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首页> 中文期刊> 《国际眼科杂志》 >角膜胶原蛋白交联疗法对人工晶状体大泡性角膜病变的作用

角膜胶原蛋白交联疗法对人工晶状体大泡性角膜病变的作用

         
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AIM: To evaluate the efficacy of riboflavin administration and ultraviolet A ( UVA ) cross - linking on advanced symptomatic bullous keratopathy. METHODS:Fifteen patients with symptomatic pseudophakic bullous keratopathy ( PBK ) were included. Slit - lamp examination, visual acuity, foreign body sensation( FBS) questionnaire, corneal clarity grading, ocular pain intensity scale and corneal thickness measures with Pentacam and ultrasound pachymetry ( UP ) , were performed before corneal cross-linking and 1 and 6mo thereafter. After using sodium chloride solution, for one week, the central 8mm ( diameter ) of the corneal epithelium was removed, and cross - linking, with riboflavin instillation every 3min for 30min, and UVA irradiation for 30min was performed. RESULTS:Five males and 10 females with mean age of 66±13y were included. Mean follow up time was 6. 2mo. Corneal transparency in all eyes was statistically significantly better 1 month after treatment than preoperatively ( P< 0. 05 ). At 6mo, however, corneal transparency was better in 8 eyes, the same in 5 eyes, and worse in 2 eyes compared with preoperative levels ( P=0. 218 ). Foreign body sensation subsided in 70% of patients. The average CCT decreased within 1mo after the procedure ( P < 0. 05 ). At 6mo, all but 3 eyes had progressive swelling, and the CCT increased; however, the CCT was still statistically significantly thinner than preoperatively (P = 0. 006). The improvement in mean CDVA from preoperatively to 1mo postoperatively was statistically significant (P=0. 010). At 6mo, no significant differences were observed (P=0. 130). The pain scores at 1mo were statistically significantly better than preoperatively (P=0. 007). At 6mo, however the mean pain score was higher than at 1mo and not statistically significantly different from the preoperative score (P=0. 070). CONCLUSION: Corneal CXL significantly improved corneal transparency, corneal thickness, and ocular pain 1 month postoperatively. However, it did not seem to have a long-lasting effect in decreasing pain and maintaining corneal transparency in patients with PBK. This procedure extends the time interval for corneal transplantation and increases visualization at DSAEK procedure.%目的：研究核黄素和紫外线( UVA )交联疗法对晚期大泡性角膜病的疗效。　　方法：15例人工晶状体大泡性角膜病变( PBK )患者参与研究。分别于角膜交联前和干预后1,6mo,对患者行裂隙灯检查、视敏度、异物调查表、角膜透明度分级、眼部疼痛度范围、分析仪角膜厚度分析及超声波角膜厚度测量。氯化钠溶液处理1 wk后,去除8 mm直径范围的中央角膜上皮,在角膜上频繁点滴核黄素30min,后行3min紫外线( UVA)照射交联疗法。　　结果：15例患者(5男,10女),平均年龄为66依13岁。平均随访时间6.2mo。治疗后1mo全眼角膜透明度统计结果明显优于术前(P<0.05)。6mo时8眼角膜透明度较术前更佳,5眼持平,2眼低于术前( P=0.218)。70%病患异物感减弱。处理后1mo平均中央角膜厚度( CCT)减少( P<0.05)。6mo时,除3眼外均出现渐进性肿胀,但统计显示CCT明显薄于术前(P=0.006)。统计显示术后1mo平均矫正远视力( CDVA)明显优于术前( P=0.010)。6 mo后无显著差异(P=0.130)。1mo痛值统计结果明显优于术前(P=0.007)。但6mo平均痛值较1mo高,较术前无明显差异(P=0.070)。　　结论：术后1 mo结果显示角膜胶原交联疗法可显著改善角膜透明度、角膜厚度和眼痛。但是,它对减少PBK患者疼痛和维持角膜透明度方面似乎并无长期持久的效果。这种方法延长了角膜移植的时间间隔,并提高了角膜内皮移植术( DSAEK)过程的可视化。

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