中文摘要：

目的 探讨离子电渗技术介导的跨上皮角膜交联术（i-CXL）治疗较薄型圆锥角膜的早期临床效果.方法 前瞻性非随机临床研究.2013年5至12月间在厦门大学附属厦门眼科中心确诊为进展期圆锥角膜且符合最薄角膜厚度（含上皮）为380～ 420 μm的患者,予住院治疗并进行i-CXL术.在术前和术后1周内,术后1、3、6及12个月时分别进行疼痛及异物感评分、裂隙灯检查、裸眼与矫正视力、角膜地形图、前节OCT、角膜内皮细胞计数及角膜共聚焦显微镜检查,记录并配对t检验进行统计分析.结果 绝大多数患者接受i-CXL术后1d时存在中度疼痛和异物感,在术后3d时基本消失.术后早期存在少量角膜上皮缺损,术后3d内完全修复.部分患者裸眼视力提高,部分患者最佳矫正视力提高.术后3至12个月的角膜最大曲率及最小曲率均低于术前,其中术后第12个月Kmax值为（52.94±4.87）,术前为（54.37±5.56）,术后第12个月最小曲率Kmin值为（46.78±3.71）,术前为（48.53±3.57）,差异均具有统计学意义（Kmax,t=2.912,P＜0.01;Kmin,t=2.508,P＜0.05）.术后1个月内,前节OCT可见浅层基质密度增高,前后基质间存在“分界线”;共聚焦显微镜下可见浅层基质内纤维增粗,纤维间连接增加,深度约133 μm.术前及术后12个月角膜内皮细胞密度差异无统计学意义（t=0.915,P＞0.05）.所有患者未见角膜感染、瘢痕、角膜溃疡、持续性上皮缺损等并发症.结论 i-CXL治疗进展期圆锥角膜效果良好,尤其适用于最薄角膜厚度约400 μm者;其手术时间短,恢复快,几乎无明显不良反应.

英文摘要：

Objective To evaluate the early clinical results of keratoconic eyes treated with transepithelial iontophoresis corneal collagen cross-linking （i-CXL） within 1 year.Methods Propective nonrandomized study.Twenty-three eyes of 23 patients with progressive keratoconus with minimum corneal thickness from 380 μm to 420 μm （including the epithelium） were included in this prospective,nonrandomized clinical study and treated with i-CXL.Scoring of pain and foreign body sensation,slit lamp examination,uncorrected visual acuity （UCVA） and best corrected distance visual acuity （BCVA）,corneal topography,anterior segment optical coherence tomography （AS-OCT）,in vivo corneal confocal microscopy and endothelial cell count were assessed before surgery and at 1,3,6 and 12 months （m） postoperatively.Paired t test was applied for statistical analysis.Results Moderate pain and foreign body sensation were reported by most patients on postoperative Day （D） 1,but rapidly decreased and eventually disappeared on D3.Mild epithelial damage was observed on D1,and the epithelium fully recovered on D3.Improvement of UCVA and BCVA were recorded at 3 months and 12 months postoperatively.Orbscan Ⅱ corneal topography revealed the significant reductions of Kmax and Kmin from 3m to 12m （Kmax,t=2.912,P〈0.01,Kmin,t=2.508,P〈0.05） postoperatively while the other parameters remained stable.The Kmax and Kmin at 12m was （52.94±4.87） and （46.78±3.71） respectively,while the preoperative values was （54.37 ± 5.56） and （48.53 ± 3.57） respectively.Within lm postoperatively,AS-OCT exhibited an increase of reflectance with a white line （demarcation line） in the anterior stroma,in vivo confocal microscopy also showed the significant thickening and increased connections of collagen fibers with maximal depth of about 133 μm.The corneal endothelial cell density remained stable （t=0.915,P〉0.05）.None of the patients showed postoperative complications such as corneal infection,scarring,ulcer,persisten