Bagatin Freja, Radman Ivana, Ranđelović Karla, Petric Vicković Ivanka, Lacmanović Lončar Valentina, Iveković Renata, Vatavuk Zoran
Department of Ophthalmology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia.
Diagnostics (Basel). 2024 Oct 11;14(20):2267. doi: 10.3390/diagnostics14202267.
Corneal crosslinking (CXL) is a medical procedure used to treat keratoconus. CXL works by strengthening the collagen fibers of the cornea through the application of riboflavin (vitamin B2) and ultraviolet (UV) light, which helps to stabilize the cornea and prevent further deterioration. There is a recognized risk that CXL can trigger the reactivation of dormant herpes simplex virus (HSV), leading to herpetic keratitis even in patients with no history of herpetic disease. We examined the medical history of 52 patients who underwent CXL procedures due to previously diagnosed keratoconus. We reviewed the patient's medical histories to assess whether there was a herpes labialis infection and/or herpetic keratitis. Altogether, 52 eyes (from 52 patients) were analyzed. Of those, four (7.69%) patients were diagnosed with epithelial herpetic keratitis on the 5-8th day after surgery. All four patients had a history of herpes labialis and no prior HSV keratitis infection. Two patients developed herpetic keratitis despite prophylactic therapy with acyclovir 5 days before surgery. A positive history of HSV lip infection before CXL was present in 18/52 (34.62%). During a one-year follow-up period, no patient experienced a recurrence. Close follow-up is crucial for diagnosing herpetic keratitis after corneal crosslinking. The use of prophylactic antiviral therapy in patients who are asymptomatic and have a history of recurrent herpes labialis does not guarantee the prevention of infection.
角膜交联术（CXL）是一种用于治疗圆锥角膜的医疗程序。角膜交联术的原理是通过应用核黄素（维生素B2）和紫外线来强化角膜的胶原纤维，这有助于稳定角膜并防止其进一步恶化。人们已经认识到角膜交联术存在引发潜伏性单纯疱疹病毒（HSV）重新激活的风险，即使是没有疱疹病史的患者也可能因此患上疱疹性角膜炎。我们检查了52例因先前诊断为圆锥角膜而接受角膜交联术患者的病史。我们回顾患者的病史以评估是否存在唇疱疹感染和/或疱疹性角膜炎。总共分析了52只眼睛（来自52名患者）。其中，4例（7.69%）患者在术后第5 - 8天被诊断为上皮性疱疹性角膜炎。所有4例患者都有唇疱疹病史，且既往无HSV角膜炎感染。尽管在手术前5天用阿昔洛韦进行了预防性治疗，但仍有2例患者发生了疱疹性角膜炎。52例中有18例（34.62%）在角膜交联术前有HSV唇部感染的阳性病史。在一年的随访期内，没有患者出现复发。密切随访对于诊断角膜交联术后的疱疹性角膜炎至关重要。对无症状且有复发性唇疱疹病史的患者使用预防性抗病毒治疗并不能保证预防感染。
