Abstract：
OBJECTIVE: The aim of this study was to report a case series of central toxic keratopathy (CTK) after collagen cross-linking (CXL) in keratoconus.
METHODS: This is a retrospective case series between January 2020 and September 2021. In this period, CXL was performed for progressive keratoconus in 964 eyes. CXL was performed using the epithelium-off accelerated protocol in all patients with a riboflavin soak time of 20 minutes and a UVA light exposure of 9 mW for 10 minutes using the Avedro KXL (Glaukos Inc, Aliso Viejo, CA) cross-linking system.
RESULTS: Twelve of 964 eyes (1.2%) developed CTK within 1 week of CXL. All patients presented with well-circumscribed, central disciform haze that was broader in the anterior stroma and narrower in the posterior stroma. We noted initial flattening in keratometry up to 3 months post-CXL in these patients, which gradually steepened over 12 months, but did not reach preoperative levels. We also noted exuberant flattening in pachymetry in the first 3 months, which improved over 12 months. There was a statistically significant decrease in pachymetry in patients who developed CTK at 3 and 12 months postoperatively when compared to patients who underwent CXL but did not develop CTK.
CONCLUSIONS: Several reports of CTK postrefractive surgery have been described previously. However, the association of CXL in the development of CTK has not been described previously. Here, we elucidated the clinical features of CTK after CXL and how it differs from corneal scarring or haze that occurs post-CXL.
METHODS: This is a retrospective case series between January 2020 and September 2021. In this period, CXL was performed for progressive keratoconus in 964 eyes. CXL was performed using the epithelium-off accelerated protocol in all patients with a riboflavin soak time of 20 minutes and a UVA light exposure of 9 mW for 10 minutes using the Avedro KXL (Glaukos Inc, Aliso Viejo, CA) cross-linking system.
RESULTS: Twelve of 964 eyes (1.2%) developed CTK within 1 week of CXL. All patients presented with well-circumscribed, central disciform haze that was broader in the anterior stroma and narrower in the posterior stroma. We noted initial flattening in keratometry up to 3 months post-CXL in these patients, which gradually steepened over 12 months, but did not reach preoperative levels. We also noted exuberant flattening in pachymetry in the first 3 months, which improved over 12 months. There was a statistically significant decrease in pachymetry in patients who developed CTK at 3 and 12 months postoperatively when compared to patients who underwent CXL but did not develop CTK.
CONCLUSIONS: Several reports of CTK postrefractive surgery have been described previously. However, the association of CXL in the development of CTK has not been described previously. Here, we elucidated the clinical features of CTK after CXL and how it differs from corneal scarring or haze that occurs post-CXL.
摘要：
目的：本研究的目的是报道一系列圆锥角膜胶原交联（CXL）后的中枢中毒性角膜病变（CTK）。
方法：这是2020年1月至2021年9月之间的回顾性病例系列。在这个时期,对964只眼进行性圆锥角膜行CXL。使用AvedroKXL（GlaukosInc，AlisoViejo,CA)交联系统。
结果：964只眼睛中有12只（1.2％）在CXL的1周内出现CTK。所有患者都有很好的界限，中央盘状浑浊，在前基质中较宽，在后基质中较窄。我们注意到这些患者在CXL后3个月角膜曲率测量中的初始平坦化，在12个月内逐渐变陡，但未达到术前水平。我们还注意到前3个月的测厚仪出现了旺盛的平坦化，改善超过12个月。与接受CXL但未发生CTK的患者相比，在术后3个月和12个月发生CTK的患者的厚度测量有统计学上的显着降低。
结论：先前已经描述了一些CTK后手术的报道。然而,CXL在CTK发展中的关联以前没有描述过.这里,我们阐明了CXL后CTK的临床特征,以及它与CXL后发生的角膜瘢痕或霾的区别.
方法：这是2020年1月至2021年9月之间的回顾性病例系列。在这个时期,对964只眼进行性圆锥角膜行CXL。使用AvedroKXL（GlaukosInc，AlisoViejo,CA)交联系统。
结果：964只眼睛中有12只（1.2％）在CXL的1周内出现CTK。所有患者都有很好的界限，中央盘状浑浊，在前基质中较宽，在后基质中较窄。我们注意到这些患者在CXL后3个月角膜曲率测量中的初始平坦化，在12个月内逐渐变陡，但未达到术前水平。我们还注意到前3个月的测厚仪出现了旺盛的平坦化，改善超过12个月。与接受CXL但未发生CTK的患者相比，在术后3个月和12个月发生CTK的患者的厚度测量有统计学上的显着降低。
结论：先前已经描述了一些CTK后手术的报道。然而,CXL在CTK发展中的关联以前没有描述过.这里,我们阐明了CXL后CTK的临床特征,以及它与CXL后发生的角膜瘢痕或霾的区别.
