kmax 从57.57依8.30下降到55.91依8.14,差异具有统计学意义(t =2.398,P =0.026),角膜顶点厚度从476.90依38.71下降到454.43依40.86μm ( t =2.853,P=0.010),角膜最薄厚度从464.38依39.92下降到433.86依50.78μm,差异具有统计学意义( t =3.485,P =0.002)。角膜散光度数、眼压和角膜内皮细胞密度无明显变化。
　　结论：I-CXL 治疗进展期圆锥角膜安全、有效,2a 内能够阻止进展期圆锥角膜病情恶化,但长期效果仍需进一步观察。

A two-year's results of iontophoresis-assisted transepithelial corneal cross-linking for progressive keratoconus

AIM: To report a two- year's results of iontophoresis-assisted transepithelial corneal cross-linking (I-CXL) for progressive keratoconus.
METHODS: Thirty - four eyes in 24 patients with progressive keratoconus ( mean age 21. 0 ± 5. 6 years;range: 14-32 years) were treated. After 1g/ L riboflavin-distilled water solution was administered by iontophoresis-assited (current 1mA) transepithelial method for 5min in total, standard surface UVA irradiation ( 370nm, 3mW/cm2 ) was performed at a 1 - cm distance for 30min. The best corrected visual acuity ( BCVA ) measured as LogMAR number, corneal refractive astigmatism, K1, K2, Kmean, Kmax, intraocular pressure, endothelial cell density, the thickness at corneal apex and the thinnest point were measured preoperatively and 2a postoperatively.
RESULTS:At 2a after the procedure, BCVA (LogMAR) improved from 0. 32 ± 0. 25 to 0. 25 ± 0. 19 ( t = 2. 849, P =0. 015). K1 decreased from 47. 12±4. 33 to 46. 06±4. 77 (t =2. 652, P= 0. 015). K2 decreased from 51. 36±5. 59 to 50. 40±6. 16 (t= 2. 121, P= 0. 047). Kmean decreased from 49. 12±4. 76 to 48. 10±5. 25(t = 2. 663, P = 0. 015). Kmax decreased from 57. 57±8. 30 to 55. 91±8. 14 (t = 2. 398, P = 0. 026). The corneal apex thickness decreased from 476. 90±38. 71μ m to 454. 43 ± 40. 86μ m ( t = 2. 853, P = 0. 010 ). The thinnest thickness decreased from 464. 38 ± 39. 92μ m to 433. 86 ±50. 78μ m ( t = 3. 485, P = 0. 002 ). Corneal refractive astigmatism, intraocular pressure and endothelial cell density did not show significant changes.
CONCLUSION: I - CXL for progressive keratoconus is safe and effective which can prevent deterioration of progressive keratoconus within 2a, but further long-term studies are necessary still.