目的：探讨跨上皮快速交联术联合术后配戴硬性透气性角膜接触镜(RGPCL)治疗圆锥角膜患者的临床效果。

方法：回顾性研究。选取 2014-10/2015-10在福建中医药大学附属第二人民医院确诊为进展性圆锥角膜并进行跨上皮快速角膜交联术联合术后配戴RGPCL的患者16例25眼，平均年龄25.31±5.92岁，术前最大角膜曲率为58.96±6.76D，角膜最薄点厚度为439.52±53.24μm。使用核黄素及45mW/cm²紫外光照射进行跨上皮快速交联，总能量7.2J/cm²，术后配戴RGPCL。术后随访3～6a，平均52.44±11.39mo，观察患者治疗前后BCVA(配戴RGPCL)、平坦子午线角膜曲率(K₁)、陡峭子午线角膜曲率(K₂)、最大角膜曲率(Kmax)、角膜屈光力(MPP)、角膜前后表面膨隆状态评价参数包括BCVf、BCVb、前表面曲率不对称指数(SIf)、后表面曲率不对称指数(SIb)、圆锥角膜前表面最高点(KVf)、圆锥角膜后表面最高点(KVb)、角膜最薄处厚度(ThkMin)、晶状体混浊、角膜内皮细胞计数。

结果：所有患者手术过程顺利，无术中并发症，术后1d均有轻微刺痛伴异物感，轻微畏光流泪； 2例2眼患者术后1d摘绷带镜后角膜上皮小片脱失，重新戴绷带镜3d后上皮愈合； 随访期间所有患者均未出现晶状体混浊，角膜内皮细胞计数较术前无差异(P>0.05)； 术后BCVA(配戴RGPCL)较术前BCVA明显改善，术后Kmax、SIf、KVf、BCVf、BCVb均较术前降低(P<0.05)。

结论：跨上皮快速角膜交联术联合RGPCL治疗圆锥角膜能有效且安全控制圆锥角膜进展，长期效果稳定。

METHODS: This was a retrospective study of patients with progressive keratoconus diagnosed in the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine in October 2014, and underwent transepithelial rapid keratoplasty. After surgery 16 patients(25 eyes)used RGPCL. Average age was 25.31±5.92 years old, maximum preoperative corneal curvature was 58.96±6.76D, thinnest corneal thickness was 439.52±53.24μm. Rapid cross-linking was performed using riboflavin and 45mW/cm² ultraviolet light(UV)irradiation with a total energy of 7.2J/cm². RGPCL was used after surgery. Follow up of 3-6a, average follow-up time was 52.44±11.39mo. The best corrected visual acuity \〖(BCVA), in RGPCL\〗, corneal curvature of flat meridian(K₁), corneal curvature of steep meridian(K₂), maximum corneal curvature(Kmax), corneal refractive power(MPP), Baiocchi Calossi Versaci index of anterior and posterior surface(BCVf and BCVb)asymmetry index of anterior surface curvature(SIf), asymmetry index of posterior surface curvature(SIb), the highest point of anterior cone cornea(KVf), the highest point of posterior cone cornea(KVb), the change of corneal thickness(ThkMin), lens opacity, and corneal endothelial cell count were observed.

RESULTS: All patients had a successful operation, and no intraoperative complications. On the first day after surgery, all cases felt slight tingling and slight photophobia tears. After 1d of operation, the corneal epithelium was removed in two eyes. While 3d after re-wearing the bandage, the epithelium healed. None of lens in the patients was opacified during follow-up, and there was no significant difference in corneal endothelial cell count compared with preoperative(P>0.05). The BCVA(wearing RGPCL)after operation is obviously improved compared with preoperative. All postoperative Kmax, SIf, KVf, BCVf, BCVb were lower than preoperative(P<0.05).

CONCLUSION: Transepithelial rapid corneal cross-linking combined with RGPCL is safe and effective in controlling the progress of keratoconus. And the long-term effect is stable.