From the Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas.
J Cataract Refract Surg. 2021 Aug 1;47(8):1075-1080. doi: 10.1097/j.jcrs.0000000000000620.
Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.
角膜交联术是美国食品和药物管理局批准的一种治疗方法，用于使角膜变硬并预防圆锥角膜患者的角膜扩张。标准程序包括在治疗前去除角膜上皮（上皮下）。标准程序的变体包括加速交联和经上皮程序。本研究回顾了上皮下交联后感染的风险、病原体谱和临床结果。确定了 26 篇出版物。所有眼睛术后均配带绷带接触镜。现有数据表明，上皮下交联术后感染性角膜炎的总体发生率较低。细菌性感染最为常见，术后平均出现时间为 4.8 天。术后立即使用类固醇和绷带接触镜以及特应性或疱疹性疾病史与感染有关。这些患者需要进行强化的术后护理，并在适当情况下进行预防性抗病毒治疗。
