PDF(Pubmed)
Abstract：
OBJECTIVE: We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK).
METHODS: A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision.
RESULTS: Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery.
CONCLUSIONS: Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.
METHODS: A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision.
RESULTS: Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery.
CONCLUSIONS: Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.
摘要：
目的：我们描述了一例角膜交联（CXL）后严重角膜融化的病例的处理方法，该方法采用结膜瓣，然后进行深前板层角膜移植术（DALK）。
方法：一名12岁男性在加速上皮脱离CXL方案后出现严重的角膜融化，并伴有穿孔。我们最初用结膜瓣治疗患者以防止穿孔。三个月后,我们进行了DALK以恢复视力。
结果：结膜瓣手术使我们避免了角膜穿孔和穿透性角膜移植术（PK）。一旦炎症消退，我们凹陷结膜并执行DALK光学目的。十二个月后,移植物清晰，矫正视力为20/25（Snellen）。术后无并发症发生。
结论：尽管CXL被认为是一种安全的手术，在极少数情况下，它会导致严重的并发症，如角膜雾霾，感染性和非感染性角膜炎，基质熔化和穿孔。角膜融化和穿孔通常由紧急PK管理。在此，我们建议采用分阶段的方法，包括紧急结膜瓣，然后在以后的时间进行DALK，使我们能够避免PKàchaud。
方法：一名12岁男性在加速上皮脱离CXL方案后出现严重的角膜融化，并伴有穿孔。我们最初用结膜瓣治疗患者以防止穿孔。三个月后,我们进行了DALK以恢复视力。
结果：结膜瓣手术使我们避免了角膜穿孔和穿透性角膜移植术（PK）。一旦炎症消退，我们凹陷结膜并执行DALK光学目的。十二个月后,移植物清晰，矫正视力为20/25（Snellen）。术后无并发症发生。
结论：尽管CXL被认为是一种安全的手术，在极少数情况下，它会导致严重的并发症，如角膜雾霾，感染性和非感染性角膜炎，基质熔化和穿孔。角膜融化和穿孔通常由紧急PK管理。在此，我们建议采用分阶段的方法，包括紧急结膜瓣，然后在以后的时间进行DALK，使我们能够避免PKàchaud。
