Krok Magdalena, Wróblewska-Czajka Ewa, Kokot Joanna, Micińska Anna, Wylęgała Edward, Dobrowolski Dariusz
Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Panewnicka 65 Street, 40-760 Katowice, Poland.
Ophthalmology of Department, District Railway Hospital, Panewnicka 65 Street, 40-760 Katowice, Poland.
J Clin Med. 2022 Jan 25;11(3):585. doi: 10.3390/jcm11030585.
This paper's objective is to analyze patients with keratoconus who developed sterile infiltrate after corneal collagen cross-linking (CXL), and to evaluate possible risk factors for their occurrence.
543 medical histories of patients after cross-linking (Epi-off, Epi-on) procedure performed according to the Dresden protocol were analyzed retrospectively.
Sterile corneal infiltrates occurred in four men (0.7%) in the age range (16-28) years, the average age being 20.3. The average time from procedure to onset of symptoms was 3.5 days (2-5 days). Inflammatory infiltration resolved in all patients, leaving scars on corneal stroma in two patients. Corneal healing time ranged from 4-12 weeks. In vivo confocal microscopy (IVCM), round inflammatory cells, and Langerhans cells in the epithelium and Bowman's layer were observed at the site of infiltration. The Optical coherence tomography (OCT) shows hyperreflective lesions of various sizes which decreased over time. The corneal topographic parameters and Best-corrected visual acuity (BCVA) improved after the CXL procedure in all of the described cases.
Most likely, damage to the epithelium and the phototoxic effect of the procedure is of significant importance in the formation of sterile corneal infiltrates. Appropriate classification and selection of CXL procedures in combination with protective measures in people at risk may have an overwhelming impact on the incidence of this complication.
本文旨在分析圆锥角膜患者在角膜胶原交联（CXL）后发生无菌性浸润的情况，并评估其发生的可能危险因素。
回顾性分析了543例按照德累斯顿方案进行交联手术（上皮去除、上皮保留）后的患者病历。
4名男性（0.7%）出现无菌性角膜浸润，年龄在16 - 28岁之间，平均年龄为20.3岁。从手术到症状出现的平均时间为3.5天（2 - 5天）。所有患者的炎症浸润均消退，2例患者角膜基质留下瘢痕。角膜愈合时间为4 - 12周。在浸润部位通过活体共聚焦显微镜（IVCM）观察到上皮和Bowman层中有圆形炎症细胞和朗格汉斯细胞。光学相干断层扫描（OCT）显示大小各异的高反射性病变，且随时间减少。在所有上述病例中，CXL手术后角膜地形图参数和最佳矫正视力（BCVA）均有所改善。
上皮损伤和手术的光毒性作用很可能在无菌性角膜浸润的形成中起重要作用。对CXL手术进行适当分类和选择，并对高危人群采取保护措施，可能会对该并发症的发生率产生重大影响。
