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目的总结角膜交联术治疗进展期圆锥角膜的并发症。设计回顾性病例系列。研究对象2015年1-12月北京同仁医院收治的进展期圆锥角膜患者40例(40眼)。方法回顾性分析患者术后临床资料,术前含上皮最薄角膜厚度在375~450μm,行去上皮角膜交联术。术后1天、3天、1周、1个月通过问卷调查对患者疼痛感及异物感程度进行评估,并行眼前节检查。主要指标患者治疗前后视力、眼压、眼部疼痛程度、角膜上皮修复及角膜水肿情况。结果患者术后1天存在明显疼痛感(3.19±0.37分)与异物感(3.15±0.23分),可见部分角膜上皮缺损,术后3天患者异物感(2.23±0.43分)与疼痛(2.23±0.32分)感明显减轻,且角膜上皮大部分修复;术后1周,所有患者仅有轻微异物感(0.23±0.07分)及疼痛(0.22±0.11分),角膜上皮基本修复。术后1个月患者无明显异物感及疼痛感。随访6个月,40例患者病情均得到控制,30例患者术后复查裸眼视力均有不同程度提高,35例患者矫正视力有明显提高,无角膜感染、瘢痕、溃疡、上皮缺损等并发症发生。结论角膜胶原交联术治疗进展期圆锥角膜效果好,主要并发症是术后早期疼痛及角膜上皮缺损。
Objective To summarize the corneal cross-linking treatment of advanced keratoconus complications. Design retrospective case series. Participants Forty patients (40 eyes) with advanced keratoconus who were admitted to Beijing Tongren Hospital from January to December in 2015 were enrolled. Methods The postoperative clinical data of patients were retrospectively analyzed. The thinnest corneal epithelium with preoperative corneal thickness was 375-450μm. One day, three days, one week and one month after operation, the degree of pain and foreign body sensation of the patients were evaluated by questionnaire, and the anterior segment examination was performed in parallel. The main indicators of patients before and after treatment of visual acuity, intraocular pressure, eye pain, corneal epithelial repair and corneal edema. Results There was obvious pain (3.19 ± 0.37) and foreign body sensation (3.15 ± 0.23) on day 1 postoperatively. Some corneal epithelial defects were observed. The foreign body sensation (2.23 ± 0.43) and pain 0.32 points), and most of the corneal epithelium was repaired. Only slight foreign body sensation (0.23 ± 0.07 points) and pain (0.22 ± 0.11 points) were found in all the patients at one week after operation. The corneal epithelium was basically repaired. One month after surgery, there was no obvious foreign body sensation and pain. The follow-up of 6 months, 40 patients were in control of the disease, 30 patients postoperative visual acuity were improved to varying degrees, 35 patients corrected visual acuity was significantly improved, no corneal infection, scar, ulcers, epithelial defects and other complications . Conclusion Corneal collagen cross-linking treatment of advanced keratoconus good results, the main complication is early postoperative pain and corneal epithelial defects.