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进行性圆锥角膜儿童角膜交联后假性进展分析

Schuerch K, Tappeiner C, Frueh BE

期刊名称:Acta Ophthalmologica

卷期:2016年第94卷第7期

摘要

目的:旨在分析圆锥角膜患儿角膜交联(CXL)的长期疗效,并描述假性进展的检测标准。方法:回顾性收集儿童(年龄在18岁或以下)CXL后角膜地形(Placido系统)和断层扫描(Scheimpflug系统)结果,并进行前瞻性评估。这项研究共包括25例患者(33只眼)。在1年,2年,3年和4年对随访进行评估。进展定义为1年中至少一次屈光度(D)最大角膜曲率测量(Kmax)增加。结果:对于整个组,CXL之前的平均Kmax55.3±7.3D,并且在1年后显着降低(p = 0.00001)致53.4±7.4D。在23例患者中,进展停止。确定了5例可能进展病例。1例在CXL4年显示出明显的Kmax陡峭,但地形参数没有改变。重复断层扫描并显示Kmax稳定。2例角膜缘性春季角膜结膜炎(VKC)的角膜断层扫描和地形图结果恶化。在角膜缘炎症消退后,Kmax值恢复到炎症前值。我们发现2例真正进展的病例。这两例病例在CXL之前出现晚期圆锥角膜,术前Kmax分别为64.475.1D。结论:我们的结果证实CXL对稳定儿童圆锥角膜是有效的。 37.5个月(SD±10个月)的随访期内33只眼中2只眼确定为CXL后真实进展。两种不同的测量方法可以帮助检测诊断差异并防止假结论的出现。此外,角膜缘的春季变化可能导致短暂的伪进展,在充分治疗后可逆转。

PURPOSE:To analyse the long-term efficacy of corneal cross-linking (CXL) in children with keratoconus and to describe criteria for the detection of pseudoprogression.METHODS:Evaluation of retrospectively collected corneal topography (Placido system) and tomography (Scheimpflug system) results after CXL in children (age 18 or younger). Twenty-five patients (33 eyes) were included. Follow-up was assessed after 1, 2, 3 and 4years. Progression was defined as an increase in maximal keratometry (Kmax) of at least one dioptre (D) in 1year.RESULTS:For the entire group, mean Kmax prior to CXL was 55.3±7.3D and decreased significantly (p=0.00001) after 1year to 53.4±7.4D. In 23 patients, the progression could be halted. Five cases of presumed progression were identified. One case showed marked steepening in Kmax 4years after CXL, but the topographic parameters were unchanged. The tomography was repeated and showed that Kmax was stable. Two cases with limbal vernal keratoconjunctivitis (VKC) worsened both in corneal tomography and topography. After resolution of the limbal inflammation, the Kmax values returned to the values before the inflammation. We found two cases of true progression both of which had advanced keratoconus prior to CXL with a preoperative Kmax of 64.4, respectively, 75.1D.CONCLUSION:Our results confirm that CXL is effective in stabilizing keratoconus in children. True progression after CXL could only be verified in two of 33 eyes in a follow-up period of 37.5months (SD±10months). Two different measuring methods can help to detect diagnostic discrepancies and prevent false conclusions. Moreover, limbal vernal changes can cause transient pseudoprogression, reversible upon sufficient treatment.


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