Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey.
Cornea. 2014 Jun;33(6):630-3. doi: 10.1097/ICO.0000000000000110.
To present a case of acute idiopathic endotheliitis occurred early after corneal collagen cross-linking (CXL) for progressive keratoconus, and to discuss possible risk factors, causes, and other similar complications in the literature.
A 24-year-old woman with bilateral keratoconus underwent a corneal de-epithelization and subsequently CXL in the right eye, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to ultraviolet-A light (370 nm, 2.9-3.1 mW/cm) for 30 minutes. A bandage contact lens was placed until complete re-epithelialization. Postoperatively, the patient received 0.5% topical moxifloxacin (3 times a day) and preservative free artificial tears (6 times a day).
Postoperatively, the patient presented with significant hyperemia and photophobia on day 3. On biomicroscopy, ring-shaped endothelial infiltrates and localized corneal edema were observed in the inferior paracentral location of the cornea. Idiopathic endotheliitis was diagnosed, the therapeutic contact lens was removed, and 1% prednisolone acetate suspension was started every hour in addition to hypertonic ophthalmic solution every 3 hours. After this intensive corticosteroid treatment, the infiltrates improved and completely resolved after 1 week.
We reported a successfully treated acute idiopathic endotheliitis occurring early after routine CXL. This very rare complication is hypothesized to occur as a result of the phototoxic effect of ultraviolet-A transmission on the corneal endothelium, or as an inflammatory response to surgical trauma or solutions used throughout the procedure.
介绍 1 例在角膜胶原交联（CXL）治疗进展性圆锥角膜后早期发生的急性特发性内皮炎病例，并讨论文献中可能的危险因素、病因和其他类似并发症。
1 例双侧圆锥角膜 24 岁女性患者，行角膜去上皮化，随后右眼行 CXL，应用 0.1%核黄素和 20%葡聚糖，暴露于紫外线-A 光（370nm，2.9-3.1mW/cm）30 分钟。戴绷带接触镜直至完全上皮化。术后患者接受 0.5%局部莫西沙星（每日 3 次）和无防腐剂人工泪液（每日 6 次）滴眼。
术后第 3 天，患者出现明显的充血和畏光。在生物显微镜下，观察到角膜下周边位置的环形内皮浸润和局部角膜水肿。诊断为特发性内皮炎，去除治疗性接触镜，除 3 小时滴 1 次高渗盐水外，每小时加用 1%醋酸泼尼松龙混悬液滴眼。经过这种强化皮质类固醇治疗后，浸润改善，1 周后完全消退。
我们报告了 1 例常规 CXL 后早期成功治疗的急性特发性内皮炎。这种非常罕见的并发症被假设是由于角膜内皮的紫外线-A 传输的光毒性作用，或作为手术创伤或整个手术过程中使用的溶液的炎症反应而发生。
