Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus
Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus
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DOI：
10.1016/j.clae.2014.10.004
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发表时间：
2015-04-01
影响因子：
3.2
通讯作者：
Shah, S.
中科院分区：
文献类型：
--
作者：
Rana, M.;Lau, A.;Shah, S.
目的：报道2例角膜胶原交联术（corneal collagen crosslinking，CXL）后并发角膜穿孔的微生物性角膜炎。方法：回顾性病例报告。结果：第1例为19岁女性，CXL术后3天出现葡萄球菌性角膜脓肿。住院期间发生角膜穿孔，并通过角膜胶粘成功治疗。通过局部和全身抗生素治疗，微生物性角膜炎最终得到解决，导致血管化角膜瘢痕。第二例病例是一名18岁男性，在CXL手术治疗进行性圆锥角膜后5天发生耐甲氧西林金黄色葡萄球菌（MRSA）角膜脓肿。在就诊后48小时发生角膜穿孔，患者接受了顺利的角膜胶合。虽然感染性角膜炎局部治疗成功，病人有视觉效果的计数手指由于scarrying.Conclusions：CXL已被广泛用于治疗角膜扩张的条件和并发症，如感染性角膜炎，是罕见的术后。我们报告两例严重的微生物性角膜炎，在CXL后7天内发生角膜穿孔。加速角质层溶解过程的确切机制尚不清楚。尽管如此，患者应该充分了解这种潜在的破坏性并发症。(C)2014年由Elsevier Ltd代表英国接触透镜协会发布。
Purpose: To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL).Methods: Retrospective case note review.Results: First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring.Conclusions: CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication. (C) 2014 Published by Elsevier Ltd on behalf of British Contact Lens Association.