Офтальмохирургия. 2015; : 43-46
Результаты лечения кератоэктазий методом кросслинкинга роговицы у детей и подростков
https://doi.org/undefinedАннотация
Цель. Оценить результаты и особенности лечения кератоэктазий у детей и подростков методом кросслинкинга роговичного коллагена.
Материал и методы. Обследованы 14 детей (17 глаз) с кератоэктазиями в возрасте от 11 до 18 лет, которым был проведен кросслинкинг роговицы на аппарате «УФалинк» с использованием фотосенсибилизатора по стандартному «Дрезденскому протоколу». Диагноз кератоконуса был установлен на 14 глазах, краевая дегенерация роговицы – на 3 глазах, среди них I стадия заболевания имела место в 2 случаях (2 глаза), II стадия – в 12 (12 глаз). Для обследования пациентов применяли следующие методы исследования: визометрию, биомикроскопию, офтальмоскопию, авторефрактометрию, тонометрию, кератометрию, кератотопографию, пахиметрию, конфокальную микроскопию.
Результаты. Во время процедуры, а также в ранний и поздний послеоперационные периоды осложнений не было. У всех пациентов, начиная с первой недели, наблюдали псевдохейз разной степени выраженности. При конфокальной микроскопии на вторые сутки после процедуры кросслинкинга отмечали множество гиперрефлексогенных кератоцитов и явления апоптоза в области роговицы, подвергшейся воздействию УФ-облучения, на глубине 280±40 мкм - полиморфные гиперрефлектирующие структуры. Через 6 мес. после операции преломляющая сила роговицы уменьшалась в среднем на 1,14±2,13 дптр, толщина роговицы в центре – на 28,04±0,14 мкм. Уменьшение роговичного астигматизма в среднем на 1,55±1,4 дптр отмечали через 24 мес. после проведения процедуры кросслинкинга. Острота зрения пациентов без коррекции через 6 мес. после операции повысилась в среднем до 0,45±0,16 (до операции - 0,32±0,14) и через 24 мес. - до 0,5±0,14. Корригированная острота зрения также улучшилась, составляя через 6 мес. 0,6±0,12 (до операции - 0,5±0,16), через 24 мес. - 0,7±0,14.
Выводы. Кросслинкинг роговичного коллагена является безопасным и эффективным методом лечения прогрессирующих форм кератоэктазий у детей и подростков и способствует стабилизации заболевания.
Список литературы
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16. Raiskup-Wolf F., Hoyer A., Spoerl E. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: longterm results // J. Cataract Refract. Surg. – 2008. – Vol. 34, № 5. – P. 796-801.
17. Salman A.G. Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group // J. Cataract Refract. Surg. – 2013. – Vol. 39, № 8. – P. 1104-1110.
18. Soeters N., Van der Lelij A., van der Valk R. Corneal crosslinking for progressive keratoconus in four children // J. Pediatr. Ophthalmol. Strabismus. – 2011. – Vol. 21. – P. 48.
19. Vinciguerra P., Albé E., Frueh B.E. Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus // Am. J. Ophthalmol. – 2012. – Vol. 154. – P. 520-526.
20. Viswanathan D., Males J. Prospective longitudinal study of corneal collagen cross-linking in progressive keratoconus // Clin. Experiment. Ophthalmol. – 2013. – Vol. 41, № 6. – P. 531-536.
21. Wittig-Silva C., Whiting M., Lamoureux E. et al. A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results // J. Refract. Surg. – 2008. – Vol. 24. – № 7. – P. 720-725.
22. Wollensak G., Spoerl E., Seiler T. Riboflavin/ ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus // Am. J. Ophthalmol. – 2003. – Vol. 135, № 5. – P. 620-627.
23. Zadnik K., Barr J.T., Gordon M.O. Biomicroscopic signs and disease severity in keratoconus. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group // Cornea. – 1996. – Vol. 15. – P. 139-146.
24. Zadnik K., Steger-May K., Fink B.A. CLEK Study Group. Collaborative longitudinal evaluation of keratoconus. Between-eye asymmetry in keratoconus // Cornea. – 2002. – Vol. 21. – P. 671-679.
25. Zotta P.G., Moschou K.A., Diakonis V.F. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: A feasibility study // J. Refract. Surg. – 2012. – Vol. 28. – P. 793-799.
Fyodorov Journal of Ophthalmic Surgery. 2015; : 43-46
Results of treatment of keratectasia by the corneal cross-linking method in children and teenagers
https://doi.org/undefinedAbstract
Purpose. The aim is to assess the results and features of keratectasia treatment in children and teenagers by the method of corneal collagen cross-linking.
Material and methods. The study included 14 children (17 eyes) with keratectasia aged from 11 to 18 years, who underwent corneal cross-linking surgery using the UFalink device with a photo-sensitizer according to the standard Dresden protocol. The diagnosis of keratoconus was detected in 14 eyes, marginal degeneration of cornea – in 3 eyes, among them the stage I of disease occurred in 2 patients (2 eyes ), the stage II – in 12 cases (12 eyes). The examination of patients used the following ophthalmic research methods: visometry, bio-microscopy, ophthalmoscopy, autorefractometry, tonometry, keratometry, corneal topography, pachymetry, confocal microscopy.
Results. There were no complications intra-operatively as well as in early and late postoperative periods. A pseudo-haze of various severity degree was observed in all patients, starting from the first week. In the confocal microscopy, many of hyperreflexogenic keratocytes and phenomena of apoptosis in the corneal area, exposed to UV-irradiation at a depth of 280±40μm, polymorphic hyper-reflecting structures were noted on the second day after the cross-linking procedure. The refractive power of the cornea decreased on an average by 1.14±2.13D, the thickness of the cornea in the center - by 28.04±0.14μm 6 months after surgery. Corneal astigmatism decreased on an average by 1.55±1.4D 24 months after the cross-linking procedure. The uncorrected visual acuity (UCVA) of patients 6 months after the surgery increased on an average up to 0.45±0.16 (preoperatively 0.32±0.14) and 24 months later – up to 0.5±0.14. The best corrected visual acuity (BCVA) improved as well, 6 months later and was 0.6±0.12 (preoperatively 0.5±0.16), 24 months later – 0.7±0.14.
Conclusions. The cross-linking of corneal collagen is a safe and effective treatment method for progressive forms of keratectasia in children and teenagers and contributes to the stabilization of the disease.
References
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4. Arora R., Gupta D., Goyal J.L. Results of corneal collagen cross-linking in pediatric patients // J. Refract. Surg. – 2012. – Vol. 28. – P. 759-762.
5. Bakshi E., Barkana Y., Goldich Y. Corneal Cross-Linking for Progressive Keratoconus in Children: Our Experience // Int. J. Keratoco Ectatic. Corneal. Dis. – 2012. – Vol. 1. – P. 53-56.
6. Buzzonetti L., Petrocelli G. Transepithelial corneal cross-linking in pediatric patients: Early results // J. Refract. Surg. – 2012. – Vol. 28. – P. 763-767.
7. Caporossi A., Mazzotta C., Baiocchi S. Riboflavin-UVA-induced corneal collagen cross-linking in pediatric patients // Cornea. – 2012. – Vol. 31. – P. 227-231.
8. Chatzis N., Hafezi F. Progression of keratoconus and efficacy of pediatric [corrected] corneal collagen cross-linking in children and adolescents // J. Refract Surg. – 2012. – Vol. 28. – P. 753-758.
9. Cheng E.L., Maruyama I., Sundar Raj N. et al. Expression of type XII collagen and hemidesmosome-associated proteins in keratoconus corneas// Curr. Eye Res. – 2001. – Vol. 22. – P. 333-340.
10. Hafezi F., Randleman J.B. Corneal Collagen Cross-Linking – SLACK Incorp, 2013. – 197 p.
11. Léoni-Mesplié S., Mortemousque B., Touboul D. et al. Scalability and severity of keratoconus in children // Am. J. Ophthalmol. – 2012. – Vol. 154. – P. 56-62.
12. Li X., Yang H., Rabinowitz Y.S. Longitudinal study of keratoconus progression // Exp. Eye Res. – 2007. – Vol. 85. –P. 502-507.
13. Magli A., Forte R., Tortori A. Epithelium-off corneal collagen cross-linking versus transepithelial cross-linking for pediatric keratoconus // Cornea. – 2013. – Vol. 32. – P. 597-601.
14. Rabinowitz Y.S. Keratoconus // Surv. Ophthalmol. – 1998. – Vol. 42. – P. 297-319.
15. Radner W., Zehemayer M., Skorpik C. Altered organization of collagen in apex of keratoconus corneas // Ophthalmic. Res. – 1998. – Vol. 30. – P. 327-332.
16. Raiskup-Wolf F., Hoyer A., Spoerl E. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: longterm results // J. Cataract Refract. Surg. – 2008. – Vol. 34, № 5. – P. 796-801.
17. Salman A.G. Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group // J. Cataract Refract. Surg. – 2013. – Vol. 39, № 8. – P. 1104-1110.
18. Soeters N., Van der Lelij A., van der Valk R. Corneal crosslinking for progressive keratoconus in four children // J. Pediatr. Ophthalmol. Strabismus. – 2011. – Vol. 21. – P. 48.
19. Vinciguerra P., Albé E., Frueh B.E. Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus // Am. J. Ophthalmol. – 2012. – Vol. 154. – P. 520-526.
20. Viswanathan D., Males J. Prospective longitudinal study of corneal collagen cross-linking in progressive keratoconus // Clin. Experiment. Ophthalmol. – 2013. – Vol. 41, № 6. – P. 531-536.
21. Wittig-Silva C., Whiting M., Lamoureux E. et al. A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results // J. Refract. Surg. – 2008. – Vol. 24. – № 7. – P. 720-725.
22. Wollensak G., Spoerl E., Seiler T. Riboflavin/ ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus // Am. J. Ophthalmol. – 2003. – Vol. 135, № 5. – P. 620-627.
23. Zadnik K., Barr J.T., Gordon M.O. Biomicroscopic signs and disease severity in keratoconus. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group // Cornea. – 1996. – Vol. 15. – P. 139-146.
24. Zadnik K., Steger-May K., Fink B.A. CLEK Study Group. Collaborative longitudinal evaluation of keratoconus. Between-eye asymmetry in keratoconus // Cornea. – 2002. – Vol. 21. – P. 671-679.
25. Zotta P.G., Moschou K.A., Diakonis V.F. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: A feasibility study // J. Refract. Surg. – 2012. – Vol. 28. – P. 793-799.
