不含丝裂霉素 C 的定制化经皮层 PRK 结合加速角膜交联与单纯角膜交联术后角膜混浊的前瞻性客观分析。

IF 2.9 3区医学 Q1 OPHTHALMOLOGY

Journal of refractive surgery Pub Date : 2024-09-01 DOI:10.3928/1081597x-20240715-03

Shady T Awwad,Yara Bteich,Jad F Assaf,Andre Ghosn,Farhad Hafezi,Emilio Torres-Netto,Lily M Chacra,Karim Kozhaya

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Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units.\r\n\r\nRESULTS\r\nIn both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group (P < .001) and by 0.7 lines in the CXL group (P = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) (P < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) (P = .004). 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引用次数: 0

摘要

目的比较接受联合加速角膜交联术（A-CXL）和选择性波前引导经上皮光屈光性角膜切除术（WG-transPRK）而不接受丝裂霉素 C（MMC）的患者与接受 A-CXL 的患者的雾度和屈光结果。方法这项前瞻性研究分析了 2018 年 10 月至 2022 年 10 月期间 95 只患有进行性角膜炎的眼睛（86 例患者）。第一组接受CXL联合角膜或眼球WG-transPRK（CXL+PRK，n = 52），针对高阶像差（HOA）。第二组仅进行了 CXL（n = 43），两组均在 SCHWIND Amaris 激光平台（SCHWIND eye-tech-solutions）上采用相同的加速 CXL 方案，不使用 MMC。基线和术后评估（1、3、6 和 12 个月）包括未矫正（UDVA）和矫正（CDVA）远距离视力、明显屈光度、断层扫描、角膜 HOAs 和光学相干断层扫描（OCT）。结果两组患者的角膜前部雾度反射率和上皮下雾度在术后 3 个月达到峰值，然后在 6 个月和 12 个月逐渐降低。两组患者在任何时间点的混浊度均无差异。到 12 个月时，CXL+PRK 组的 CDVA 增加了 2.5 行（P < .001），CXL 组增加了 0.7 行（P = .10），最大角膜屈光度从 51.70 ± 5.10 降至 47.90 ± 7.90 屈光度（D）（CXL+PRK 组）（P < .001），最大角膜屈光度从 51.20 ± 5.10 降至 50.30 ± 4.60 D（CXL 组）（P = .004）。结论与单用 A-CXL 相比，将 CXL 与不含 MMC 的 WG-transPRK 结合使用不会导致雾度增加。这种联合方法在视觉、地形和像差参数方面都有更大的改善。[J Refract Surg. 2024;40（9）：e583-e594]。

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Prospective Objective Analysis of Corneal Haze Following Customized Transepithelial PRK Without Mitomycin C Combined With Accelerated Corneal Cross-Linking Versus Corneal Cross-Linking Alone.

PURPOSE To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL. METHODS This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units. RESULTS In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group (P < .001) and by 0.7 lines in the CXL group (P = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) (P < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) (P = .004). Corneal HOAs decreased in both groups but more in the CXL+PRK group. CONCLUSIONS Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. [J Refract Surg. 2024;40(9):e583-e594.].

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来源期刊

$Journal of refractive surgery$

Journal of refractive surgery 医学-外科

CiteScore

5.10

自引率

12.50%

发文量

160

审稿时长

4-8 weeks

期刊介绍： The Journal of Refractive Surgery, the official journal of the International Society of Refractive Surgery, a partner of the American Academy of Ophthalmology, has been a monthly peer-reviewed forum for original research, review, and evaluation of refractive and lens-based surgical procedures for more than 30 years. Practical, clinically valuable articles provide readers with the most up-to-date information regarding advances in the field of refractive surgery. Begin to explore the Journal and all of its great benefits such as: • Columns including “Translational Science,” “Surgical Techniques,” and “Biomechanics” • Supplemental videos and materials available for many articles • Access to current articles, as well as several years of archived content • Articles posted online just 2 months after acceptance.