快速角膜胶原交联(CXL)联合FS-LASIK在近视诊疗中的应用

Application of Rapid Corneal Collagen Crosslinking (CXL) Combined with FS-LASIK in the Diagnosis and Treatment of Myopia

摘要: 目的：飞秒激光原位角膜磨镶术(FS-LASIK)联合快速角膜胶原交联(CXL)矫正近视后裸眼远视力(UDVA)、角膜曲率及等效球镜的变化特点，评估联合手术矫正近视的术后效果。方法：横断面研究。纳入2022年1月至2022年12月在我院就诊的近视患者，共17例34眼，其中男性15人，女性2人，年龄17岁至24岁，平均年龄(19.47 ± 2.15)岁，近视时间为(7.88 ± 1.71)年。所有近视患者角膜最薄点厚度 > 400 um，眼压介于10~21 mmHg，未经过相关眼科治疗；未受眼外伤，眼底检查未见明显异常或眼底异常未影响中心视力；未佩戴角膜接触镜或停戴角膜接触镜至少2周。随访术后一周、术后一个月、术后三个月、末次随访，记录UDVA、角膜曲率平均值、角膜曲率最大值，术后并发症情况。结果：所有患者UDVA术后第一天较术前改善明显；角膜曲率较术前降低；角膜均透明；未见角膜炎症反应，术后随访中，有8眼出现UDVA回退，占23.53%；其中有6眼回退后的UDVA低于1.0，占17.65%，所有UDVA回退的患者中，等效球镜最小变化为0.25 D，最大变化为1.5 D，术后随访中，有4眼出现角膜混浊现象，占11.76%，用药后一周角膜透明；其中有2眼发现一枚Haze，用药后一周消失，所有患者术后随访，角膜曲率趋于平整状态。结论：术后随访时间(5.47 ± 3.97)月，CXL联合FS-LASIK术后远视力恢复较好，稳定性强，角膜曲率趋于平缓。

Abstract: Objective: To evaluate the postoperative effect of femtosecond laser-assisted in situ keratomyelitis (FS-LASIK) combined with rapid corneal collagen crosslinking (CXL) on myopia correction of uncor-rected distance visual acuity (UDVA), corneal curvature and spherical equivalent refraction. Meth-ods: Cross-sectional study. A total of 17 cases of 34 myopia patients admitted to our hospital from January 2022 to December 2022 were included, including 15 males and 2 females, aged from 17 to 24 years old, with an average age of (19.47 ± 2.15) years and a duration of myopia of (7.88 ± 1.71) years. The thinnest-point corneal thickness of all myopic patients was >400 um, and the iOP was between 10 mmHg and 21 mmHg, without any relevant ophthalmic treatment. No eye injury, no obvious abnormality in fundus examination or fundus abnormality did not affect central vision; Do not wear contact lenses or stop wearing contact lenses for at least 2 weeks. UDVA, mean corneal curvature, maximum corneal curvature and postoperative complications were recorded at the last follow-up one week, one month and three months after surgery. Results: UDVA improved signifi-cantly in all patients on the first day after operation. The corneal curvature was lower than that be-fore operation. The cornea is transparent; No corneal inflammation was observed. UDVA regression occurred in 8 eyes (23.53%) during postoperative follow-up. Among the patients with UDVA regres-sion, 6 eyes had UDVA lower than 1.0, accounting for 17.65%. Among all patients with UDVA regres-sion, the minimum change by equivalent spherical lens was 0.25 D and the maximum change was 1.5 D. During postoperative follow-up, 4 eyes showed corneal opacity, accounting for 11.76%, and the cornea became clear one week after medication. Haze was found in 2 eyes, which disappeared one week after treatment, and the corneal curvature of all patients tended to be flat during postop-erative follow-up. Conclusion: Postoperative follow-up time (5.47 ± 3.97) months, CXL combined with FS-LASIK postoperative far vision recovery is good and has strong stability, corneal curvature tends to be flat.