Abstract
Objective To observe the safety,efficacy and long-term stability of Cornealcollagen cross linking(CXL)in the treatment of advanced keratoconus(KC)by using corneal rings to increase riboflavin penetration 1 to 5 years after the surgery.Methods Retrospective case study.50 patients(84 eyes)with age(22.27±5.11)and 37 males(15 fe-males)were enrolled in Southeast Eye Hospital of Fuzhou from January 2018 to December 2023.The minimum corneal thickness was≥450 μm and the cornea was infiltrated with 0.1%riboflavin for 10 min utes.The total energy of 4 min con-tinuous ultraviolet irradiation was 7.2 J/cm2,and the illumination was 30 mW/cm2.Among them,44 cases(77 eyes)were recorded at 1-year follow-up,32 cases(52 eyes)at 2-year follow-up,22 cases(36 eyes)at 3-year follow-up,9 cases(12 eyes)at 4-year follow-up,and 9 cases(12 eyes)at 5-year follow-up.Spss 27.0 statistical software was used for statistical analysis.The changes of corneal flat curvature value(SimK1),steep curvature value(SimK2),corneal endothelial cell count and morphology,and the thinnest corneal thickness were compared before and after operation for 1～5 years.Re-sults All patients successfully completed the operation,no intraoperative and postoperative complications were ob-served,and the globular degree,equivalent globular degree and astigmatism degree of the 5 groups at 1,2,3,4,and 5 years after the operation were reduced or stable compared with those before the surgery,and the visual acuity was im-proved,but the difference was not statistically significant(P>0.05).The flat curvature of cornea(SimK1)was(47.09±5.27)D,days before the surgery and(45.89±5.07)D,days 1 year after the surgery.2 years after the surgery(46.43±5.25)D,The difference was statistically significant at 3 years(46.83±5.48)D,days after the surgery(P<0.001),and no statistically significant at 4 and 5 years(47.83±5.95)D,days after the surgery(P>0.05).Corneal steepness value(SimK2)was(48.05±5.76)D,before the surgery(48.91±5.72)D,1 year after the surgery(49.53±5.86)D,2 years after the surgery and(49.68±5.85)D,3 years after the surgery.The difference was statistically significant(P<0.001),and the difference was not statistically significant(P>0.05)at(50.55±6.60)D,4 and 5 years after the surgery.The thickness of the thinnest cornea was(489.01±39.70)μm,before the surgery,(473.53±47.281)μm,1 year after the surgery,(477.46±48.07)μm,2 years after the surgery,and(474.14±53.68)μm,3 years after the surgery,the differences were statistically significant(P<0.001).At 4 and 5 years after the operation,there was no significant difference(466.25±53.68)μm,(P>0.05).Corneal endothelial cell count before the surgery(2 884.29±341.63)cells/mm2,1 year after the surgery(2 798.55±367.20)cells/mm2,2 years after the surgery(2 798.55±367.20)cells/mm2,3 years after the surgery(2 888.25±378.96)cells/mm2,There was statistical significance(P<0.001),and no statistical significance(P>0.05)at 4 and 5 years after the surgery(2 818.42±392.96)cells/mm2.During 1～5 years of follow-up,the morphology of corneal en-dothelial cells at 5 observation nodes were hexagonal and moderate in size.Conclusions Rapid deepithelialization of cor-neal collagen crosslinking is safe and effective in the treatment of advanced keratoconus.After 1～5 years of observation,the visual acuity,corrected visual acuity,corneal curvature and corneal thickness of the patients after treatment were all controlled to a certain extent,and the nμmber of corneal endothelial cells did not change significantly,which is a better treatment method for advanced keratoconus at present.关键词
角膜环/核黄素/角膜交联术/进展期圆锥角膜/临床疗效Key words
Corneal ring/Riboflavin/Corneal crosslinking/Advanced keratoconus/Clinical effect
