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Cross-linking in resistant to medical treatment corneal infections: a preliminary study on 12 cases

Poster Details

First Author: A.Amraoui MOROCCO

Co Author(s):    A. Mchachi   M. Bouazza   L. Benhmidoune   A. Mami     

Abstract Details



Purpose:

The management of severe corneal infections is hard to perform in many cases due to microbial resistance to drugs and toxic effects of them to ocular surface leading to poor clinical results including corneal melting and complications such as endophtalmitis or corneal perforations

Setting:

Hospital, Department of ophthalmology, Casablanca, Morocco

Methods:

The authors propose a prospective preliminary study using UV-A activated riboflavin corneal collagen cross-linking as an additive treatment to pharmacological medications in these indications. A preliminary non systematic prospective study on 12 cases of bacterial or fungal corneal infections non healed by classical treatment. All inclueded patients had maximal medical treatment for at least 3 weeks. They underwent to a classical procedure of 30 minutes irradiation of UV-A at 3 mW/cm2 fluence after surgical epithelial and necrotic tissues removal with 30 minutes of instillation of 0.1% riboflavin. The follow up was performed on clinical outcomes, fluorescein staining imaging, topographic findings when possible, and corneal OCT measurements.

Results:

12 patients (12 eyes) underwent to cross-linking procedure. Mean age was 54 y.o. sex ratio was 0,71. 10 patients had bacterial keratitis like streptococcus mitis (among them 1 case of corneal abcess on keratoplasty) and 2 had fungal infection by scedosporium apiospermum in one case. Success of the procedure was assessed on total corneal reepithelialization (fluorescein negative image). 10 patients had corneal reepithelialization within 15 days after the procedure, one patient had a persistant corneal ulcer after 30 days and one patient had a corneal perforation and endophtalmitis 8 days after cross linking. One patient had visual acuity improved from hand movement to 5/20. The presentation includes all cases' imaging before and after cross-linking

Conclusions:

Corneal infections are severe ocular diseases that can lead to vision loss and anatomic destruction of the eye in various cases when medical treatment has poor effects. Since 2000 and the pilot study of T. Seiler team, many papers have assessed the benefits of collagen cross-linking on small series of patients. Our study confirm these encouraging results and establishes that is no significant side effects on endothelium even in corneas thinner than 400 micron so the technique could be used safely on these corneas. A certain amount of questions could be answered on further studies such as the optimal delay to introduce cross linking in case of non response to medical treatment, the systematic introduction of cross-linking in fungal keratitis as it needs long term treatment, and the real place of cross-linking in non healing viral keratitis whereas a herpetic infection could be a contra-indication for the technique. FINANCIAL INTEREST: NONE

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