Avedro快速角膜交联术治疗圆锥角膜的短期临床疗效与转归

发布时间：2018-08-23 10:09

【摘要】：目的:评估和观察Avedro快速去上皮角膜交联术(30mW/cm2,4分钟)治疗圆锥角膜的短期有效性、安全性及临床转归过程,考察的参数包括角膜曲率值及角膜厚度、裸眼远视力(UDVA)、矫正远视力(CDVA)、主觉验光屈光状态、交联线、角膜光密度、内皮细胞密度及眼压。材料和方法:本研究为病例系列分析,属于回顾性、观察性研究。收集2016年3月至10月期间,于浙江大学医学院附属邵逸夫医院眼科中心门诊行Avedro快速去上皮角膜交联术,术后随访时长至少6个月的64名患者的80例眼,术中使用0.1%核黄素溶液(VibeX Rapid)浸润,30mW/cm2辐射度365nm波长的A波紫外光照射4分钟,相当于能量7.2J/cm2。于术后1周内评估角膜上皮化完成情况及手术相关并发症,术后1月、3月,6月随访,查眼压、视力、PentacamHR、眼前节OCT、角膜共聚焦显微镜。考察主要参数术前,术后1月、3月及6月的差异采用重复测量方差分析,结果以均值±标准差表示,P0.05时认为有统计学意义。结果:统计80例术眼分析得:(1)角膜最大曲率在术后1月时较术前增大,由54.87±8.54 D到55.80±8.57 D,p0.01,角膜前表面陡轴曲率在术后1月时较术前增大,由49.23±4.69D到50.00±5.13D,p0.01,角膜前表面平轴曲率在术后1月时较术前增大,由45.95±3.66D到46.35±4.00D,p0.01。角膜最薄点厚度在术后1月时较术前变薄,由469.7±38.3μm到457.6±38.6μm,p0.05。以上参数均在术后3月及6月复查时相较术前无明显差异。瞳孔2mm直径区角膜全层平均光密度术后前期历次随访均明显高于术前,直至术后6月恢复至术前水平。角膜后表面陡轴及平轴曲率在术后1月、3月及6月相较术前均无明显改变。(2)UDVA、CDVA、球镜值、柱镜值及等效球镜值在术后1月、3月及6月时相较术前均无明显改变。(3)角膜内皮细胞密度在术后1月时相较术前变小,均值由2507.3±163.8个/mm2降至2473.2±126.8个/mm2,尚在安全范围内,且于术后3月、6月复查时恢复至术前。(4)97.5%的术眼于术后1月左右可于眼前节OCT观察到明显交联线,平均深度为241±78μm。(5)术后出现细菌性角膜炎1例,诱发单纯疱疹病毒性角膜炎2例。结论:Avedro快速去上皮角膜交联术(30mW/cm2,4分钟)治疗进展期圆锥角膜,在术后短期内未见疾病进展,可稳定角膜形态,且安全性高。(1)术眼视力、角膜曲率稳定,术后1月术眼角膜参数数值上呈现轻度变凸变薄状态,但术后3月、6月复查均恢复至术前;术后6月虽尚无统计学意义上视力明显改善或角膜局部突起变平的证据,但考察各项均值,已出现视力改善、角膜曲率变小的趋势,有待长期随访结果支持。(2)角膜内皮细胞密度、眼压稳定,上皮化正常;瞳孔区角膜光密度于术后早期显著升高,至6月恢复;96.25%的术眼随访期间无明显并发症,3例感染术眼得到及时有效处理,无一出现角膜瘢痕或视力受损后遗症。
[Abstract]:Objective: to evaluate and observe the short-term efficacy, safety and clinical outcome of Avedro rapid epithelial corneal cross-linking (30MW / cm2min) in the treatment of keratoconus. The parameters included corneal curvature and corneal thickness. Naked far visual acuity (UDVA),) was used to correct the (CDVA), principal optometry, cross-linking line, corneal optical density, endothelial cell density and intraocular pressure (IOP). Materials and methods: this study is a case series analysis, which is a retrospective and observational study. From March to October 2016, 80 eyes of 64 patients who were followed up for at least 6 months after Avedro rapid epithelial corneal cross-linking were collected from the outpatient clinic of run Shaw Hospital affiliated to Zhejiang University Medical College. Intraoperative irradiation with 0.1% riboflavin solution (VibeX Rapid) infiltrating 30 MW / cm ~ 2 radiance 365nm wavelength A wave ultraviolet light for 4 minutes, equivalent to energy 7.2 J / cm ~ (2). The corneal epithelialization and complications were evaluated within 1 week after operation. The intraocular pressure (IOP) visual acuity Pentacam HRA anterior segment OCTs and confocal cornea microscope were followed up at 1 month 3 months and 6 months after operation. The main parameters before operation, 1 month, 3 months and 6 months after operation were analyzed by repeated analysis of variance. The results showed that there was statistical significance when mean 卤standard deviation (P 0.05). Results: (1) the maximum corneal curvature increased from 54.87 卤8.54 D to 55.80 卤8.57 DX 0.01 at 1 month after operation. From 49.23 卤4.69D to 50.00 卤5.13Dp0.01, the mean curvature of the anterior corneal surface was increased from 45.95 卤3.66D to 46.35 卤4.00Dp0.01 at 1 month after operation. The thickness of the thinnest spot became thinner at 1 month after operation, from 469.7 卤38.3 渭 m to 457.6 卤38.6 渭 m (P 0.05). There was no significant difference in the above parameters between 3 months and 6 months after operation. The average optical density of the whole corneal layer in pupil 2mm diameter area was significantly higher than that before operation, and recovered to the preoperative level at 6 months after operation. There were no significant changes in the curvature of the steep axis and flat axis of the posterior corneal surface in 1 month, 3 months and 6 months after the operation. (2) the value of CDVA of UDVA, spherical lens, and so on. There were no significant changes in the values of column and equivalent spherical endoscopy at 1 month, 3 months and 6 months after operation. (3) the density of corneal endothelial cells decreased from 2507.3 卤163.8 / mm2 to 2473.2 卤126.8 / mm ~ (2), which was still within the safe range. (4) 97.5% of the eyes had obvious cross-linking lines in anterior segment OCT about one month after operation, the average depth was 241 卤78 渭 m. (5) bacterial keratitis occurred in 1 case after operation, and herpes simplex keratitis was induced in 2 cases. Conclusion the rapid exfoliative keratectomy (30 MW / cm 2 min) for advanced keratoconus has no progress in the short term after operation. It can stabilize the corneal morphology and be safe. (1) the visual acuity and the curvature of the cornea are stable. The corneal parameters showed slight convexity and thinning in the first month after operation, but all of them recovered to the preoperative level in 3 months and 6 months after operation, although there was no evidence of significant improvement in visual acuity or flattening of local corneal protrusions in 6 months after operation. However, the visual acuity has been improved and the corneal curvature has become smaller. (2) the corneal endothelial cell density, intraocular pressure is stable, epithelialization is normal, and the corneal optical density in pupil area is significantly increased in the early postoperative period. By the end of 6 months, 96. 25% of the eyes had no obvious complications and 3 cases of infection were treated in time and effectively, and no corneal scar or visual acuity sequelae were found.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R779.6

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