Avedro快速角膜交聯(lián)術(shù)治療圓錐角膜的短期臨床療效與轉(zhuǎn)歸
發(fā)布時(shí)間：2018-08-23 10:09
【摘要】：目的:評(píng)估和觀察Avedro快速去上皮角膜交聯(lián)術(shù)(30mW/cm2,4分鐘)治療圓錐角膜的短期有效性、安全性及臨床轉(zhuǎn)歸過程,考察的參數(shù)包括角膜曲率值及角膜厚度、裸眼遠(yuǎn)視力(UDVA)、矯正遠(yuǎn)視力(CDVA)、主覺驗(yàn)光屈光狀態(tài)、交聯(lián)線、角膜光密度、內(nèi)皮細(xì)胞密度及眼壓。材料和方法:本研究為病例系列分析,屬于回顧性、觀察性研究。收集2016年3月至10月期間,于浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院眼科中心門診行Avedro快速去上皮角膜交聯(lián)術(shù),術(shù)后隨訪時(shí)長至少6個(gè)月的64名患者的80例眼,術(shù)中使用0.1%核黃素溶液(VibeX Rapid)浸潤,30mW/cm2輻射度365nm波長的A波紫外光照射4分鐘,相當(dāng)于能量7.2J/cm2。于術(shù)后1周內(nèi)評(píng)估角膜上皮化完成情況及手術(shù)相關(guān)并發(fā)癥,術(shù)后1月、3月,6月隨訪,查眼壓、視力、PentacamHR、眼前節(jié)OCT、角膜共聚焦顯微鏡。考察主要參數(shù)術(shù)前,術(shù)后1月、3月及6月的差異采用重復(fù)測(cè)量方差分析,結(jié)果以均值±標(biāo)準(zhǔn)差表示,P0.05時(shí)認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果:統(tǒng)計(jì)80例術(shù)眼分析得:(1)角膜最大曲率在術(shù)后1月時(shí)較術(shù)前增大,由54.87±8.54 D到55.80±8.57 D,p0.01,角膜前表面陡軸曲率在術(shù)后1月時(shí)較術(shù)前增大,由49.23±4.69D到50.00±5.13D,p0.01,角膜前表面平軸曲率在術(shù)后1月時(shí)較術(shù)前增大,由45.95±3.66D到46.35±4.00D,p0.01。角膜最薄點(diǎn)厚度在術(shù)后1月時(shí)較術(shù)前變薄,由469.7±38.3μm到457.6±38.6μm,p0.05。以上參數(shù)均在術(shù)后3月及6月復(fù)查時(shí)相較術(shù)前無明顯差異。瞳孔2mm直徑區(qū)角膜全層平均光密度術(shù)后前期歷次隨訪均明顯高于術(shù)前,直至術(shù)后6月恢復(fù)至術(shù)前水平。角膜后表面陡軸及平軸曲率在術(shù)后1月、3月及6月相較術(shù)前均無明顯改變。(2)UDVA、CDVA、球鏡值、柱鏡值及等效球鏡值在術(shù)后1月、3月及6月時(shí)相較術(shù)前均無明顯改變。(3)角膜內(nèi)皮細(xì)胞密度在術(shù)后1月時(shí)相較術(shù)前變小,均值由2507.3±163.8個(gè)/mm2降至2473.2±126.8個(gè)/mm2,尚在安全范圍內(nèi),且于術(shù)后3月、6月復(fù)查時(shí)恢復(fù)至術(shù)前。(4)97.5%的術(shù)眼于術(shù)后1月左右可于眼前節(jié)OCT觀察到明顯交聯(lián)線,平均深度為241±78μm。(5)術(shù)后出現(xiàn)細(xì)菌性角膜炎1例,誘發(fā)單純皰疹病毒性角膜炎2例。結(jié)論:Avedro快速去上皮角膜交聯(lián)術(shù)(30mW/cm2,4分鐘)治療進(jìn)展期圓錐角膜,在術(shù)后短期內(nèi)未見疾病進(jìn)展,可穩(wěn)定角膜形態(tài),且安全性高。(1)術(shù)眼視力、角膜曲率穩(wěn)定,術(shù)后1月術(shù)眼角膜參數(shù)數(shù)值上呈現(xiàn)輕度變凸變薄狀態(tài),但術(shù)后3月、6月復(fù)查均恢復(fù)至術(shù)前;術(shù)后6月雖尚無統(tǒng)計(jì)學(xué)意義上視力明顯改善或角膜局部突起變平的證據(jù),但考察各項(xiàng)均值,已出現(xiàn)視力改善、角膜曲率變小的趨勢(shì),有待長期隨訪結(jié)果支持。(2)角膜內(nèi)皮細(xì)胞密度、眼壓穩(wěn)定,上皮化正常;瞳孔區(qū)角膜光密度于術(shù)后早期顯著升高,至6月恢復(fù);96.25%的術(shù)眼隨訪期間無明顯并發(fā)癥,3例感染術(shù)眼得到及時(shí)有效處理,無一出現(xiàn)角膜瘢痕或視力受損后遺癥。
[Abstract]:Objective: to evaluate and observe the short-term efficacy, safety and clinical outcome of Avedro rapid epithelial corneal cross-linking (30MW / cm2min) in the treatment of keratoconus. The parameters included corneal curvature and corneal thickness. Naked far visual acuity (UDVA),) was used to correct the (CDVA), principal optometry, cross-linking line, corneal optical density, endothelial cell density and intraocular pressure (IOP). Materials and methods: this study is a case series analysis, which is a retrospective and observational study. From March to October 2016, 80 eyes of 64 patients who were followed up for at least 6 months after Avedro rapid epithelial corneal cross-linking were collected from the outpatient clinic of run Shaw Hospital affiliated to Zhejiang University Medical College. Intraoperative irradiation with 0.1% riboflavin solution (VibeX Rapid) infiltrating 30 MW / cm ~ 2 radiance 365nm wavelength A wave ultraviolet light for 4 minutes, equivalent to energy 7.2 J / cm ~ (2). The corneal epithelialization and complications were evaluated within 1 week after operation. The intraocular pressure (IOP) visual acuity Pentacam HRA anterior segment OCTs and confocal cornea microscope were followed up at 1 month 3 months and 6 months after operation. The main parameters before operation, 1 month, 3 months and 6 months after operation were analyzed by repeated analysis of variance. The results showed that there was statistical significance when mean 鹵standard deviation (P 0.05). Results: (1) the maximum corneal curvature increased from 54.87 鹵8.54 D to 55.80 鹵8.57 DX 0.01 at 1 month after operation. From 49.23 鹵4.69D to 50.00 鹵5.13Dp0.01, the mean curvature of the anterior corneal surface was increased from 45.95 鹵3.66D to 46.35 鹵4.00Dp0.01 at 1 month after operation. The thickness of the thinnest spot became thinner at 1 month after operation, from 469.7 鹵38.3 渭 m to 457.6 鹵38.6 渭 m (P 0.05). There was no significant difference in the above parameters between 3 months and 6 months after operation. The average optical density of the whole corneal layer in pupil 2mm diameter area was significantly higher than that before operation, and recovered to the preoperative level at 6 months after operation. There were no significant changes in the curvature of the steep axis and flat axis of the posterior corneal surface in 1 month, 3 months and 6 months after the operation. (2) the value of CDVA of UDVA, spherical lens, and so on. There were no significant changes in the values of column and equivalent spherical endoscopy at 1 month, 3 months and 6 months after operation. (3) the density of corneal endothelial cells decreased from 2507.3 鹵163.8 / mm2 to 2473.2 鹵126.8 / mm ~ (2), which was still within the safe range. (4) 97.5% of the eyes had obvious cross-linking lines in anterior segment OCT about one month after operation, the average depth was 241 鹵78 渭 m. (5) bacterial keratitis occurred in 1 case after operation, and herpes simplex keratitis was induced in 2 cases. Conclusion the rapid exfoliative keratectomy (30 MW / cm 2 min) for advanced keratoconus has no progress in the short term after operation. It can stabilize the corneal morphology and be safe. (1) the visual acuity and the curvature of the cornea are stable. The corneal parameters showed slight convexity and thinning in the first month after operation, but all of them recovered to the preoperative level in 3 months and 6 months after operation, although there was no evidence of significant improvement in visual acuity or flattening of local corneal protrusions in 6 months after operation. However, the visual acuity has been improved and the corneal curvature has become smaller. (2) the corneal endothelial cell density, intraocular pressure is stable, epithelialization is normal, and the corneal optical density in pupil area is significantly increased in the early postoperative period. By the end of 6 months, 96. 25% of the eyes had no obvious complications and 3 cases of infection were treated in time and effectively, and no corneal scar or visual acuity sequelae were found.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
本文編號(hào)：2198730
[Abstract]:Objective: to evaluate and observe the short-term efficacy, safety and clinical outcome of Avedro rapid epithelial corneal cross-linking (30MW / cm2min) in the treatment of keratoconus. The parameters included corneal curvature and corneal thickness. Naked far visual acuity (UDVA),) was used to correct the (CDVA), principal optometry, cross-linking line, corneal optical density, endothelial cell density and intraocular pressure (IOP). Materials and methods: this study is a case series analysis, which is a retrospective and observational study. From March to October 2016, 80 eyes of 64 patients who were followed up for at least 6 months after Avedro rapid epithelial corneal cross-linking were collected from the outpatient clinic of run Shaw Hospital affiliated to Zhejiang University Medical College. Intraoperative irradiation with 0.1% riboflavin solution (VibeX Rapid) infiltrating 30 MW / cm ~ 2 radiance 365nm wavelength A wave ultraviolet light for 4 minutes, equivalent to energy 7.2 J / cm ~ (2). The corneal epithelialization and complications were evaluated within 1 week after operation. The intraocular pressure (IOP) visual acuity Pentacam HRA anterior segment OCTs and confocal cornea microscope were followed up at 1 month 3 months and 6 months after operation. The main parameters before operation, 1 month, 3 months and 6 months after operation were analyzed by repeated analysis of variance. The results showed that there was statistical significance when mean 鹵standard deviation (P 0.05). Results: (1) the maximum corneal curvature increased from 54.87 鹵8.54 D to 55.80 鹵8.57 DX 0.01 at 1 month after operation. From 49.23 鹵4.69D to 50.00 鹵5.13Dp0.01, the mean curvature of the anterior corneal surface was increased from 45.95 鹵3.66D to 46.35 鹵4.00Dp0.01 at 1 month after operation. The thickness of the thinnest spot became thinner at 1 month after operation, from 469.7 鹵38.3 渭 m to 457.6 鹵38.6 渭 m (P 0.05). There was no significant difference in the above parameters between 3 months and 6 months after operation. The average optical density of the whole corneal layer in pupil 2mm diameter area was significantly higher than that before operation, and recovered to the preoperative level at 6 months after operation. There were no significant changes in the curvature of the steep axis and flat axis of the posterior corneal surface in 1 month, 3 months and 6 months after the operation. (2) the value of CDVA of UDVA, spherical lens, and so on. There were no significant changes in the values of column and equivalent spherical endoscopy at 1 month, 3 months and 6 months after operation. (3) the density of corneal endothelial cells decreased from 2507.3 鹵163.8 / mm2 to 2473.2 鹵126.8 / mm ~ (2), which was still within the safe range. (4) 97.5% of the eyes had obvious cross-linking lines in anterior segment OCT about one month after operation, the average depth was 241 鹵78 渭 m. (5) bacterial keratitis occurred in 1 case after operation, and herpes simplex keratitis was induced in 2 cases. Conclusion the rapid exfoliative keratectomy (30 MW / cm 2 min) for advanced keratoconus has no progress in the short term after operation. It can stabilize the corneal morphology and be safe. (1) the visual acuity and the curvature of the cornea are stable. The corneal parameters showed slight convexity and thinning in the first month after operation, but all of them recovered to the preoperative level in 3 months and 6 months after operation, although there was no evidence of significant improvement in visual acuity or flattening of local corneal protrusions in 6 months after operation. However, the visual acuity has been improved and the corneal curvature has become smaller. (2) the corneal endothelial cell density, intraocular pressure is stable, epithelialization is normal, and the corneal optical density in pupil area is significantly increased in the early postoperative period. By the end of 6 months, 96. 25% of the eyes had no obvious complications and 3 cases of infection were treated in time and effectively, and no corneal scar or visual acuity sequelae were found.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
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