国际眼科纵览

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圆锥角膜胶原交联术后进展的影响因素

梁登峰1 曾庆延1,2,3   

  1. 1中南大学爱尔眼科学院,长沙 410000;2武汉爱尔眼科医院汉口医院,武汉 430000; 3湖北科技学院,咸宁 437000
  • 收稿日期:2020-02-20 出版日期:2020-08-22 发布日期:2020-09-01
  • 通讯作者: 曾庆延,Email: zengqingyan1972@163.com E-mail:zengqingyan1972@163.com
  • 基金资助:
    武汉市临床医学科研项目(WX17A13); 湖北科技学院五官医学院专项科研基金(2020XZ38)

Influencing factors on the postoperative progression of corneal collagen crosslinking in keratoconus

Liang Dengfeng1, Zeng Qingyan 1,2,3   

  1. 1 Aier School of Ophthalmology, Central South University, Changsha 410000, China ; 2 Hankou Aier Eye Hospital, Wuhan 430000, China; 3 Hubei University of Science and Technology, Xianning 437000, China
  • Received:2020-02-20 Online:2020-08-22 Published:2020-09-01
  • Contact: Zeng Qingyan, Email: zengqingyan1972@163.com E-mail:zengqingyan1972@163.com
  • Supported by:
    Wuhan Clinical Medical Research Project (WX17A13); Special Research Fund of Ophthalmology and Otorhinolaryngology College of Hubei University of Science and Technology (2020XZ38) 

摘要: 角膜胶原交联术已被证明可以延缓或阻止圆锥角膜的进展,特别是在疾病的早中期。但研究也显示经胶原交联术后,圆锥角膜仍有一定几率继续进展。交联术后继续进展的影响因素包括:交联术后进展的诊断标准、手术方式(是否保留上皮、核黄素的给药方式、紫外线照射时长与模式)、年龄、锥顶位置、术前Kmax值、揉眼与过敏等。一般认为,阻止进展效果依次为去上皮交联法、离子导入法交联、促渗剂交联,Dresden法优于快速交联法,高龄患者优于低龄患者,锥顶位于角膜中央的圆锥角膜优于周边型圆锥角膜,术前低Kmax者优于术前高Kmax者,无揉眼过敏者优于有揉眼过敏者,可作为临床干预及预后评估的参考。

Abstract: Corneal collagen crosslinking (CXL) has been demonstrated to retard or arrest progression of the keratoconus, especially in the middle and early stages of the disease. So far, articles have shown that there was still a certain possibility of continuous progression post CXL. Factors of postoperative progression include that: criteria of postoperative progression, surgical protocol (epithelium-off or transepithelial CXL, drug-delivery of riboflavin, duration and pattern of ultraviolet A irradiation), age, cone location, preoperative Kmax value, eye rubbing and (or) allergies. Most articles suggested that the effect of preventing keratoconus progression were as follows: epithelium-off CXL >iontophoretic CXL >riboflavin penetration enhanced CXL, Dresden protocol >accelerated CXL, adult >pediatric, central cone >peripheral cone, preoperative low Kmax >preoperative high Kmax, no eye rubbing and allergy >combined with eye rubbing and (or) allergy. This paper will detail the above factors that influence the progression of the keratoconus after CXL and provide reference for clinical intervention and prognosis evaluation.