Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

Sasaki, Takanori; Ide, Takeshi; Toda, Ikuko; Kato, Naoko

doi:10.1159/000487074

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…This procedure is effective in restoring eye integrity and vision but exposes patients to prolonged steroid therapy and the risk of graft rejection, endothelial failure, secondary glaucoma and cataract formation [ 20 ]. Sasaki et al [ 19 ] described a case of amniotic membrane transplant (AMT), which allowed them to control the inflammation, to prevent perforation and to avoid PK. AMT may be considered an alternative option to a conjunctival flap for the treatment of acute stromal melting.…”

Section: Discussionmentioning

confidence: 99%

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Moramarco,

di Geronimo,

Gardini

et al. 2024

BMC Ophthalmol

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Purpose We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK). Methods A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision. Results Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery. Conclusions Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.

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Section: Discussionmentioning

confidence: 99%

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Moramarco,

di Geronimo,

Gardini

et al. 2024

BMC Ophthalmol

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show abstract

“…[12][13][14][15][16][17]23,24 This procedure is effective in restoring eye integrity and vision but exposes patients to prolonged steroid therapy and the risk of graft rejection, endothelial failure, secondary glaucoma and cataract formation. 13 Sasaki et al 31 described a case of amniotic membrane transplant (AMT), which allowed them to control the in ammation, to prevent perforation and to avoid PK. AMT may be considered an alternative option to a conjunctival ap for the treatment of acute stromal melting.…”

Section: Discussionmentioning

confidence: 99%

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Moramarco,

Geronimo,

Gardini

et al. 2023

Preprint

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Purpose: We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK). Methods: A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision. Results: Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery. Conclusions: Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.

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“…Progression was halted in 90–95 % of cases in clinical trials [ 2 – 5 ]. However, several rare complications have been described, including delayed epithelial healing [ 6 , 7 ], stromal melting [ 7 , 8 ], sterile infiltration [ 8 – 10 ], early infectious keratitis [ 11 – 21 ], stromal hazing and demarcation after several weeks [ 9 ], deep stromal scarring [ 22 ], failure [ 9 ], and progressive flattening [ 23 , 24 ]. Infectious keratitis is the most concerning complication; scarring and irregular astigmatism may develop even after infection control, thus impairing the vision of young patients.…”

Section: Introductionmentioning

confidence: 99%

Infectious keratitis after corneal crosslinking for keratoconus caused by levofloxacin-resistant microorganisms

et al. 2021

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Introduction We present seven cases of infectious keratitis after corneal crosslinking (CXL) to attenuate keratoconus progression. Methods Of 524 consecutive patients who underwent CXL, 7 cases (4 males and 3 females; 21.5 ± 7.1 years) developed postoperative infectious keratitis were retrospectively reviewed. CXL was performed using the Dresden protocol or an accelerated protocol involving epithelial removal. Results All cases appeared normal on the day after surgery, but subsequently developed eye pain, blurred vision, corneal infiltration, inflammation of the anterior chamber, and ciliary injection on day 2 or 3. Methicillin-resistant Staphylococcus aureus was cultured from two eyes, methicillin-sensitive Staphylococcus aureus from two eyes, and Streptococcus pneumoniae from one eye. All detected bacteria were resistant to levofloxacin (LVFX). Five of the seven cases, especially four of the five severe cases with hypopyon, had a history of atopic dermatitis. All cases were observed after 2015. Conclusions Infectious keratitis after CXL caused by microbes resistant to LVFX is increasing. In addition to careful postoperative observation of the cornea, preoperative evaluation of bacteria within the conjunctival sac evident on nasal swab cultures may be useful to identify potentially problematic microbes and inform the selection of appropriate antibiotics.

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Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

Cited by 5 publications

References 16 publications

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

Infectious keratitis after corneal crosslinking for keratoconus caused by levofloxacin-resistant microorganisms

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