去上皮角膜胶原交联术治疗青少年圆锥角膜的临床效果

发布时间：2018-05-23 20:15

本文选题：青少年 + 去上皮　；参考：《山东大学》2017年硕士论文

【摘要】：背景圆锥角膜是一种角膜退行性病变,主要特征是角膜渐进性地前突和薄化,可以严重影响患者的视力和日常生活。由核黄素和紫外线A介导的角膜交联术近年来作为一种新兴的治疗手段,通过两者之间的相互作用形成新的化学键,可以明显增强角膜的生物力学强度,改善患者的视力,延缓疾病的进展。已有大量文献证实其治疗成年圆锥角膜患者的有效性和安全性,但关于角膜交联治疗青少年患者的疗效研究仍相对较少。青少年作为一个特殊的群体,疾病对其学习和生活都有着较大的影响,故本研究对青少年原发性圆锥角膜患者接受角膜胶原交联治疗前后进行随访观察,以探讨该方法的临床效果。目的观察核黄素/紫外线A介导的去上皮角膜胶原交联治疗青少年圆锥角膜患者的安全性和有效性。方法本研究为回顾性自身前后对照研究,选取山东大学附属省立医院因原发性圆锥角膜接受去上皮角膜胶原交联治疗的青少年患者共22例(33眼),平均年龄为14-18岁,观察并整理术前及术后裸眼视力(LogMAR表示)、最佳矫正视力(LogMAR表示)、角膜最大K值、角膜最薄点厚度、角膜内皮细胞计数等参数,并观察是否有并发症发生。术前预防性应用抗生素滴眼液点眼3天,无菌条件下表面麻醉后微型角膜刀去除角膜中央区上皮,而后每3min 1次采用核黄素等渗溶液点术眼,共持续30 min,OCT测量最薄处角膜厚度达到400μm且于裂隙灯下可观察到角膜全层黄染、前房内存在核黄素闪辉后行370nm波长紫外线A照射30min(照射期间能量密度保持稳定为3mW/cm2,照射光束直径为9mm,照射距离为5cm),期间继续于术眼点用核黄素等渗溶液。照射结束后于术眼佩戴角膜接触镜,滴眼液点眼治疗,至角膜上皮愈合后摘除软镜,加用激素类滴眼液点眼。采用SPSS 20.0统计软件,术前术后各观察点之间差异比较采用单组重复测量资料的方差分析,组内两两比较采用Bonferroni方法进行统计学分析,以α=0.05作为检验水准,P0.05为差异具有统计学意义。结果1.视力(LogMAR表示):裸眼视力(uncorrected visual acuity,UCVA)和最佳矫正视力(best-corrected visual acuity,BCVA)分别由术前的 0.82±0.35 和0.43±0.33提高到术后第12个月时的0.71 ±0.33和0.25±0.23,与术前相比,两者均有统计学意义的提高。其中有24/33只眼裸眼视力提高1行及以上;23/33只眼最佳矫正视力提高1行及以上。2.角膜最大K值:治疗前平均为62.45±11.24D,术后第12个月随访时降低为60.37±9.74D,两者差异有统计学意义。其中有20/33只眼术后较术前降低1D以上。3.最薄点角膜厚度:由术前的442.69±43.47μm降低到术后第12个月的427.44±41.75μm,角膜明显变薄,差异有统计学意义。4.角膜内皮细胞计数:交联前为3038±361个/mm2,术后最后一次随访时为2998±345个/mm2,差异无统计学意义,细胞形态无明显变化。所有患者术眼角膜上皮均于术后5d内愈合,术中术后无感染、角膜内皮失代偿、晶状体和视网膜损伤等并发症发生。结论核黄素/紫外线A诱导的去上皮角膜胶原交联在术后1年的随访期内,可以有效提高青少年圆锥角膜患者的裸眼视力和最佳矫正视力,降低角膜K值且无并发症发生。
[Abstract]:Background keratoconus (keratoconus) is a kind of corneal degeneration, characterized by progressive corneal protrusion and thinning of the cornea, which can seriously affect the visual acuity and daily life of the patients. Corneal crosslinking mediated by riboflavin and ultraviolet A has been used as a new therapeutic method in recent years to form new chemical bonds through the interaction between the two. In order to significantly enhance the biomechanical strength of the cornea, improve the visual acuity of the patient and delay the progress of the disease, a large number of literatures have proved its effectiveness and safety in the treatment of adult keratoconus. However, there are still relatively few studies on the curative effect of corneal crosslinking treatment for young people. In order to explore the clinical effect of this method, the clinical effect of this method was observed before and after corneal collagen cross-linking treatment in the primary keratoconus patients. Objective To observe the safety and effectiveness of corneal collagenous crosslinking in keratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratocones. Methods in this study, 22 young patients (33 eyes) with primary keratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratokeratoconus were selected for retrospective study. The average age of 33 eyes was 14-18 years old. The best corrected visual acuity (LogMAR) was observed and the best corrected visual acuity (LogMAR) was observed before and after the operation. The maximum K value of the cornea, the thinnest point thickness of the cornea, the corneal endothelial cell count and other parameters, and observe the occurrence of complications. Preoperatively, prophylactic use of antibiotic eye drops for 3 days, microscalpel removal in the central corneal epithelium after surface anaesthesia under aseptic conditions, and then 1 times per 3min with riboflavin isosotic solution point, lasting 30 m In, OCT measured the thickness of the cornea at the thinnest point of 400 mu m and observed the full layer yellow dye of the cornea under the slit lamp. The memory of the anterior chamber was irradiated with the 370nm wavelength by UV A after the riboflavin flashing. The energy density remained stable at 3mW/cm2, the diameter of the irradiated beam was 9mm, the distance from the irradiation was 5cm), and the riboflavin was continued at the point of the operation. After the end of the irradiation, the corneal contact lens was worn and the eye drops were treated with eye drops. After the corneal epithelium was healed, the soft glasses were removed and the eye drops were added to the eye drops. The SPSS 20 statistical software was used. The difference of the difference of the observation points between the observation points before and after the operation was compared, and the 22 in the group was compared with the Bonferroni method. Statistical analysis, with alpha =0.05 as a test level, P0.05 was statistically significant. Results 1. visual acuity (LogMAR): the naked eye vision (uncorrected visual acuity, UCVA) and the best corrected visual acuity (best-corrected visual acuity, BCVA) were increased by 0.82 + 0.35 and 0.43 + 0.33 before the operation to 0.71 + twelfth months after the operation. .33 and 0.25 + 0.23, compared with preoperative, both had statistically significant improvement. Among them, the visual acuity of 24/33 eyes was increased by 1 lines and above, and the best corrected visual acuity in 23/33 eyes was increased by 1 lines and above the maximum K of.2. cornea: the average before treatment was 62.45 + 11.24D and 60.37 + 9.74D after twelfth months of follow-up. The difference was statistically significant. The thinnest corneal thickness of 20/33 was lower than 1D before operation. The corneal thickness was reduced from 442.69 + 43.47 m before operation to 427.44 + 41.75 mu m after twelfth months of operation. The cornea was thinner obviously. The difference was statistically significant.4. corneal endothelial cell count: 3038 + 361 /mm2 before cross-linking, and 2998 + 345 /mm2 after the last follow-up. The corneal epithelium of all patients was healed within 5D after operation, no infection, corneal endothelial decompensation, lens and retina damage occurred in all patients. Conclusion the collagen cross-linking induced by riboflavin / ultraviolet A can be found during the 1 year follow-up period. It can improve the naked eyesight and best corrected visual acuity of keratoconus patients, reduce the corneal K and no complications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

【相似文献】