目的：分析跨上皮角膜胶原交联手术治疗进展期圆锥角膜后1a的疗效并讨论其临床意义。方法：收集2017-01/2018-12于我院进行快速跨上皮角膜胶原交联手术的进展期圆锥角膜患者45例48眼，术后随访1a，分析手术前后视力、角膜最薄点厚度、角膜内皮细胞计数、角膜交联线深度、角膜前表面曲率Km值及角膜生物力学参数等变化情况。结果：与术前比较，本组患者术后裸眼视力明显改善(P<0.05)，但最佳矫正视力、角膜最薄点厚度和角膜内皮细胞计数均无明显变化(P>0.05)，术后6mo，1a角膜前表面曲率Km值(48.54±2.57、48.77±2.29D)均显著下降，角膜生物力学参数第1次压平宽度(1.52±0.21、1.57±0.22mm)均显著降低(P<0.05)，第2次压平速度绝对值(0.82±0.09、0.82±0.18m/s)均显著增加(P<0.05)。结论：快速跨上皮角膜胶原交联手术治疗进展期圆锥角膜对裸眼视力有明显改善，术后角膜生物力学也有改善，但最佳矫正视力改善不明显。

AIM: To analyze the effectiveness of transepithelial-corneal collagen cross-linking for 1a after the treatment of progressive keratoconus and discuss its clinical significance. METHODS:A total of 45 cases(48 eyes)of progressive keratoconus who underwent accelerated transepithelial-corneal collagen cross-linking in our hospital from Jan. 2017 to Dec. 2018 were collected. After 1a of postoperative follow-up, the changes of visual acuity, corneal thinnest point thickness, corneal endothelial cell count, corneal cross-linking line depth, Km of anterior corneal curvature and corneal biomechanical parameters before and after surgery were analyzed.RESULTS:Compared with preoperative, the uncorrected visual acuity(UCVA)was improved obviously postoperative in this group patients(P<0.05), but the best-corrected visual acuity(BCVA), corneal thinnest point thickness and corneal endothelial cell counts were no significant change(P>0.05). At 6mo and 1a postoperative, Km of anterior corneal curvature(48.54±2.57, 48.77±2.29D)are decreased significantly, the first flatten width of corneal biomechanical parameters(1.52±0.21, 1.57±0.22mm)were significantly lower(P<0.05). The absolute value of the second flattening velocity(0.82±0.09, 0.82±0.18m/s)was significantly increased(all P<0.05).CONCLUSION:Accelerated transepithelial-corneal collagen cross-linking surgery for progressive keratoconus can significantly improve the UCVA and corneal biomechanics postoperative, but the BCVA was not significantly improved.

西安市科技计划项目[No.2017116SF/YX010(4)]; 陕西省社会发展攻关项目(No.2016SF-274)