Vandevenne Magali M S, Berendschot Tos T J M, Visser Nienke, Dickman Mor M, Nuijts Rudy M M A
Maastricht University Medical Centre+ University Clinic of Ophthalmology, the Netherlands, P.O. box 5800, 6202 AZ Maastricht, the Netherlands.
Am J Ophthalmol Case Rep. 2024 Jun 16;35:102090. doi: 10.1016/j.ajoc.2024.102090. eCollection 2024 Sep.
We describe a patient after customized crosslinking (CXL) for progressive keratoconus who developed corneal edema with spontaneous resolution.
A 24-year-old male with progressive keratoconus of the left eye underwent a customized CXL procedure with a total energy of 10 J/cm for 16.4 minutes. Preoperative corrected distance visual acuity (CDVA) was 20/30 with a maximum keratometry (K)-value of 58.6 diopter (D) and the thinnest point measured 414 μm. The preoperative endothelial cell density (ECD) was 2414 cells/mm. During treatment, corneal thickness was 325 μm after epithelial debridement and 375 μm after the application of 0.1 % riboflavin containing HPMC. After the treatment, antibiotic and steroid drops were prescribed for 5 days and 3 weeks, respectively. At the 1-month post-CXL visit the patient had no complaints, visual acuity and clinical examination showed no irregularities. At the 4-months post-CXL visit the patient complained of blurry vision. The CDVA was 20/100 and slit-lamp examination showed microcystic corneal edema. The corneal thickness at the thinnest point measured 440 μm. One month later the edema had resolved spontaneously and CDVA had restored to 20/25. Corneal thickness at the thinnest point measured 415 μm, the ECD was 1514 cells/mm and confocal microscopy showed normal structural changes in the anterior stroma after CXL, with the demarcation line located at a depth of 414 μm, just above the corneal endothelium.
We report a case of corneal edema following customized CXL with endothelial cell loss that resolved spontaneously. We recommend either adhering to a minimal stromal thickness of 400 μm before administering UV-A irradiation, using a contact lens or adjusting the irradiation to prevent this complication.
我们描述了一名接受定制交联术（CXL）治疗进行性圆锥角膜后出现角膜水肿且自行消退的患者。
一名24岁左眼患有进行性圆锥角膜的男性接受了定制CXL手术，总能量为10 J/cm，持续16.4分钟。术前矫正远视力（CDVA）为20/30，最大角膜曲率（K）值为58.6屈光度（D），最薄点测量为414μm。术前内皮细胞密度（ECD）为2414个细胞/mm²。治疗期间，上皮清创后角膜厚度为325μm，应用含0.1%核黄素的羟丙基甲基纤维素后为375μm。治疗后，分别开具了5天的抗生素滴眼液和3周的类固醇滴眼液。在CXL术后1个月的随访中，患者无不适主诉，视力和临床检查均无异常。在CXL术后4个月的随访中，患者抱怨视力模糊。CDVA为20/100，裂隙灯检查显示微囊性角膜水肿。最薄点处的角膜厚度测量为440μm。1个月后，水肿自行消退，CDVA恢复至20/25。最薄点处的角膜厚度测量为415μm，ECD为1514个细胞/mm²，共聚焦显微镜检查显示CXL术后前基质的结构变化正常，分界线位于角膜内皮上方414μm深度处。
我们报告了一例定制CXL术后出现角膜水肿伴内皮细胞丢失且自行消退的病例。我们建议在进行紫外线A照射前，要么坚持最小基质厚度为400μm，要么使用隐形眼镜或调整照射以预防这种并发症。
