角膜交联联合光疗性角膜切除术伴或不伴地形引导的光屈光性角膜切除术的安全性和有效性。

IF 1.9 3区医学 Q2 OPHTHALMOLOGY

Cornea Pub Date : 2025-06-10 DOI:10.1097/ICO.0000000000003921

Pedro Gil, João Quadrado Gil, Margarida Dias, Telmo Cortinhal, Nuno Alves, Andreia Rosa, Joaquim Murta

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引用次数: 0

摘要

目的：比较经上皮光疗性角膜切除术（PTK）与角膜交联（CXL）和地形引导光屈光性角膜切除术（TG-PRK）的视力、屈光和层析结果。方法：纵向回顾性病例对照研究。进展性圆锥角膜患者接受PTK-CXL或PTK + TG-PRK + CXL （PRK-CXL）方案，取决于基线视度数和矫正距离视力（CDVA）。最少随访12个月至3年。结果：120例患者共纳入120只眼，PTK-CXL组占51.7% (n = 62)， PRK-CXL组占48.3% （n = 58）。各组间基线特征相似，但logMAR CDVA (PTK-CXL: 0.36±0.24；Prk-cxl: 0.47±0.21；P = 0.025)，最薄测厚仪(PTK-CXL: 436.58±37.09 μm；Prk-cxl: 460.83±21.90；P = 0.002)。LogMAR CDVA显著改善，各组间在所有时间点均无差异。但PRK-CXL组末次随访与基线间的平均改善更高(PTK-CXL: -0.12±0.19；Prk-cxl: -0.24±0.22；P = 0.015)。PTK-CXL的最大角膜度数保持稳定(基线：60.82±6.94D；1年：60.82±8.05；P = 0.993)，但在PRK-CXL组中趋于平缓(基线：59.05±5.97；1年：54.45±5.88；P < 0.001)。两组患者的总像差和高阶像差均有改善，但球像差和彗差仅在PRK-CXL后改善。所有层析特征在随访期间保持稳定。结论：PTK-CXL和TG-PRK + CXL方案在阻止疾病进展和提供视力改善方面安全有效。后者使角膜进一步扁平化，视力改善更大，角膜畸变更少。对于角膜厚度足够的进行性圆锥角膜患者，我们推荐TG-PRK联合CXL， PTK-CXL方案保留给视力较好或角膜较薄的患者。

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Safety and Efficacy of Corneal Crosslinking Combined With Phototherapeutic Keratectomy With or Without Topography-Guided Photorefractive Keratectomy.

Purpose: To compare the visual, refractive, and tomographic outcomes between transepithelial phototherapeutic keratectomy (PTK) with corneal crosslinking (CXL) and topography-guided photorefractive keratectomy (TG-PRK) with PTK and CXL.

Methods: Longitudinal retrospective case-control study. Patients with progressive keratoconus submitted to either PTK-CXL or PTK and TG-PRK plus CXL (PRK-CXL) protocols were included, depending on baseline pachymetry and corrected distance visual acuity (CDVA). Minimum follow-up of 12 months up to 3 years.

Results: A total of 120 eyes from 120 patients were included, 51.7% (n = 62) in the PTK-CXL and 48.3% (n = 58) in the PRK-CXL groups. Baseline characteristics were similar between groups, except for logMAR CDVA (PTK-CXL: 0.36 ± 0.24; PRK-CXL: 0.47 ± 0.21; P = 0.025) and thinnest pachymetry (PTK-CXL: 436.58 ± 37.09 μm; PRK-CXL: 460.83 ± 21.90; P = 0.002). LogMAR CDVA significantly improved, with no differences between groups across all time points. But the mean improvement between the last follow-up and baseline was higher in the PRK-CXL group (PTK-CXL: -0.12 ± 0.19; PRK-CXL: -0.24 ± 0.22; P = 0.015). Maximum keratometry remained stable in the PTK-CXL (baseline: 60.82 ± 6.94D; 1 year: 60.82 ± 8.05; P = 0.993) but flattened in the PRK-CXL groups (baseline: 59.05 ± 5.97; 1 year: 54.45 ± 5.88; P < 0.001). Total and higher-order aberrations improved in both groups, but spherical aberration and coma only improved after PRK-CXL. All tomographic features remained stable across the follow-up.

Conclusions: PTK-CXL and TG-PRK plus CXL protocols are safe and effective both at arresting the disease progression and providing visual improvement. The latter brings further corneal flattening, greater visual improvement, and less corneal aberrations. For patients with progressive keratoconus with adequate corneal thickness, we recommend combined TG-PRK plus CXL, with the PTK-CXL protocol reserved for patients with better visual acuity or thinner corneas.

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来源期刊

Cornea 医学-眼科学

CiteScore

5.20

自引率

10.70%

发文量

354

审稿时长

3-6 weeks

期刊介绍： For corneal specialists and for all general ophthalmologists with an interest in this exciting subspecialty, Cornea brings together the latest clinical and basic research on the cornea and the anterior segment of the eye. Each volume is peer-reviewed by Cornea''s board of world-renowned experts and fully indexed in archival format. Your subscription brings you the latest developments in your field and a growing library of valuable professional references. Sponsored by The Cornea Society which was founded as the Castroviejo Cornea Society in 1975.