Phylactou Maria, Din Nizar, Aiello Francesco, Angunawela Romesh
Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and.
Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
Cornea. 2023 Oct 1;42(10):1293-1296. doi: 10.1097/ICO.0000000000003258. Epub 2023 May 11.
The aim of this study was to report the first case of successful use of corneal collagen cross-linking (CXL) to halt the progression of keratoconus in a patient with concurrent iridocorneal endothelial (ICE) syndrome.
A 30-year-old White man was referred to our subspecialty corneal clinic for further investigation of right corectopia. The patient was asymptomatic and was otherwise fit. Slit-lamp examination revealed a right oval-shaped pupil decentered superiorly, a transillumination defect at the 5-o'clock position, minimal gutta-like changes in the corneal endothelium, and few inferior peripheral anterior synechiae. Dilated fundoscopy was normal in both eyes, with healthy optic discs, maculae, and peripheral retinae. Specular microscopy and slit-lamp findings suggested ICE syndrome. Subsequent investigation with corneal tomography showed progressive signs of inferior corneal ectasia with steepening, and thinning in the right eye, consistent with keratoconus. The left eye was unremarkable.
Epithelium-off accelerated corneal CXL was performed in the affected eye. Early post-CXL follow-up (1 week) was unremarkable, and further follow-ups were arranged at 3, 6, 12, and 24 months, respectively. In subsequent reviews, the patient's vision and corneal tomography findings were stable.
We describe the first case of corneal CXL for progressive keratoconus with ICE syndrome. co-existing keratoconus and ICE syndrome can occur, and corneal cross-linking was used successfully in this case to halt keratoconus progression. However, further studies will need to establish the impact of epithelium-off corneal cross-linking, especially in more severely affected eyes.
本研究的目的是报告首例成功使用角膜胶原交联（CXL）来阻止圆锥角膜进展的同时合并虹膜角膜内皮（ICE）综合征的患者。
一名30岁白人男性因右角膜异位前来我们的角膜专科门诊进一步检查。患者无症状，身体状况良好。裂隙灯检查发现右眼椭圆形瞳孔向上移位，5点钟位置有透照缺损，角膜内皮有轻微水滴样改变，下方周边前粘连较少。双眼散瞳眼底检查正常，视盘、黄斑和周边视网膜均健康。角膜内皮显微镜检查和裂隙灯检查结果提示ICE综合征。随后的角膜地形图检查显示右眼下方角膜扩张有进展性体征，角膜变陡、变薄，符合圆锥角膜表现。左眼无异常。
对患眼进行了去上皮加速角膜胶原交联术。胶原交联术后早期随访（1周）无异常，随后分别在3、6、12和24个月安排了进一步随访。在随后的复查中，患者的视力和角膜地形图检查结果稳定。
我们描述了首例针对合并ICE综合征的进行性圆锥角膜行角膜胶原交联术的病例。圆锥角膜和ICE综合征可以同时存在，本病例成功使用角膜交联术阻止了圆锥角膜进展。然而，需要进一步研究来确定去上皮角膜交联术的影响，尤其是在病情更严重的患眼中。
