PDF(Pubmed)
Abstract：
UNASSIGNED: The question of whether the epithelium should be removed in corneal cross-linking (CXL) in the treatment of keratoconus and other corneal ectatic disorders remains controversial. The motivation for epithelium-on CXL methods, which are not yet FDA approved and vary greatly in methodology, is to reduce the risk of vision-threatening complications related to debridement. However, as discussed in this counterpoint piece, most high-level evidence suggests that removal of the epithelium facilitates greater crosslinking effectiveness as measured by primary clinical outcome metrics such as topographic flattening and stabilization of disease. Furthermore, quality evidence is still lacking for a significant reduction in rates of infectious keratitis or loss of vision that can be attributed to debridement-related complications. In the absence of comparative effectiveness trials or long-term follow-up studies that show otherwise, the FDA-approved epi-off protocol is still the standard-bearer for safe and effective stabilization of corneal ectatic disease.
摘要：
未经授权：在圆锥角膜和其他角膜外生性疾病的治疗中，是否应在角膜交联（CXL）中去除上皮的问题仍然存在争议。上皮上CXL方法的动机，尚未获得FDA批准，方法差异很大，是为了降低与清创相关的视力威胁并发症的风险。然而,正如在这篇对位文章中所讨论的，大多数高水平的证据表明,通过主要的临床结局指标,如地形平坦化和疾病稳定,去除上皮有助于提高交联效果.此外，仍缺乏可显著降低可归因于清创相关并发症的感染性角膜炎或视力丧失的质量证据.在没有比较有效性试验或长期随访研究表明，FDA批准的epi-off方案仍然是安全有效稳定角膜扩张疾病的标准.
