Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus

Angunawela, Romesh; Arnalich‐Montiel, Francisco; Allan, Bruce

doi:10.1016/j.jcrs.2008.11.050

Cited by 83 publications

(61 citation statements)

References 8 publications

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“…Hypotheses for possible aetiologies have included alterations in antigenicity that occur in native proteins after CXL, leading to patients recognizing the proteins as non-self and mounting immune responses, 7 and enhanced cell-mediated immunity to staphylococcal antigen deposition in areas of static tear pooling beneath the bandage contact lens. 11 In our patients, the fact that all cases occurred on a single list did recommend the possibility of the cases being infective. UVA radiation is bactericidal, but infectious keratitis after CXL can and does occur.…”

Section: Discussionmentioning

confidence: 72%

“…To date no clear risk factors or cause for the development of these sterile infiltrates has been found and the true etiology of these infiltrates is unknown, although several different authors have come up with different hypotheses for possible causes of these sterile infiltrates. [7][8][9][10][11] As all the cases occurred on a single list at our clinic, this suggested that all the patients were probably exposed to the same predisposing factor. Therefore, we used this undesired event as a unique opportunity to investigate for factors that predispose to sterile infiltrates.…”

Section: Introductionmentioning

confidence: 79%

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

Lam

Georgoudis

Nanavaty

et al. 2014

Eye

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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 crosslinking (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 mm) than the 144 who did not (57.0 ± 8.2 D, P ¼ 0.05; 454.6 ± 45.4 mm, P ¼ 0.08). A corneal curvature of 460 Dand a pachymetry of o425 mm 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 preoperative 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.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 79%

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

Lam

Georgoudis

Nanavaty

et al. 2014

Eye

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“…Only a few cases of post-CXL complications have been reported; these include bacterial keratitis, 21 herpetic keratitis, 22 and limited corneal melting. 23 In a prospective study of CXL complications, Koller et al 24 reported a rate of 2.9% of significant complications (with loss of 2 Snellen lines of CDVA). Risk factors included age older than 35 years and CDVA better than 20/25.…”

Section: Safety and Treatment Failurementioning

confidence: 99%

Corneal collagen crosslinking in progressive keratoconus: Multicenter results from the French National Reference Center for Keratoconus

Asri

Touboul

Fournié

et al. 2011

Journal of Cataract and Refractive Surgery

200

135

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“…-Haze-like aspect due to a transitory anterior corneal scar responsible for a reversible decrease in visual acuity within the first 3 months [42] . -Aseptic peripheral infiltrates (due to the immune reaction to staphylococcal antigens) [43] . -Infectious keratitis, with the main identified germs being Pseudomonas aeruginosa , Escherichia coli , Staphylococcus epidermidis , and even plurimicrobial infections [44,45] .…”

Section: Adverse Effectsmentioning

confidence: 99%

Corneal Collagen Crosslinking Techniques: Updates

Cassagne¹,

Hout²,

Malecaze³

2015

Cornea

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Corneal collagen crosslinking (CXL) is usually practiced on keratoconic corneas to strengthen the corneal biomechanical structure. The conventional CXL procedure, with riboflavin and ultraviolet A (UVA), initially involves corneal de-epithelialization to allow riboflavin penetration into the stroma. Discomfort and complications are related to this corneal debridement. Thus, transepithelial CXL has emerged to substitute for the conventional method. This technique preserves the epithelium and tends to ensure the same efficiency of corneal stiffening. To allow riboflavin penetration through the epithelial barrier, several chemical modifications to riboflavin, such as addition of enhancers (EDTA, benzalkonium chloride or 20% alcohol), and osmolar modifications have been applied. The most studied transepithelial riboflavin is Ricrolin TE ® , which combines two enhancers: amino alcohol and EDTA. The results of clinical studies have not demonstrated effectiveness yet. Moreover, the iontophoresis technique, a noninvasive procedure during which a low-intensity electric current is applied to enhance the penetration of riboflavin into the stroma, stands out as being as efficient as conventional application of riboflavin, based on a pre-clinical study. Another area of improvement of CXL is modification of the UVA irradiation profile or shortening of the UVA irradiation time while increasing the irradiation power. A longer follow-up and more investigations are still necessary to define the future of transepithelial CXL, but it is an exciting and rapidly evolving area.

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Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus

Cited by 83 publications

References 8 publications

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

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

Corneal collagen crosslinking in progressive keratoconus: Multicenter results from the French National Reference Center for Keratoconus

Corneal Collagen Crosslinking Techniques: Updates

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