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。
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.