Sterile corneal infiltrates after corneal collagen cross-linking: evaluation of risk factors
Sterile corneal infiltrates after corneal collagen cross-linking: evaluation of risk factors
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DOI：
10.1111/aos.13218
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发表时间：
2017-03-01
影响因子：
3.4
通讯作者：
Toker, Ebru
中科院分区：
文献类型：
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作者：
Cerman, Eren;Ozcan, Deniz Ozarslan;Toker, Ebru
目的：目的：探讨角膜胶原交联术（Corneal Collagen Crosslinking，CXL）后无菌性角膜浸润的可能危险因素。方法：回顾性分析459例（588眼）CXL术后Epi-off（n = 461）和Epi-on（n = 127）患者的临床资料。评估了风险因素，包括术前睑缘炎和春季结膜炎、术后局部非甾体抗炎药（NSAID）的使用以及Kmax和角膜厚度测量。对无菌浸润的患者进行了体内共聚焦显微镜（IVCM）和眼前节光学相干断层扫描（AS-OCT）分析。结果：19例（3.2%）出现无菌浸润。Epi-on组中没有患者发生无菌浸润。将CXL手术加速作为风险因素的评估显示，四个不同的Epi-off组之间的浸润发生率没有具体差异（3 mW/cm（2）-30 min、9 mW/cm（2）-10 min、18 mW/cm（2）-5 min、30 mW/cm（2）-4 min手术; p > 0.05，全部）。睑缘炎、春季结膜炎、Kmax和角膜厚度测量未被确定为危险因素（p > 0.05）。术后使用NSAID是一个重要因素（p = 0.007），它使无菌浸润的机会增加了4.09倍（95% CI，1.463-11.428）。在体内共聚焦显微镜（IVCM）显示非特异性炎症与树突状细胞在上皮和Bowman的层。在AS-OCT中，在前基质水平观察到深度为100-140 μ m的高反射带。对眼睑炎、NSAID使用、春季结膜炎、CXL手术持续时间和光照强度等风险因素的评价表明，上皮损伤可能是发病机制中的常见途径，因为Epi-on CXL中未发生无菌浸润，术后使用非甾体类抗炎药使无菌性浸润的风险增加约4倍。
Purpose: To evaluate possible risk factors leading to sterile corneal infiltrates following corneal collagen cross-linking (CXL).Methods: A total of 588 eyes of 459 patients treated with Epi-off (n = 461) or Epi-on (n = 127) CXL were retrospectively evaluated. Risk factors, including preoperative blepharitis and vernal conjunctivitis, the postoperative use of topical non-steroidal anti-inflammatory drugs (NSAIDs), as well as Kmax and pachymetry measurements, were assessed. In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) analyses were performed in patients with sterile infiltrates.Results: Sterile infiltrates developed in 19 cases (3.2%). No patients in the Epi-on group developed sterile infiltrates. The evaluation of acceleration of the CXL procedure as a risk factor revealed no specific difference in the incidence of infiltrates among four different Epi-off groups (3 mW/cm(2)-30 min, 9 mW/cm(2)-10 min, 18 mW/cm(2)-5 min, 30 mW/cm(2)-4 min procedures; p > 0.05, all). Blepharitis, vernal conjunctivitis, Kmax and pachymetry were not identified as risk factors (p > 0.05). Postoperative use of NSAIDs was a significant contributor (p = 0.007), and it increased the chance of sterile infiltrates 4.09 times (95% CI, 1.463-11.428). In vivo confocal microscopy (IVCM) showed non-specific inflammation with dendritic cells at the epitheliumand at Bowman's layer. InAS-OCT, a hyper-reflective band at the level of the anterior stroma to a depth of 100-140 mu m was observed.Conclusion: The evaluation of the risk factors such as blepharitis, the use of NSAIDs, vernal conjunctivitis, the duration of CXL procedure and amount of light intensity showed that epithelial damage is possibly the common pathway in the pathogenesis, as no sterile infiltrates in Epi-on CXL occurred, and the postoperative use of NSAIDs increased the risk of developing sterile infiltrates about four times.