摘要目的:比较高能量紫外线去上皮快速角膜胶原交联术（A-CXL）治疗青少年与成人原发性圆锥角膜的1年临床疗效差异。方法:回顾性队列研究。收集2022年8月至2023年12月在中南大学湘雅医院眼科中心接受高能量紫外线去上皮A-CXL的72例（110只眼）圆锥角膜患者资料，其中男性52例、女性20例，年龄（20.3±5.5）岁。根据年龄分为青少年组（≤18岁，35例，56只眼）和成人组（>18岁，37例，54只眼）。比较两组术前及术后1、3、12个月的视力（裸眼远视力、最佳矫正视力）、角膜内皮参数［角膜内皮细胞密度、角膜内皮细胞面积变异系数（CV）、六边形细胞比率］、形态参数［平坦角膜曲率、陡峭角膜曲率、最大角膜曲率（Kmax）、中央角膜厚度、最薄点角膜厚度等］及生物力学参数［应力应变指数（SSI）、水平方向Ambrósio相关厚度（ARTh）等］变化。结果:青少年组术后1、3、12个月的最佳矫正视力从术前的0.09±0.21分别变为0.20±0.23、0.13±0.22和0.14±0.22（均 P<0.05），成人组最佳矫正视力仅术后1个月从0.16±0.29变为0.24±0.30（ P<0.05）。青少年组术后1个月CV为29.3%±2.1%，显著高于术前的28.4%±2.3%（ P<0.05），成人组CV则保持稳定（ P>0.05）。术后1个月，青少年组Kmax从术前（53.85±6.56）D增加至（55.00±6.93）D，成人组从（54.13±10.02）D增至（56.41±8.55）D（均 P<0.05），术后3个月均恢复至基线水平。成人组术后3个月和12个月Kmax较术前基线值的变化绝对值分别为（1.06±2.49）和（1.52±2.62）D，显著高于青少年组的（0.01±2.37）和（0.43±2.57）D（均 P<0.05）。生物力学分析显示，成人组术后3个月SSI为0.79±0.16，显著高于青少年组的（0.72±0.13）（ P<0.05），而ARTh为（187.3±81.8）μm，低于青少年组的（235.0±117.0）μm（ P<0.05）。至术后12个月，成人组SSI持续高于青少年组（ P<0.05）。 结论:高能量紫外线去上皮A-CXL术后1年内，成人原发性圆锥角膜患者角膜刚度改善更显著且角膜形态变化较青少年患者更明显，提示该术式对成人圆锥角膜的短期疗效优于青少年患者。

abstractsObjective:To compare the 1-year clinical efficacy differences of high-ultraviolet energy epithelium-removing accelerated corneal collagen cross-linking (A-CXL) in the treatment of primary keratoconus in juveniles and adults.Methods:This is a retrospective cohort study. The data of 72 patients (110 eyes) with keratoconus who received high-ultraviolet energy epithelium-removing A-CXL in the Ophthalmology Center of Xiangya Hospital, Central South University from August 2022 to December 2023 were collected. There were 52 male patients and 20 female patients, with aged (20.3±5.5) years. According to the age, they were divided into a juvenile group (≤18 years old, 35 cases, 56 eyes) and an adult group (>18 years old, 37 cases, 54 eyes). The visual acuity (uncorrected distant visual acuity, best corrected visual acuity), corneal endothelial parameters [corneal endothelial cell density, coefficient of variation of corneal endothelial cell area (CV), hexagonal cell ratio], morphological parameters [flat corneal curvature, steep corneal curvature, maximum corneal curvature (Kmax), central corneal thickness, thinnest point corneal thickness, etc.] and biomechanical parameters [stress-strain index (SSI), horizontal Ambrósio-related thickness (ARTh), etc.] before surgery and at 1, 3, and 12 months after surgery were compared between the two groups.Results:The best corrected visual acuity of the juvenile group at 1, 3, and 12 months after surgery was changed from 0.09±0.21 before surgery to 0.20±0.23, 0.13±0.22, and 0.14±0.22 respectively (all P<0.05). The best corrected visual acuity of the adult group was only changed from 0.16±0.29 to 0.24±0.30 at 1 month after surgery ( P<0.05). The CV of the juvenile group at 1 month after surgery was 29.3%±2.1%, which was significantly higher than 28.4%±2.3% before surgery ( P<0.05), while the CV of the adult group remained stable ( P>0.05). At 1 month after surgery, the Kmax of the juvenile group increased from (53.85±6.56) D before surgery to (55.00±6.93) D, and that of the adult group increased from (54.13±10.02) D to (56.41±8.55) D (both P<0.05), and both returned to the baseline level at 3 months after surgery. The absolute values of the changes in Kmax of the adult group at 3 months and 12 months after surgery compared with the preoperative baseline values were (1.06±2.49) D and (1.52±2.62) D respectively, which were significantly higher than (0.01±2.37) D and (0.43±2.57) D of the juvenile group (both P<0.05). Biomechanical analysis showed that the SSI of the adult group at 3 months after surgery was 0.79±0.16, which was significantly higher than 0.72±0.13 of the juvenile group ( P<0.05), while the ARTh was (187.3±81.8) μm, which was lower than (235.0±117.0) μm of the juvenile group ( P<0.05). By 12 months after surgery, the SSI of the adult group was still higher than that of the juvenile group ( P<0.05). Conclusion:Within 1 year after high-energy A-CXL, the improvement of corneal stiffness is more significant and the changes in corneal morphology are more obvious in adult patients, suggesting that the short-term efficacy of this surgical procedure for adult keratoconus is better than that for juvenile patients.