Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, University of Health Sciences Turkey, 34420, Istanbul, Turkey.
Int Ophthalmol. 2020 Dec;40(12):3269-3277. doi: 10.1007/s10792-020-01512-3. Epub 2020 Jul 26.
To evaluate the early- and late-stage complications of accelerated cross-linking (A-CXL) in a large case series and investigate the relationship of A-CXL complications with ocular and systemic conditions accompanying keratoconus.
Retrospectively, records of 2025 eyes of 1184 patients diagnosed with keratoconus between March 2013 and 2020 who underwent A-CXL (18 mW/cm for 5 min) treatment were reviewed. Comorbid ocular and systemic diseases other than keratoconus were recorded. In the postoperative follow-up, early and late complications and their association with accompanying diseases were examined.
The mean age of patients was 26.16 ± 6.05 (range 18-42), and the mean follow-up time was 3.40 ± 1.63 years (range 1-8 years). Vernal keratoconjunctivitis (3.7%) was the most common disease accompanying keratoconus. Less frequently, systemic allergic diseases (2.9%) and Down syndrome (2.3%) were observed. The most common complication in the early postoperative period was haze formation (9.1%), while failure of the treatment (4.2%) occurred in the late period. Other common complications were loss of two or more Snellen lines (2.4%) and delayed epithelial healing (1.8%). There was a significant relationship between vernal keratoconjunctivitis and delayed epithelial healing (p = 0.011). Statistically significant relationships were found between Down syndrome and haze formation (p < 0.001) and sterile infiltrate formation (p = 0.041).
Although A-CXL complication rates are low, vernal keratoconjunctivitis following A-CXL might increase the risk of delayed epithelial healing, and similarly corneal haze and sterile infiltrates might be observed more frequently in patients with Down syndrome.
评估大样本系列中加速交联（A-CXL）的早期和晚期并发症，并研究 A-CXL 并发症与圆锥角膜伴发的眼部和全身状况之间的关系。
回顾性分析 2013 年 3 月至 2020 年间诊断为圆锥角膜并接受 A-CXL（18 mW/cm 持续 5 分钟）治疗的 1184 例患者的 2025 只眼的病历。记录除圆锥角膜以外的其他伴发性眼部和全身疾病。在术后随访中，检查了早期和晚期并发症及其与伴发疾病的关系。
患者的平均年龄为 26.16±6.05 岁（范围 18-42 岁），平均随访时间为 3.40±1.63 年（范围 1-8 年）。春季性角结膜炎（3.7%）是最常见的圆锥角膜伴发性疾病。其次为系统性过敏疾病（2.9%）和唐氏综合征（2.3%）。早期最常见的并发症是混浊形成（9.1%），而晚期则出现治疗失败（4.2%）。其他常见的并发症包括视力丧失两行或更多（2.4%）和上皮愈合延迟（1.8%）。春季性角结膜炎与上皮愈合延迟有显著的关系（p=0.011）。唐氏综合征与混浊形成（p<0.001）和无菌性浸润形成（p=0.041）有显著的关系。
尽管 A-CXL 并发症的发生率较低，但 A-CXL 后发生春季性角结膜炎可能会增加上皮愈合延迟的风险，而唐氏综合征患者可能更容易出现角膜混浊和无菌性浸润。
