1.100853 北京,解放军医学院研究生院
2.100039 北京,解放军总医院第三医学中心眼科医学部
3.100853 北京,解放军总医院第一医学中心
Received:14 November 2021,
Revised:2022-01-09,
Published:15 June 2022
移动端阅览
Kunkun YANG, Mei GE, Yifan FANG, et al. Effect of corneal cross-linking surgery on corneal densitometry in patients with keratoconus[J]. Journal of Army Medical University, 2022, 44(11): 1169-1176.
Kunkun YANG, Mei GE, Yifan FANG, et al. Effect of corneal cross-linking surgery on corneal densitometry in patients with keratoconus[J]. Journal of Army Medical University, 2022, 44(11): 1169-1176. DOI: 10.16016/j.2097-0927.202111102.
目的
2
应用Pentacam三维眼前节分析系统获取并分析角膜交联手术(corneal collagen crosslinking
CXL)对圆锥角膜(keratoconus
KC)患者角膜光密度(corneal densitometry
CD)的影响。
方法
2
选取2017年1月至2019年12月就诊于解放军总医院第一医学中心眼科并接受CXL的KC患者28例,纳入圆锥角膜-角膜光密度组(KC-CD组);选取其中所有接受单眼CXL患者共14例,将术眼纳入CXL组,非术眼纳入Non-CXL组;利用Pentacam三维眼前节分析系统获取并分析角膜交联手术前、术后1个月、术后3个月、术后1年CD值和角膜形态数据、角膜最薄点(thinnest corneal thickness,TCT);应用非参数检验、单因素卡方分析、配对
t
检验等统计方法对交联手术前后角膜光密度进行横向和纵向比较。
结果
2
所有接受CXL的圆锥角膜患者在CXL术后1个月其前层、中层、后层以及全层角膜0~2 mm和
>
2~6 mm的CD值较术前明显升高(
P
<
0.05);在CXL术后3个月前层0~2 mm、中层0~2 mm、全层0~2 mm的CD值较术前升高(
P
<
0.01),而后层0~2 mm则没有统计学差异;在CXL术后1年仅前层0~2 mm的CD值较术前存在统计学差异(
P
=0.011);在单眼接受CXL的圆锥角膜患者中,Non-CXL组的CD值在CXL手术前后无明显变化,CXL组的CD值变化趋势同KC-CD组;在术后1个月,CXL组的前层0~2 mm、
>
2~6 mm,中层0~2 mm、
>
2~6 mm,后层
>
2~6 mm,全层0~2 mm、
>
2~6 mm的CD值均较Non-CXL组明显升高(
P
<
0.05);术后3个月上述CXL组各层CD值与Non-CXL组相比仍偏高(
P
<
0.05),但其平均CD值较CXL术后1个月下降;在接受CXL术后1年,CXL组和Non-CXL组的各层CD值无明显差异。Non-CXL组和CXL组的角膜形态等数据较术前无变化。
结论
2
角膜交联手术会导致圆锥角膜患者角膜光密度升高,在术后1个月达到峰值,而后逐渐下降,在术后1年恢复正常。
Objective
2
To obtain and analyze the effect of corneal collagen crosslinking (CXL) on corneal densitometry (CD) in patients with keratoconus (KC) by using the Pentacam 3D anterior segment analysis system.
Methods
2
Twenty-eight KC patients who visited the Chinese PLA General Hospital and underwent CXL from January 2017 to December 2019 were subjected and included in the KC-CD group. There were 14 patients who underwent monocular CXL
and the operated eyes were included in the CXL group and the non-operated eyes in the non-CXL group. CD values and data of corneal morphology
and the thinnest corneal thickness (TCT) were obtained and analyzed before and in 1 and 3 months
and 1 year after the CXL using the Pentacam 3D anterior segment analysis system. Nonparametric test
one-way
Chi
-square analysis
paired
t
-test and other statistical analyses were applied to compare CD before and after surgery in a cross-sectional and longitudinal manner.
Results
2
The CD values of 0~2 mm and 2~6 mm zones in the anterior
central
and posterior layers as well as in the total cornea were significantly higher (
P
<
0.05) in all KC patients undergoing CXL (KC-CD group) at 1 month after CXL when compared to the preoperative period. At 3 months after CXL
the CD values were higher in the 0~2 mm zones of the anterior layer
the central layer
and the total layer 0~2 mm than the values preoperatively (
P
<
0.01)
whereas there was no statistical differences in the values in the 0~2 mm zone of the posterior layer. Only the CD values of the 0~2 mm zone in the anterior layer differed at 1 year after CXL when compared to the
preoperative values (
P
=0.011). In the KC patients undergoing CXL in one eye
CD values in the non-CXL group did not change significantly before and after the CXL surgery
and the trend of CD values was the same in the CXL group as that in the KC-CD group. At 1 month postoperatively
a significantly higher CD value (
P
<
0.05) was observed in the CXL group compared to the non-CXL group in the 0~2 mm and
>
2~6 mm zones of the anterior layer
the central layer
the posterior layer
and the total layer. Compared with the Non-CXL group
the CD values of the above-mentioned layer of CXL group were still higher at 3 months after surgery (
P
<
0.05)
but their mean CD values were decreased at 1 month after CXL. At 1 year after undergoing CXL
there were no significant changes in CD values in each layer between the CXL and non-CXL groups.
Conclusion
2
CXL causes an increase in CD value in KC patients with keratoconus
which peaks at 1 month postoperatively and then gradually decreased to normal level at 1 year after surgery.
OTRI A M, FARES U, AL-AQABA M A, et al . Corneal densitometry as an indicator of corneal health[J ] . Ophthalmology, 2012, 119(3): 501-508. DOI: 10.1016/j.ophtha.2011.08.024.
DONG J, ZHANG Y Q, ZHANG H N, et al . Corneal densitometry in high myopia[J ] . BMC Ophthalmol, 2018, 18(1): 182. DOI: 10.1186/s12886-018-0851-x.
CHO Y K, CHANG H S, LA T Y, et al . Anterior segment parameters using Pentacam and prediction of corneal endothelial cell loss after cataract surgery[J ] . Korean J Ophthalmol, 2010, 24(5): 284-290. DOI: 10.3341/kjo.2010.24.5.284.
LOPES B, RAMOS I, AMBRÓSIO R Jr. Corneal densitometry in keratoconus[J]. Cornea, 2014, 33(12): 1282-1286. DOI: 10.1097/ICO.0000000000000266.
CHU H Y, HSIAO C H, CHEN P Y F, et al . Corneal backscatters as an objective index for assessing fuchs' endothelial corneal dystrophy: a pilot study[J ] . J Ophthalmol, 2017, 2017: 8747013. DOI: 10.1155/2017/8747013.
SEKEROGLU M A, ANAYOL M A, GULEC M, et al . Corneal densitometry: a new technique for objective assessment of corneal clarity in pseudoexfoliation syndrome[J ] . J Glaucoma, 2016, 25(9): 775-779. DOI: 10.1097/IJG.0000000000000501.
袁倩, 刘蕾, 张亚丽, 等. SMILE和FS-LASIK对角膜光密度的影响[J]. 中华眼视光学与视觉科学杂志, 2018, 20(12): 719-724. DOI: 10.3760/cma.j.issn.1674-845X.2018.12.004.
YUAN Q, LIU L, ZHANG Y L, et al . Effect of SMILE and FS-LASIK on corneal densitometry after myopic correction[J ] . Chin J Optom Ophthalmol Vis Sci, 2018, 20(12): 719-724. DOI: 10.3760/cma.j.issn.1674-845X.2018.12.004.
ALNAWAISEH M, ZUMHAGEN L, ZUMHAGEN S, et al . Corneal densitometry as a novel technique for monitoring amiodarone therapy[J ] . Ophthalmology, 2016, 123(11): 2294-2299. DOI: 10.1016/j.ophtha.2016.08.001.
XU L, WANG Y X, GUO Y, et al . Prevalence and associations of steep cornea/keratoconus in Greater Beijing. The Beijing Eye Study[J ] . PLoS One, 2012, 7(7): e39313. DOI: 10.1371/journal.pone.0039313.
张梦瑶, 林启, 邵毅. 儿童圆锥角膜的治疗进展[J]. 国际眼科杂志, 2020, 20(4): 619-623. DOI: 10.3980/j.issn.1672-5123.2020.4.08.
ZHANG M Y, LIN Q, SHAO Y. Application advancement of corneal cross-linking inpediatric keratcoconus[J]. Int Eye Sci, 2020, 20(4): 619-623. DOI: 10.3980/j.issn.1672-5123.2020.4.08.
李金晶, 薛劲松, 蒋沁, 等. 角膜胶原交联术治疗圆锥角膜的研究进展[J]. 国际眼科杂志, 2020, 20(3): 477-480. DOI: 10.3980/j.issn.1672-5123.2020.3.15.
LI J J, XUE J S, JIANG Q, et al . Res earch progress of corneal collagen cross-linking in the treatment of keratoconus[J ] . Int Eye Sci, 2020, 20(3): 477-480. DOI: 10.3980/j.issn.1672-5123.2020.3.15.
张梦雨, 田磊, 郭莉莉, 等. 圆锥角膜的光密度分析及其与角膜形态学的相关性研究[J]. 眼科, 2020, 29(4): 278-283. DOI: 10.13281/j.cnki.issn.1004-4469.2020.04.007.
ZHANG M Y, TIAN L, GUO L L, et al . Corneal densitometry analysis and its correlation with corneal topography in keratoconus[J ] . Ophthalmol China, 2020, 29(4): 278-283. DOI: 10.13281/j.cnki.issn.1004-4469.2020.04.007.
KOSEKAHYA P, ATILGAN K G, ATILGAN C U, et al . Could corneal densitometry be used as a diagnostic and screening tool for ocular involvement in patients with gout?[J ] . Int Ophthalmol, 2019, 39(5): 991-1001. DOI: 10.1007/s10792-018-0901-7.
RAMM L, SPOERL E, PILLUNAT L E, et al . Corneal densitometry in diabetes mellitus[J ] . Cornea, 2020, 39(8): 968-974. DOI: 10.1097/ICO.0000000000002310.
HO WANG YIN G, SAMPO M, SOARE S, et al . Visual acuity, pachymetry and corneal density after 5% sodium chloride treatment in corneal edema after surgery[J ] . J Fr Ophtalmol, 2015, 38(10): 967-973. DOI: 10.1016/j.jfo.2015.07.002.
JABBARVAND M, KHODAPARAST M, JAMALI A, et al . Changes in the optical corneal densitometry, visual acuity, and refractive error after the annular intracorneal inlay implantation[J ] . J Curr Ophthalmol, 2021, 33(1): 23-30. DOI: 10.4103/JOCO.JOCO_154_20.
ALZAHRANI K, MOFTY H, LIN E Y, et al . Corneal imaging and densitometry measurements in juvenile and adult keratoconus patients to evaluate disease progression and treatment effects after corneal cross-linking[J ] . Clin Optom(Auckl), 2019, 11: 173-180. DOI: 10.2147/OPTO.S226000.
PIRCHER N, PACHALA M, PRAGER F, et al . Changes in straylight and densitometry values after corneal collagen crosslinking[J ] . J Cataract Refract Surg, 2015, 41(5): 1038-1043. DOI: 10.1016/j.jcrs.2014.07.043.
KIM B Z, JORDAN C A, MCGHEE C N J, et al . Natural history of corneal haze after corneal collagen crosslinking in keratoconus using Scheimpflug analysis[J ] . J Cataract Refract Surg, 2016, 42(7): 1053-1059. DOI: 10.1016/j.jcrs.2016.04.019.
MAIER P, REINHARD T, KOHLHAAS M. Corneal collagen cross-linking in the stabilization of keratoconus[J]. Dtsch Arztebl Int, 2019, 116(11): 184-190. DOI: 10.3238/arztebl.2019.0184.
ELFLEIN H M, HOFHERR T. Measuring corneal clouding in patients suffering from mucopolysaccharidosis with the Pentacam densitometry programme[J]. Br J Ophthalmol, 2013, 97(7): 829-833. DOI: 10.1136/bjophthalmol-2012-302913.
GREENSTEIN S A, KRISTEN L F, BHATT J, et al . Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and Biomicroscopic analysis[J ] . J Cataract Refract Surg, 2010, 36(12): 2105-2114. DOI: 10.1016/j.jcrs.2010.06.067.
XIA Y, LIU B C, FAN Z J, et al . Corneal collagen fibril changes after ultraviolet a/riboflavin corneal crosslinking[J ] . Cornea, 2014, 33(1): 56-59. DOI: 10.1097/ICO.0000000000000017.
FREEGARD T J. The physical basis of transparency of the normal cornea[J]. Eye(Lond), 1997, 11(Pt 4): 465-471. DOI: 10.1038/eye.1997.127.
ROZEMA J J, KOPPEN C, BRAL N, et al . Changes in forward and backward light scatter in keratoconus resulting from corneal cross-linking[J ] . Asia Pac J Ophthalmol(Phila), 2013, 2(1): 15-19. DOI: 10.1097/APO.0b013e3182729df0.
RABINOWITZ Y S. Keratoconus[J]. Surv Ophthalmol, 1998, 42(4): 297-319. DOI: 10.1016/S0039-6257(97)00119-7.
UÇAKHAN O O, KANPOLAT A, YLMAZ N, et al . In vivo confocal microscopy findings in keratoconus[J ] . Eye Contact Lens, 2006, 32(4): 183-191. DOI: 10.1097/01.icl.0000189038.74139.4a.
WANG M M, ZHANG F J, ZHAO X, et al . Riboflavin concentration analysis in rabbit corneas before and after corneal collagen cross-linking using confocal laser scanning microscopy[J ] . Asia Pac J Ophthalmol, 2014, 3(6): 388-394. DOI: 10.1097/apo.0000000000000100.
LOMBARDO G, MICALI N L, VILLARI V, et al . Assessment of stromal riboflavin concentration-depth profile in nanotechnology-based transepithelial corneal crosslinking[J ] . J Cataract Refract Surg, 2017, 43(5): 680-686. DOI: 10.1016/j.jcrs.2017.03.026.
O'BRART N A L, O'BRART D P S, ALDAHLAWI N H, et al . An investigation of the effects of riboflavin concentration on the efficacy of corneal cross-linking using an enzymatic resistance model in porcine corneas[J ] . Invest Ophthalmol Vis Sci, 2018, 59(2): 1058-1065. DOI: 10.1167/iovs.17-22994 .
GOMES J A P, TAN D, RAPUANO C J, et al . Global consensus on keratoconus and ectatic diseases[J ] . Cornea, 2015, 34(4): 359-369. DOI: 10.1097/ICO.0000000000000408.
KOSEKAHYA P, KOC M, CAGLAYAN M, et al . Longitudinal corneal tomographical changes in eyes of patients with unilateral and bilateral non-progressive keratoconus[J ] . Cont Lens Anterior Eye, 2019, 42(4): 434-438. DOI:10.1016/j.clae.2018.10.027.
0
Views
0
下载量
0
CSCD
Publicity Resources
Related Articles
Related Author
Related Institution
京公网安备11010802024621
