Moshirfar Majid, Vaidyanathan Uma, Hopping Grant C, Ronquillo Yasmyne C, Hoopes Phillip C
John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
Utah Lions Eye Bank, Murray, UT, USA.
Med Hypothesis Discov Innov Ophthalmol. 2019 Fall;8(3):250-256.
In this case series, we report a potentially novel association of corneal collagen crosslinking (CCL) with the development of photophobia symptoms in a series of patients at a tertiary ophthalmology clinic and describe their clinical course. Photosensitivity is a rare and seemingly unpredictable complication of refractive surgery but can present as a disabling, bilateral ocular pain that requires immediate treatment. This complication, termed transient light-sensitivity syndrome (TLSS), can have a substantially delayed presentation after ocular procedures and is associated with inflammation of structures in the anterior chamber that can be imperceptible on slit-lamp examination. Traditionally, exposure to high-energy femtosecond lasers is hypothesized to create stromal gas bubbles powering postoperative inflammatory reactions. TLSS-like symptoms after CCL may be due to a secondary inflammatory response involving activated keratocytes and cytokine release. However, free radical damage from the interaction of riboflavin and ultraviolet in CCL may also drive this inflammatory process.
在本病例系列中，我们报告了在一家三级眼科诊所的一系列患者中，角膜胶原交联（CCL）与畏光症状发展之间可能存在的新关联，并描述了其临床病程。光敏性是屈光手术罕见且似乎不可预测的并发症，但可表现为使人致残的双侧眼痛，需要立即治疗。这种并发症称为短暂性光敏感综合征（TLSS），在眼科手术后可能有显著延迟的表现，并且与前房结构的炎症相关，而裂隙灯检查可能无法察觉这种炎症。传统上，假设暴露于高能飞秒激光会产生基质气泡，从而引发术后炎症反应。CCL后出现的类似TLSS的症状可能是由于涉及活化角膜细胞和细胞因子释放的继发性炎症反应。然而，CCL中核黄素与紫外线相互作用产生的自由基损伤也可能推动这一炎症过程。
