Abstract：
Purpose: To compare the refractive efficacy and morphological changes in the cornea following a novel biphasic higher fluence transepithelial corneal crosslinking (BI-TE-CXL) and transepithelial corneal crosslinking (TE-CXL) in adults keratoconus.Methods: Patients with progressive keratoconus who required corneal crosslinking were assigned to the BI-TE-CXL group (32 eyes, phase 1: 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro; phase 2: 3.6 J/cm2 for 6 min and 40 s of continuous light exposure at the front curvature apex with a 6 mm diameter light spot, UVX-2000, IROC) or the TE-CXL group (32 eyes, uniform 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal fluorescein staining (CFS), corneal topography, anterior segment optical coherence tomography (AS-OCT), and in vivo corneal confocal microscopy (IVCM) were performed 3, 6, 12 and 24 months after surgery.Results: The CFS scores in the BI-TE-CXL group were significantly higher than those in the TE-CXL group on the first two days after surgery (p < 0.001). The Kmax (at 12 and 24 months) and CDVA (logMAR) were significantly lower in the BI-TE-CXL group than those in the TE-CXL group (p < 0.05). The corneal demarcation line under AS-OCT was visible in 81.3% of patients in the BI-TE-CXL group and 15.6% in the TE-CXL group. The depth of the demarcation line under IVCM was significantly deeper in the BI-TE-CXL group (248.3 ± 25.0 μm) than that of the TE-CXL group (136.5 ± 15.6 μm) in the central cornea (p < 0.001). The cross-linked collagen structures in the central cornea were still present after 12 months in the BI-TE-CXL group. No significant difference in sub-basal nerve density between the two groups (p > 0.05).Conclusions: Following BI-TE-CXL, CDVA was significantly improved, accompanied by deeper demarcation line depth and persistent crosslinked structures in the central corneal stroma.
摘要：
目的比较新型双相高通量跨上皮角膜交联（BI-TE-CXL）和跨上皮角膜交联（TE-CXL）在成人圆锥角膜中的屈光功效和形态学变化。方法将需要角膜交联的进行性圆锥角膜患者分为BI-TE-CXL组（32只眼，阶段1：7.2J/cm2，5分钟20秒的脉冲光曝光，KXL,Glaukos-Avedro；第2阶段：3.6J/cm2，在前曲率顶点处连续曝光6分钟40秒，具有6mm直径的光斑，UVX-2000，IROC）或TE-CXL组（32眼，均匀的7.2J/cm2，5分钟20秒的脉冲光曝光，KXL,Glaukos-Avedro）。未矫正的远距视力（UDVA），矫正视力（CDVA），角膜荧光素染色（CFS），角膜地形图,眼前节光学相干断层扫描（AS-OCT），术后3、6、12和24个月进行体内角膜共聚焦显微镜（IVCM）。结果BI-TE-CXL组术后第2天的CFS评分明显高于TE-CXL组(P<0.001)。BI-TE-CXL组的Kmax（12个月和24个月时）和CDVA（logMAR）明显低于TE-CXL组（P<0.05）。在BI-TE-CXL组中81.3%的患者和TE-CXL组中15.6%的患者在AS-OCT下可见角膜分界线。在中央角膜中，BI-TE-CXL组IVCM下的分界线深度（248.3±25.0μm）明显高于TE-CXL组（136.5±15.6μm）（P<0.001）。在BI-TE-CXL组中,在中央角膜中的交联的胶原结构在12个月后仍然存在。两组基底下神经密度差异无统计学意义(P>0.05)。结论在BI-TE-CXL之后，CDVA显著提高,伴有较深的分界线深度和中央角膜基质中持续的交联结构。
