Knutsson Karl Anders, Genovese Paola Noemi, Paganoni Giorgio, Ambrosio Oriella, Ferrari Giulio, Zennato Arianna, Cataldo Madeleine, Caccia Michela, Rama Paolo
Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, 20132 Milan, Italy.
J Clin Med. 2022 Nov 30;11(23):7093. doi: 10.3390/jcm11237093.
A large retrospective study evaluated the safety of a post-operative therapy protocol after epithelium-off corneal collagen cross-linking (CXL). In total, 1703 eyes of the 1190 patients with progressive keratoconus were enrolled in a retrospective cohort study in a tertiary care university hospital. CXL was performed using a standardized technique (Dresden protocol: 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase followed by 30-min ultraviolet A irradiation (3 mW/cm)). Postoperatively, a bandage contact lens was applied, and therapy included a topical fluoroquinolone antibiotic until the epithelium healed, followed by topical fluorometholone treatment for three weeks. Post-operative complications were recorded and analyzed. No cases of infectious keratitis occurred, whereas peripheral sterile infiltrates were observed in 1.17% of cases. Trace haze was typically present but did not have an impact on visual acuity. In fifteen cases (0.88%), visually significant anterior stromal opacity developed. Mild signs of dry eye were observed in 22 eyes (1.29%). The present study demonstrates that a post-operative treatment protocol including fluoroquinolone antibiotics and a BCL in the first phase until complete epithelial healing, followed by a three-week period of topical steroid treatment is safe and not associated with the development of microbial keratitis.
一项大型回顾性研究评估了上皮剥脱性角膜交联术（CXL）后术后治疗方案的安全性。在一所三级医疗大学医院中，对1190例进行性圆锥角膜患者的1703只眼进行了回顾性队列研究。采用标准化技术进行CXL（德累斯顿方案：在浸润阶段使用含20%右旋糖酐的0.1%核黄素溶液30分钟，随后进行30分钟的紫外线A照射（3 mW/cm））。术后，佩戴绷带式隐形眼镜，治疗包括在角膜上皮愈合前局部使用氟喹诺酮类抗生素，随后局部使用氟米龙治疗三周。记录并分析术后并发症。未发生感染性角膜炎病例，而1.17%的病例观察到周边无菌浸润。通常会出现微量 haze，但对视力无影响。15例（0.88%）出现了对视力有显著影响的前基质混浊。22只眼（1.29%）观察到轻度干眼体征。本研究表明，术后治疗方案包括在第一阶段直至角膜上皮完全愈合期间使用氟喹诺酮类抗生素和绷带式隐形眼镜，随后进行为期三周的局部类固醇治疗是安全的，且与微生物性角膜炎的发生无关。
