Department of Ophthalmology, National Defense Medical College, Saitama, Japan.
Cornea. 2013 Jul;32(7):895-8. doi: 10.1097/ICO.0b013e318280c6da.
To describe 3 cases with deep corneal stromal opacity that occurred several months after corneal cross-linking.
A 36-year-old man, a 19-year-old man, and a 14-year-old girl underwent corneal cross-linking for their progressive keratoconus. Corneal cross-linking was performed according to the Dresden protocol. The corneal epithelium was ablated using an excimer laser in 2 cases and manually in 1 case. After 30 minutes of riboflavin presoaking, hypotonic riboflavin solution was applied until the corneal stroma swelled, after which the eyes were exposed to ultraviolet irradiation. Slit-lamp microscopy findings, uncorrected visual acuity, best-corrected visual acuity, manifest refraction, intraocular pressure, and corneal endothelial cell counts were evaluated, and corneal topography with Scheimpflug imaging was performed.
In all cases, the epithelium healed without delay. All eyes showed mild stromal infiltration a few days after the procedure; however, the inflammation was resolved within 1 week. The corneal stroma revealed no opacity up to 1 month after the procedure. A deep stromal opacity that extended to the inferior paracentral area developed after a few months and remained for 6 months to 1 year. Because the opacity was not on the visual axis, the visual acuity was not involved.
Deep stromal opacity developed several months after uneventful corneal cross-linking. Postoperative inflammation may play a crucial role in its pathogenesis.
描述 3 例在角膜交联术后数月发生深层角膜基质混浊的病例。
3 例患者分别为 1 名 36 岁男性、1 名 19 岁男性和 1 名 14 岁女孩，均患有进行性圆锥角膜，行角膜交联术治疗。根据德累斯顿方案进行角膜交联术，其中 2 例采用准分子激光消融角膜上皮，1 例手动消融。在 30 分钟的核黄素浸泡后，应用低渗核黄素溶液直至角膜基质肿胀，然后进行紫外线照射。评估裂隙灯显微镜检查结果、未矫正视力、最佳矫正视力、主觉验光、眼压和角膜内皮细胞计数，并进行角膜地形图和 Scheimpflug 成像。
所有患者的上皮均无延迟愈合。术后几天所有眼均出现轻度基质浸润，但 1 周内炎症消退。术后 1 个月内角膜基质无混浊。术后数月，在下方周边区出现深层基质混浊，并持续 6 个月至 1 年。由于混浊未位于视轴上，因此视力不受影响。
在无并发症的角膜交联术后数月出现深层基质混浊。术后炎症可能在其发病机制中起关键作用。
