ramon c. ghanem, m.d. 1, 2 ; vinícius c. ghanem, m.d. 1, 2 ; marcony santhiago, m.d. 2,3 ; marcelo...
DESCRIPTION
Methods A prospective study including 362 eyes with progressive keratoconus was carried out. After a 9.0 mm epithelial removal, 0.1% riboflavin with 20% dextran was applied for 30 minutes followed by ultraviolet-A (UVA) irradiation (370 nm, 3 mW/cm 2 ) 1. Therapeutic contact lenses were placed for one week. RC. Ghanem, Poster WCC Wollensak G, et al. AJO. 2003TRANSCRIPT
Peripheral Sterile Corneal Ring Infiltrate after Riboflavin-UVA Collagen Crosslinking
in Keratoconus
Ramon C. Ghanem, M.D.1, 2; Vinícius C. Ghanem, M.D.1, 2; Marcony Santhiago, M.D. 2,3; Marcelo V. Netto, M.D. 2,3;
Steven E. Wilson, M.D.3
1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.2. University of São Paulo (USP), São Paulo, Brazil.3. Cleveland Clinic, Cole Eye Institute, Ohio, USA
Financial DisclosuresThe authors do not have a commercial or
proprietary interest in this work.
RC. Ghanem, Poster WCC 2010
PurposeTo report a case series of peripheral ring-
shaped corneal infiltrates that occurred a few days after crosslinking (CXL) for progressive keratectasia secondary to keratoconus.
MethodsA prospective study including 362 eyes with
progressive keratoconus was carried out. After a 9.0 mm epithelial removal, 0.1%
riboflavin with 20% dextran was applied for 30 minutes followed by ultraviolet-A (UVA) irradiation (370 nm, 3 mW/cm2)1.
Therapeutic contact lenses were placed for one week.
RC. Ghanem, Poster WCC 2010
1. Wollensak G, et al. AJO. 2003
ResultsThree eyes (0.8%) developed an unusual type
of peripheral infiltrate. These had a ring-shape and affected the
anterior stroma in the transition between the treated and untreated peripheral cornea a few days after treatment.
RC. Ghanem, Poster WCC 2010
Case 1• 25-year-old male • After 12 days of
CXL
Case 1epithelial ulceration
360 degrees peripheral ring-like infiltrate at the 9.0-mm zone
Case 1• After 3 months
Case 2• 21-year-old male • A week after CXL
Case 3• 24-year-old male • A week after CXL
RC. Ghanem, Poster WCC 2010
Preoperative Data Postoperative Data (3 Months)
Age/Sex/
Eye
Dynamic
Refraction
DCVA
*
Biomicroscopy Max
K**
US
Pachy
Systemic
Workout
Biomicroscopy Dynamic
Refraction
DCVA* Max
K**
US
Pachy
Case 1 25/M/OD +2.0 -6.0 x 50° 20/30 Vogt´s striae 1+,
Fleisher´s ring, no
blepharitis
58.5 487 Negative 360 degrees infiltrate in
the anterior stroma,
faint central haze
+1.50 -6.0 x 50° 20/30 57.7 446
Case 2 21/M/OD -0.25 -4.5 x 180° 20/20 No blepharitis 46.3 433 Negative 180 degrees superficial
infiltrate, no central
haze
N/A N/A N/A N/A
Case 3 24/M/OD -2.25 x 155° 20/25 Two segments of
Ferrara´s ring, no
blepharitis
47.2 441 Negative Discrete inferior
peripheral infiltrate,
central haze 1+
-0.5 -0.5 x 150° 20/30 47.7 436
Cases Sumary
ResultsAll cases had rapid improvement with
steroidal therapy. Due to its shape and location, occurring in
the 9.0 mm edge of the irradiation zone with a limbal clear area, immune reaction seems to be the main explanation.
We hypothesize that the cytotoxic effects of UVA irradiation during CXL may alter the antigenic sites on native proteins in the corneal stroma resulting in a localized autoimmune reaction.
RC. Ghanem, Poster WCC 2010
ConclusionPeripheral sterile corneal infiltrates are not a
rare complication after CXL. Although the exact mechanism is unclear,
identification of this entity and its differentiation from infectious keratitis is essential.
The inflammatory response of the UVA light irradiation during CXL and its role on the immune mechanisms of the cornea demand further investigation.
RC. Ghanem, Poster WCC 2010
Thank you