Dataset Information

Sterile keratitis after combined riboflavin-UVA corneal collagen cross-linking for keratoconus.

ABSTRACT:

Purpose

To investigate patient risk factors and to look for potential causes of sterile infiltrates following an unexpected cluster of sterile keratitis after a routine collagen cross-linking (CXL) list.

Methods

The records of all 148 cases of CXL were reviewed retrospectively. The equipment and solutions used and our clinic's standard operating procedure for CXL were reviewed. An in-vitro experiment to explore the variation in ultraviolet A (UVA) irradiance from fluctuations in the working distance of the UVA lamp was conducted.

Results

The four patients who developed sterile infiltrates had steeper maximum corneal curvatures (68.0±7.3?D) and thinner pachymetry (389.9±49.0??m) than the 144 who did not (57.0±8.2?D, P=0.05; 454.6±45.4??m, P=0.08). A corneal curvature of >60?Dand a pachymetry of <425??m were significant risk factors. All four affected cases obtained a complete resolution with topical antibiotics and steroids. The unaided VA and the maximum K improved from their pre-operative levels in three out of four patients. A 2-mm reduction in distance of the VEGA C.B.M. X-Linker from a treated surface increased irradiance to 3.5-3.7?mW/cm(2), which is above the threshold for endothelial toxicity.

Conclusion

Patients with thinner and steeper corneas are at an increased risk of developing sterile keratitis. The visual outcomes despite this complication are good.

SUBMITTER: Lam FC

PROVIDER: S-EPMC4274277 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Publications

Sterile keratitis after combined riboflavin-UVA corneal collagen cross-linking for keratoconus.

Lam F C FC Georgoudis P P Nanavaty M A MA Khan S S Lake D D

Eye (London, England) 20140808 11

<h4>Purpose</h4>To investigate patient risk factors and to look for potential causes of sterile infiltrates following an unexpected cluster of sterile keratitis after a routine collagen cross-linking (CXL) list.<h4>Methods</h4>The records of all 148 cases of CXL were reviewed retrospectively. The equipment and solutions used and our clinic's standard operating procedure for CXL were reviewed. An in-vitro experiment to explore the variation in ultraviolet A (UVA) irradiance from fluctuations in t ...[more]

PMID: 25104740

Similar Datasets

Project description:Corneal collagen cross-linking (CXL) halts human corneal ectasias progression by increasing stromal mechanical stiffness. Although some reports describe that this procedure is effective in dealing with some infectious and immunologic corneal thinning diseases, there is a need for more animal models whose corneal thickness more closely resemble those occurring in these patients. To meet this need, we describe here high-intensity protocols that are safe and effective for obtaining CXL in rat corneas. Initially, a range of potentially effective UVA doses were evaluated based on their effectiveness in increasing tissue enzymatic resistance to dissolution. At UVA doses higher than a threshold level of 0.54 J/cm2, resistance to enzymatic digestion increased relative to that in non-irradiated corneas. Based on the theoretical threshold CXL dose, a CXL regimen was established in which the UVA tissue irradiance was 9 mW/cm2, which was delivered at doses of either 2.16, 2.7 or 3.24 J/cm2. Their dose dependent effects were evaluated on ocular surface morphological integrity, keratocyte apoptotic frequency, tissue thickness and endothelial cell layer density. Doses of 2.16 and 2.7 J/cm2 transiently decreased normal corneal transparency and increased thickness. These effects were fully reversed after 14 days. In contrast, 3.24 J/cm2 had more irreversible side effects. Three days after treatment, apoptotic frequency in the CXL-2.16 group was lower than that at higher doses. Endothelial cell losses remained evident only in the CXL-3.24 group at 42 days posttreatment. Stromal fiber thickening was evident in all the CXL-treated groups. We determined both the threshold UVA dose using the high-intensity CXL procedure and identified an effective dose range that provides optimal CXL with minimal transient side effects in the rat cornea. These results may help to provide insight into how to improve the CXL outcome in patients afflicted with a severe corneal thinning disease.

Dataset Information

Sterile keratitis after combined riboflavin-UVA corneal collagen cross-linking for keratoconus.

Purpose

Methods

Results

Conclusion

Publications

Sterile keratitis after combined riboflavin-UVA corneal collagen cross-linking for keratoconus.

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