角膜胶原交联术治疗圆锥角膜的疗效和安全性研究

目的：研究角膜胶原交联术治疗圆锥角膜的疗效和安全性。

方法：对2015-04/2018-08在泰国朱拉隆功国王纪念医院行角膜胶原交联术的圆锥角膜患者病历进行回顾性分析。评估术前和术后1a的视力、屈光度、角膜地形图、高阶像差(HOA)、地形图参数和角膜密度。根据患者年龄是否小于24和30岁、基线角膜最大曲率(Kmax)是否小于55 D、基线最佳矫正视力(BCVA)是否小于0.3 LogMAR分组评估年龄、基线Kmax和BCVA对手术疗效的影响。分析术前Kmax、Kmean、平均等效球镜度数(MRSE)、视力、角膜最薄点厚度值、Kmax的变化以及相关参数的变化与角膜密度测量值变化之间的关系。P<0.05具有统计学意义。

结果：共155例患者185眼纳入研究,其中119例男性,36例女性。根据Amsler-Krumeich进行分类,1期和2期占优势(分别为37.84%和35.14%)。术后1a,平均裸眼视力(UCVA)提高0.1 LogMAR(P<0.05)。与基线BCVA较好组(术前BCVA<0.3 LogMAR)相比,基线BCVA较差组(术前BCVA≥0.3 LogMAR)术后BCVA改善大于0.2 LogMAR的眼数较多(78.26% vs 21.74%,P<0.05)。平均Kmax比基线下降2.36 D(P<0.05)。术前Kmax≥55 D的患眼术后Kmax下降超过2.0 D的眼数占比73%。距角膜顶点6 mm处角膜HOA下降0.40(P<0.05)。术后1mo～1a,0～6 mm区角膜密度测量值持续增加。术后1a,角膜密度的增加与最薄点厚度的减少呈线性相关。表面变异指数、高度非对称性指数、圆锥角膜指数、高度轴偏心指数在术后1a时下降(P<0.05)。术后1a,手术成功率为90.24%。术后1wk、1、3、6mo、1a角膜混浊发生率分别为11.35%、30.27%、15.67%、10.27%、2.16%。无角膜水肿发生,但有1例无菌性角膜炎患者。

结论：角膜胶原交联术可有效治疗圆锥角膜,使角膜变平、重塑,提高视力、HOA和角膜形态指数,晚期圆锥角膜Kmax也明显降低。     

Singleton term breech deliveries in nulliparous and multiparous women: a 5-year experience at the University of Miami/Jackson Memorial Hospital.

OBJECTIVE: The purpose of this retrospective study was to evaluate the feasibility of planned vaginal delivery, the maternal morbidity and mortality, and the short-term perinatal outcome in selected multiethnic women at term with singleton breech presentations. STUDY DESIGN: Singleton breech deliveries were identified from the delivery database between January 1, 1989, and December 31, 1993. A retrospective chart review identified 310 nulliparous and 711 multiparous women at term (37-42 weeks) for a total of 1021. Parameters studied included the success rate of planned vaginal deliveries and the incidences of maternal morbidity, perinatal morbidity, and mortality as a whole stratified by parity and mode of delivery. The Student t test, chi(2) test, and Fisher exact test were used for statistical analysis. RESULTS: Among 1021 women with singleton fetuses in a breech position at term, 191 were candidates for vaginal delivery, and 135 (70.7%) of these deliveries were successful. By parity, 12.3% of 310 nulliparous women and 21.5% of 711 multiparous women were candidates for vaginal delivery; 50% of the former and 75.8% of the latter underwent vaginal delivery. Maternal morbidity was more commonly associated with multiparity and cesarean delivery. Newborn intensive care admissions were equally distributed by parity, and significantly more were for vaginal than cesarean deliveries (17.4% vs 10.8%, P =.036). Premature rupture of the membranes complicated deliveries in 23.9% of the nulliparous women and only 6.5% of the multiparous women (P =.000). CONCLUSION: In this multiethnic population 70.7% of candidates selected for attempted vaginal breech delivery at term were successful. The remaining 29.3% underwent cesarean delivery for labor disorders or nonreassuring fetal heart rate patterns.