| Objective: To analysis the safety and efficacy of high-energy(45m W/cm2)accelerated corneal collagen cross-linking for Keratoconus,and analyze the therapeutic effect and difference of different age group.Methods: This is a retrospective case study,48 eyes of 30 patients with verified keratoconus at the Eye Optical Center of the First Affiliated Hospital of Hunan Normal University from January 2017 to December 2018.During the operation,the irradiance set was 5.4J/cm2(ultraviolet light A,45 m W/cm2,2 minutes).Follow-up observation and recording of corneal epithelial repair and surgery-related complications in 1st week.Uncorrected visual acuity(UCVA),best spectacle corrected visual acuity(BSCVA),corneal-compensated intraocular pressure(IOPcc),Goldmann-correlated intraocular pressure intraocular pressure(IOPg),maximum corneal curvature(Kmax),corneal astigmatism,thinnest corneal thickness(TCT),and surgical complications were measured from preoperatively to the 1st,3rd,6th month and 1st year postoperatively.Statistical analysis was performed using SPSS 22.0.Measurement data were expressed as mean±SD,repeated measured analysis of variance(ANOVA)was uesd for compare and analyze pre-postoperative parameters,independent-sample t test was uesdfor compare pre-operative and 1st year of postoperative diffrences between parameters of different age groups,pared-samples t test was uesd for compare pre-operative diffrences between parameters of different age groups.Statistical signifcance was defined as a p-value< 0.05.Results:1.The preoperative and postoperative periods were compared(1)The incidence of postoperative complications was 12%.2 eyes(4%)had mild stroma haze,which resolved within 3 months of postoperative,corneal epithelial healing was delayed in 4 eyes(8%)for more than 1week.No patients received additional surgery,such as keratoplasty.(2)There was no significant difference the postoperative and the preoperative period in UCVA values.BSCVA decreased at postoperative1 st months(P<0.05)and improved at postoperative 1st year,the difference was statistically significant(P<0.05).Seven eyes(15%)improved UCVA by 2 lines or more,34 eyes(71%)fluctuated within 1line,and 2 eyes(4%)decreased by more than 2 lines.16 eyes(33%)with a BSCVA increased by 2 lines,32 eyes(67%)fluctuated within 1 line,and 0 eyes decreased by more than 2 lines.(3)There was no significant difference the postoperative and the preoperative period in IOPcc values.There was signifcantly improved in IOPg at postoperative 3rd,6th month and 1st year(P<0.05),which were all within the normal intraocular pressure range.(4)Index reflecting the shape of keratoconus: Maximum corneal curvature(Kmax)decreased at postoperative 1st year,the difference was statistically significant(P<0.05).Kmax decreased by 2 diopter or more in3 eyes(6%),decreased by 1 diopter or more in 6 eyes(13%),unchanged by 35 eyes(73%),increased by 1 diopter or more in 4 Eye(8%).Corneal astigmatism was no signifcantly difference at postoperative 1th,3rd,6th month,1th year.Thinnest corneal thickness(TCT)was signifcantly difference at postoperative 1th,3rd month,the difference was statistically significant(P<0.001).TCT gradually recovered at postoperative 6th month,1th year,with no significant difference compared with preoperative.2.Comparison of different age groups(1)There was no significant difference between the minor group and adult groups in the value of UCVA and BSCVA the preoperative and the change of postoperative 1st year.(2)There was no significant difference between the minor group and adult groups in the value of IOPcc and IOPg before and the change of postoperative 1st year.(3)Index reflecting the shape of keratoconus: In the minor group,Kmax was no significant difference between before and one year after surgery.In the adult group,Kmax decreased postoperative 1th year compared with preoperative,the difference is statistically significant(P<0.05).The preoperative Kmax value of the minor group was higher than that of the adult group(P<0.05),and the changes of Kmax between the minor group and the adult group was statistically significant(P<0.01).There was no significant difference in corneal astigmatism between the two groups compared with those before and after 1 year.TCT decreased postoperative 1th year compared with preoperative(P<0.05,The difference was statistically significant).There was no significant difference between the two groups in the change value of TCT before and one year after surgery.Conclusions:1.High energy(45m W/cm2)accelerated corneal crosslinking is safe and reliable in the treatment of keratoconus.2.This treatment plan can improve the best corrected vision of patients with keratoconus,reduce the maximum curvature value of the cornea,make the cornea flatten,delay and control the progression of keratoconus.3.In this study,after one year of High-energy(45m W/cm2)accelerated corneal collagen cross-linking,the effect of reducing the Kmax value in the adult group was significantly better than the minor group. |
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