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首页> 外文期刊>Journal of Ophthalmology >Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up
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Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up

机译：圆锥角膜患者的Epi-Off与Epi-On角膜胶原交联：通过2年随访的比较研究

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Aim. To evaluate two different techniques of cross-linking standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus. Methods. Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3?mW/cm2. Results. In both groups, a significant improvement in visual function (Group 1 baseline 0.36?±?0.16 logMAR, two-year follow-up 0.22?±?0.17 logMAR, ; Group 2 baseline 0.32?±?0.18 logMAR, 2-year follow-up 0.27?±?0.19 logMAR, ) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness ?55 micron and ?71 micron, resp.). One-month after treatment, OSDI? reached 13.56?±?2.15 in Group 1 () and 11.26?±?2.12 in Group 2 (). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), with and 0.356, respectively. Conclusion. Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.
机译：目标。为了评估渐进性圆锥角膜患者的两种不同的交联标准上皮脱落（CXL epi-off）与经上皮（CXL epi-on）交联的技术。方法。这项非盲目，随机对照研究从2014年6月至2015年6月对32例进行性圆锥角膜患者的40只眼进行了前瞻性研究。通过CXL Epi-off治疗20只眼，通过CLX Epi-on治疗20只眼，随机分配，并随访2年。所有患者均接受了完整的眼科检查，包括未矫正和最佳矫正的视力，中央和周边角膜厚度，角膜散光，模拟的最大，最小和平均角膜曲率，角膜共聚焦显微镜，Schirmer I和破裂时间（BUT）测试，和眼表疾病指数。记录术中和术后并发症。用于CXL脱附的溶液包含0.1％的核黄素和20.0％的葡聚糖（Ricrolin），而用于CXL脱附的溶液（Ricrolin TE）包括0.1％的核黄素，15.0％的葡聚糖，丁苯三酚（Tris）和乙二胺四乙酸。用UV-X系统以3μmW/ cm 2进行紫外线-A处理。结果。两组患者的视觉功能均有显着改善（第1组基线0.36±0.16 logMAR，两年随访0.22±0.17 logMAR;第2组基线0.32±0.18 logMAR，两年随访。记录高达0.27±0.19 logMAR，）。两组的角膜测定法保持不变。平均角膜厚度显示出显着减小（角膜厚度的平均差分别为〜55微米和〜71微米）。治疗一个月后，OSDI？第一组（）达到13.56±2.15，第二组（11.26）达到11.26±2.12。在共聚焦显微镜下，两组均发现了异常的角膜神经改变。组1的纤维化反应（43.75％）和活化的角膜细胞（62.6％）的发生率高于组2（25.0％和18.75％），分别为0.36和0.356。结论。我们的发现表明这两种方法都能够减缓圆锥角膜的进展。就结果和相关并发症而言，两种治疗方式均等效。 CXL Epi-on技术优于CXL Epi-off技术，因为它保留了角膜厚度并改善了视力，还减少了研究期间的术后眼部不适。

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