Ammermann C, Cursiefen C, Hermann M
Zentrum für Augenheilkunde, Universitätsklinikum Köln.
Klin Monbl Augenheilkd. 2014 Jun;231(6):619-25. doi: 10.1055/s-0034-1368535. Epub 2014 Jun 18.
Corneal cross-linking (CXL) with riboflavin is being used more frequently for the treatment of therapy-resistant microbial keratitis, since increasing drug resistance and specific pathogens, e.g. contact lens-associated Acanthamoeba, make this therapy appear as an attractive option to avoid a keratoplasty à chaud.
This retrospective case series of 11 consecutive patients (4 women, 7 men, aged 24-82 years) who received standardised antimicrobial CXL for therapy-resistant keratitis to avoid a keratoplasty à chaud, included 4 cases with detection of bacterial pathogens, one case with proven fungal infection and 6 cases without pathogen detection. Analysed data comprised ophthalmic medical history, general risk factors for microbial keratitis, treatment before and after CXL. The characterisation of the corneal ulcer included photometric measurements of the infiltrates with a median of 16.2 mm² and four unmeasurable cases due to extended, not circumscribed lesions.
Within the follow-up period (mean 134 ± standard deviation 82 days), a penetrating keratoplasty was successfully avoided in 6 patients (55 %). After CXL 9 patients (82 %) received additionally amniotic membrane transplantation. After CXL treatment, topical antibiotic therapy was continued for a mean 27 ± 13 days postoperatively. Steroids were applied in 91 % of the patients. The cornea cleared at least to some extent in 9 patients (82 %). Patients with neurotrophic keratopathy or potentially compromised immune system showed no increased failure rate.
These results suggest that antimicrobial CXL might be a useful option in patients with therapy-resistant corneal ulcer in order to avoid a perforating keratoplasty à chaud. For a comprehensive scientific assessment of this therapy, however, further, ideally prospective randomised interventional studies with large sample sizes are needed.
由于耐药性增加以及特定病原体（如与隐形眼镜相关的棘阿米巴）的出现，使用核黄素进行角膜交联（CXL）越来越频繁地用于治疗难治性微生物性角膜炎，这使得该疗法成为避免急诊角膜移植术的一个有吸引力的选择。
这是一项回顾性病例系列研究，连续纳入11例患者（4例女性，7例男性，年龄24 - 82岁），他们接受标准化抗菌CXL治疗难治性角膜炎以避免急诊角膜移植术，其中4例检测到细菌病原体，1例确诊为真菌感染，6例未检测到病原体。分析的数据包括眼科病史、微生物性角膜炎的一般危险因素、CXL前后的治疗情况。角膜溃疡的特征包括对浸润灶进行光度测量，中位数为16.2 mm²，4例因病变范围广、边界不清而无法测量。
在随访期内（平均134±标准差82天），6例患者（55%）成功避免了穿透性角膜移植术。CXL后，9例患者（82%）额外接受了羊膜移植。CXL治疗后，局部抗生素治疗术后平均持续27±13天。91%的患者应用了类固醇。9例患者（82%）角膜至少有一定程度的愈合。神经营养性角膜病变或潜在免疫系统受损的患者未显示失败率增加。
这些结果表明，抗菌CXL可能是难治性角膜溃疡患者避免急诊穿透性角膜移植术的一种有用选择。然而，为了对该疗法进行全面的科学评估，需要进一步开展理想的大样本前瞻性随机干预研究。
