高能量加速型角膜胶原交联术对圆锥角膜眼表的影响

doi:10.6040/j.issn.1673-3770.0.2021.432

摘要/Abstract

摘要： 目的探讨圆锥角膜患者角膜胶原交联术前后眼表的变化规律。方法选取诊断为圆锥角膜符合纳入、排除标准,且知情同意后接受行高能量加速型角膜交联术的患者42例(60眼)。以眼为单位,根据Kmax分3个组(轻度圆锥角膜组、中度圆锥角膜组、重度圆锥角膜组);根据K2与K1差值即散光分为3个组,A组(0≤K2-K1≤2.5D),B组(2.5D5D),追踪观察并且记录患者角膜交联术前、术后1mo、3mo角膜最大曲率(Kmax)、K1和K2、角膜厚度与散光、泪膜破裂时间、泪河高度等相关参数的变化规律及特点。采用 SPSS 26. 0 软件对数据进行统计学分析,对比术前及术后不同时间点各参数是否有差异,检验水准为α=0.05,P<0.05为差异有统计学意义。结果 (1)根据Kmax分组,术前基线角膜厚度、K1、K2均具有统计学意义(P<0.001),年龄、散光、泪河高度、泪膜破裂时间均无统计学意义(P=0.35、0.22、0.63、0.57),3个组手术前后不同时间点的角膜厚度、Kmax、泪河高度、K1、K2总体比较差异均具有统计学意义(F时间=52.72、5.22、3.30、5.06、5.25, 均P<0.05;F组别=9.25、38.28,P<0.05,2.48,P>0.05,13.37,P<0.05,6.28,P>0.05), 3个组手术前后不同时间点的泪膜破裂时间总体比较差异无统计学意义(F时间=1.001,P=0.38;F组别=0.953,P=0.40);(2)根据散光分组,术前基线Kmax、K1、K2均具有统计学意义(P=0.001、0.02、<0.001),年龄、角膜厚度、泪河高度、泪膜破裂时间均无统计学意义(P=0.13、0.43、0.96、0.11),3个组手术前后不同时间点的角膜厚度、Kmax、泪河高度、K1、 K2总体比较差异均具有统计学意义(F时间=45.91、6.61、4.06、5.19、8.4,均P<0.05; F组别=0.53、0.6、0.75、1.19,P>0.05,7.63,P<0.05);3个组手术前后不同时间点的泪膜破裂时间总体比较差异无统计学意义(F时间=1.103,P =0.34;F组别=1.121,P=0.34);(3)将眼表泪液参数泪河高度及泪膜破裂时间的值与角膜形态参数Kmax、K1、K2、散光的值进行术前、术后1月、3月的相关性分析,术后3个月泪河高度与散光呈负相关(P=0.04),术前及术后1个月泪河高度与散光无相关(P=0.88、0.13),术后1个月泪膜破裂时间与散光呈负相关(P=0.03),其他各时间点与散光无相关(P=0.13、0.29)。结论高能量加速型角膜交联术早期对泪膜稳定性无不良影响;高能量加速型角膜交联术早期使泪液分泌量发生轻度下降;高能量加速型角膜交联术早期泪液分泌量下降,以散光程度严重者为甚。

关键词: 高能量加速型角膜交联术, 圆锥角膜, 眼表, 泪膜破裂时间, 泪河高度

Abstract: Objective To study the changes in ocular surface before and after corneal collagen cross-linking in patients with keratoconus. Methods A retrospective study was conducted on 42 patients(60 eyes)diagnosed with keratoconus at the Ophthalmology Center of Hunan Provincial People's Hospital from November 2020 to May 2021 who met the inclusion and exclusion criteria and received high-energy accelerated corneal collagen cross-linking after providing informed consent. Based on corneal maximum curvature(Kmax), the patients were divided into the following three groups: mild, moderate, and severe. Further, the patients were divided into three groups according to the difference between flat keratometry(K1)and steep keratometry(K2), namely astigmatism: group A(0≤K2-K1≤2.5D), group B(2.5D < K2-K1≤5D), and group C(K2-K1>5D). The changes and characteristics of Kmax, K1, K2, corneal thickness, astigmatism, tear breakup time, tear meniscus height at 1 and 3 months before and after corneal collagen, and cross-linking were recorded. SPSS 26.0 software was used for statistical analysis to determine any difference in parameters at different time points before and after surgery. The test level was considered as α=0.05, and P<0.05 was considered statistically significant. Results For the Kmax group, preoperative baseline corneal thickness, K1, K2 showed statistical significance(P<0.001), whereas age, astigmatism, tear meniscus height, and tear breakup time did not(P=0.35、0.22、0.63、0.57). Significant differences were noted in corneal thickness, Kmax, tear meniscus height, K1, and K2 at different time points before and after surgery among the three groups(F_time=52.72, 5.22, 3.30, 5.06, 5.25, respectively, P<0.05; F_group=9.25,38.28,P<0.05,2.48,P>0.05,13.37,P<0.05,6.28,P>0.05). There were no significant differences in tear breakup time at different time points before and after surgery among the three groups(F_time=1.001,P=0.38;F_group=0.953,P=0.40). For the astigmatism group, preoperative baseline Kmax, K1, K2 were statistically significant(P=0.001、0.02、<0.001), whereas age, corneal thickness, tear meniscus height, and tear breakup time were not(P=0.13、0.43、0.96、0.11). Significant differences were noted in corneal thickness, Kmax, tear meniscus height, K1, and K2 at different time points before and after surgery among the three groups(F_time=45.91, 6.61, 4.06, 5.19, 8.4, P<0.05; F_group =0.53,0.6,0.75,1.19,P>0.05,7.63,P<0.05). There were no significant differences in tear breakup time among the three groups at different time points before and after surgery(F_time=1.103,P=0.34;F_group=1.121,P=0.34). Correlation analysis was conducted between the tear meniscus height and tear breakup time of ocular surface parameters and the values of corneal topography parameters Kmax, K1, K2 and astigmatism before, 1 and 3 months after surgery. The tear meniscus height was negatively correlated with astigmatism 3 months after surgery(P=0.04), while there was no correlation between the tear meniscus height and astigmatism before and 1 month after surgery(P=0.88、0.13). The tear break up time 1 month after operation was negatively correlated with astigmatism(P=0.03), but there was no correlation with astigmatism at other time points(P=0.13、0.29). Conclusion High-energy accelerated corneal collagen cross-linking has no adverse effect on tear film stability in the early stage; it can affect the amount of tear secretion and cause a slight decrease in the amount of tear secretion in the early stage. In the early stage of high-energy accelerated corneal collagen cross-linking, the amount of tear secretion decreased, especially in severe astigmatism.

Key words: High-energy accelerated corneal collagen cross-linking, Keratoconus, Ocular surface, Tear breakup time, Tear meniscus height

中图分类号:

R772.2

夏艳云,钟定娟,王华,李孟婷,李前,陈蛟,何书喜. 高能量加速型角膜胶原交联术对圆锥角膜眼表的影响[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 42-51.

XIA Yanyun, ZHONG Dingjuan, WANG Hua, LI Mengting, LI Qian, CHEN Jiao, HE Shuxi. Effect of high-energy accelerated corneal collagen cross-linking on the ocular surface of keratoconus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 42-51.

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