Diffuse lamellar keratitis after epi-off corneal crosslinking: An under-recognized complication?
| Autor: | Diana Mannschreck, Roy S. Rubinfeld, Uri Soiberman, Albert S. Jun |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Complications Visual acuity genetic structures medicine.medical_treatment Keratomileusis LASIK 03 medical and health sciences 0302 clinical medicine lcsh:Ophthalmology Ophthalmology Ectasia Case report medicine Epithelium-off Conductive keratoplasty Dresden protocol Diffuse lamellar keratitis business.industry Transepithelial Disease progression CXL medicine.disease eye diseases lcsh:RE1-994 030221 ophthalmology & optometry sense organs medicine.symptom Complication business DLK 030217 neurology & neurosurgery |
| Zdroj: | American Journal of Ophthalmology Case Reports, Vol 13, Iss, Pp 140-142 (2019) American Journal of Ophthalmology Case Reports |
| ISSN: | 2451-9936 |
| DOI: | 10.1016/j.ajoc.2019.01.004 |
| Popis: | Purpose: To report diffuse lamellar keratitis (DLK) occurring in an eye that underwent epithelium-off (epi-off) corneal cross-linking (CXL) as a treatment for post-surgical ectasia and the successful treatment of progressive ectasia with a novel epi-on CXL and conductive keratoplasty (CK) treatment. Observations: A 42-year-old man presented with corneal ectasia in his right eye 3 years after laser in situ keratomileusis (LASIK) surgery. He underwent epi-off corneal CXL using the Dresden protocol. Grade II DLK was diagnosed within days of CXL. Despite successful treatment of DLK, best-corrected visual acuity in the right eye deteriorated over the next 4 months due to progression of ectasia and remained worse than the patient's pre-operative baseline 1 year after epi-off CXL. Because of apparent disease progression, despite his CXL treatment, the patient underwent a novel, transepithelial CXL (TE-CXL) treatment combined with conductive keratoplasty (CK). This treatment improved his vision and stabilized his ectasia without subsequent DLK. Approximately 3 years after CK and TE-CXL, his eye remains stable with 4 Snellen lines of improved vision and no progression of ectasia. Conclusion and importance: Epithelium-off CXL is used increasingly to treat post-LASIK ectasia. First, in this case, DLK occurred after epi-off CXL. We suggest careful scrutiny of such cases as DLK is difficult to identify after epi-off CXL. Second, the epi-off CXL was unsuccessful in stopping the post-LASIK ectasia. Transepithelial CXL successfully treated the ongoing ectasia after resolution of the DLK with no subsequent re-occurrence of DLK. We suggest that TE-CXL may provide a successful initial treatment for post-LASIK ectasia that also minimizes the epithelial disruption that can lead to DLK. Keywords: DLK, Epithelium-off, Dresden protocol, CXL, LASIK, Complications, Transepithelial |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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