Late-Onset Sterile Peripheral Ulcerative Keratitis Post-Corneal Collagen Crosslinking
Late-Onset Sterile Peripheral Ulcerative Keratitis Post-Corneal Collagen Crosslinking
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DOI：
10.1097/ico.0000000000001842
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发表时间：
2019-03-01
期刊：
影响因子：
2.8
通讯作者：
Jarade, Elias
中科院分区：
文献类型：
--
作者：
Chanbour, Wassef;Mokdad, Israa;Jarade, Elias
目的：报告角膜胶原交联（CXL）后无菌性周围溃疡性角膜炎（PUK）的发病率、特征、临床表现、危险因素和可用的治疗方式。研究方法：本研究是一项回顾性研究，包括2010年1月至2017年6月在贝鲁特眼科和耳鼻喉科专科医院接受LASIK术后圆锥角膜或角膜扩张手术的474例患者的771只眼。平均随访期为4.2年，CXL术后至少1年。结果：8例患者中11只眼（1.4%）发生迟发性PUK，伴或不伴角膜混浊和无菌浸润。并发症发生在术后3个月至6年。他们的平均年龄为39.6 ± 7.1岁，高于无并发症患者的21.9 ± 8.8岁（P = 0.0001）。四名受影响的患者有炎症和自身免疫性疾病。性别、基质内环段的存在、平均角膜曲率和最薄角膜厚度在组间无显著差异，角膜炎患者行屈光性角膜切削术的比例更高。紫外线照射的持续时间与无菌性溃疡性角膜炎的发展有关。所有患者均对类固醇治疗有反应，只有1例复发，局部用1%环孢霉素滴剂后复发。结论：PUK是CXL术后罕见但严重的并发症。需要长期随访以发现迟发性PUK。它是一种与老年和自身免疫性疾病相关的可治疗疾病，但具有良好的视觉效果。
Purpose: To report the incidence, characteristics, clinical presentations, risk factors, and the available treatment modalities of sterile peripheral ulcerative keratitis (PUK) post-corneal collagen crosslinking (CXL). Methods: This study is a retrospective study including 771 eyes of 474 patients operated for keratoconus or ectasia after LASIK between January 2010 and June 2017 at Beirut Eye & ENT Specialist hospital. The average follow-up period was 4.2 years with a minimum of 1 year post-CXL. Results: Eleven eyes (1.4%) of 8 patients developed late-onset PUK with or without corneal haze and sterile infiltrates. The complications occurred between 3 months and 6 years postoperatively. Their mean age of 39.6 +/- 7.1 years was higher than the age of the noncomplicated patients 21.9 +/- 8.8 years (P = 0.0001). Four affected patients had inflammatory and autoimmune conditions. Sex, presence of intrastromal ring segments, mean keratometry, and the thinnest pachymetry were found to be insignificantly different between groups, and photorefractive keratectomy was performed more in patients with keratitis. Duration of ultraviolet light exposure was related to sterile ulcerative keratitis development. All patients responded to steroid treatment, and only one had a relapse which resolved with topical cyclosporine 1% drops. Conclusions: PUK is a rare but serious complication after CXL. Long-term follow-up is necessary to detect late-onset PUK. It is a treatable condition associated with older age and autoimmune conditions but has a good visual outcome.