Treating protracted corneal ulcers with UVA corneal collagen crosslinking: clinical cases
https://doi.org/10.21516/2072-0076-2021-14-3-106-112
Abstract
It has recently been proposed to use ultraviolet (UVA) corneal collagen crosslinking as an alternative method of treating bacterial ulcerative lesions of the cornea. Ambivalent results regarding the efficacy and safety of this method of treatment limit its implementation in clinical practice so far.
The purpose of this work is to analyze three clinical cases involving the use of a new device for local UVA crosslinking in the complex treatment of bacterial corneal protracted-course ulcers with the suspected development of mixed fungal infection.
Material and methods. For a dynamic follow-up of patients, we used biomicroscopy with a fluorescein test, photo registration and optical coherence tomography of the anterior part of the eye. Inflammatory changes were assessed using a point scale.
Results. 3–5 procedures of local UVA exposure (with instillations of 0.1% riboflavin solution) lasting 3–5 minutes each and given with an interval of 2–4 days ensured stable and fast epithelialization of the cornea and a significant increase in visual acuity in the inflammatory process outcome.
Conclusion. The first results of treating bacterial corneal ulcers using a new portable device for local UVA crosslinking have shown its high therapeutic efficiency and good prospects for further use in clinical practice.
About the Authors
E. V. Yani
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Cand. of Med. Sci., department of infectious and allergic eye diseases, head
14/19, Sadovaya Chernogryazskaya St., Moscow, 105062, Russia
E. N. Iomdina
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Dr. of Biol. Sci., professor principal researcher department of refraction pathology, binocular vision and ophthalmoergonomics
14/19, Sadovaya Chernogryazskaya St., Moscow, 105062, Russia
V. V. Pozdniakova
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Cand. of Med. Sci., senior researcher of the department of infectious and allergic eye diseases
14/19, Sadovaya Chernogryazskaya St., Moscow, 105062, Russia
V. A. Golikova
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
PhD student of the department of infectious and allergic eye diseases
14/19, Sadovaya Chernogryazskaya St., Moscow, 105062, Russia
K. E. Seliverstova
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
head of the unit of infectious and allergic eye diseases, ophthalmologist
14/19, Sadovaya Chernogryazskaya St., Moscow, 105062, Russia
References
1. Slonimsky A.Yu., Slonimsky Yu.B., Dolgiy S.S. Pass-through corneal transplant for purulent processes of the anterior segment of the eyeball. RMJ Clinical Ophthalmology. 2010. 1: 11 (In Russian).
2. Maychuk Yu.F. Therapeutic algorithms for infectious corneal ulcers. Vestnik oftal’mologii. 2000; 3: 35–7 (In Russian).
3. Sitnik G.V. Modern approaches to the treatment of corneal ulcers. Medical journal. 2007; 4: 100–4 (In Russian).
4. Resnikoff S., Pascolini D., Mariotti S.P., et al. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bulletin of the World Health Organization. 2008 Jan; 86 (1): 63–70. doi: 10.2471/blt.07.041210
5. Chang J.H, Garg N.K., Lunde E., et al. Corneal neovascularization: an antiVEGF therapy review. Survey of ophthalmology. 2012 Sep; 57 (5): 415–29. doi: 10.1016/j.survophthal.2012.01.007
6. Shaik-Dasthagirisaheb Y.B., Varvara G., Murmura G., et al. Vascular endothelial growth factor (VEGF), mast cells and inflammation. International journal of immunopathology and pharmacology. 2013 Apr-Jun; 26 (2): 327–35. doi: 10.1177/039463201302600206
7. Schmack I., M ller M., Klinische T. Microbial keratitis: Understand, recognize, and treat — part 1: General aspects and characteristics of bacterial keratitis. Monatsbl tter f r Augenheilkunde. 2018 Mar; 235 (3): 331–50. doi: 10.1055/s-0044-101286
8. Austin A., Lietman T., Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology. 2017 Nov; 124 (11): 1678–89. doi: 10.1016/j.ophtha.2017.05.012
9. Abbouda A., Abicca I., Ali J.L. Infectious keratitis following corneal crosslinking: a systematic review of reported cases: management, visual outcome, and treatment proposed. Seminars in ophthalmology. 2016; 31 (5): 485–91. doi: 10.3109/08820538.2014.962176
10. Bikbov M.M., Halimov A.R., Usubov E.L. Ultraviolet corneal crosslinking. Vestn. Ross. Akad. Med. Nauk. 2016; 71 (3): 224–32 (In Russian). doi: 10.15690/vramn562
11. Neroev V.V., Petukhova A.B., Danilova D.Yu., Seliverstova K.E., Gundorova R.A. Corneal collagen crosslinking in the treatment of trophic and bacterial corneal ulcers. Russian medical journal. 2013; 2: 25–8 (In Russian).
12. Kasparova, Eug. A., Yang Biao, Sobkova O.I. Modified crosslinking in the treatment of purulent corneal ulcers. Clinical case. Ophthalmology. 2019; 14 (3): 274–7 (In Russian). doi.org/10.18008/1816-5095-2017-3-274-277
13. Chentsova E.V., Verigo E.N., Makarov P.V., Khazamova A.I. Crosslinking in the complex treatment of corneal and transplant ulcers. Russian ophthalmological journal. 2017; 10 (3): 93–100 (In Russian). doi: 10.21516/2072-0076-2017-10-3-93-100
14. Iomdina E.N., Sotnikova L.F., Goncharova A.V., et al. Application of ultraviolet corneal crosslinking for corneal ulcers and other keratopathies in animals. Russian ophthalmological journal. 2019; 12 (3): 51–7 (In Russian). doi.org/10.21516/2072-0076-2019-12-3-51-57
15. Iseli H.P., Thiel M.A., Hafezi F., Kampmeier J., Seiler T. UltravioletA/riboflavin corneal cross-linking for infectious keratitis associated with corneal melts. Cornea. 2008 Jun; 27 (5): 590–4. doi: 10.1097/ICO.0b013e318169d698
16. Richoz O., Kling S., Hoogewoud F., et al. Antibacterial efficacy of accelerated photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL). J. Refract. Surg. 2014. 30: 850–4. doi: 10.3928 / 1081597X-20141118-01
17. Said D.G., Elalfy M.S, Gatzioufas Z., et al. Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting. Ophthalmology. 2014; 121 (7): 1377–82. doi: 10.1016/j.ophtha.2014.01.011
18. Chan T.C., Lau T.W, Lee J.W., et al. Corneal collagen cross-linking for infectious keratitis: an update of clinical studies. Acta Ophthalmol. 2015. 93 (8): 689–96. doi: 10.1111 / aos.12754
19. Alio J.L., Abbouda A., Valle D., et al. Corneal crosslinking and infectious keratitis: a systematic review with a meta-analysis of reported cases. J. Ophthalmic Inflamm. Infect. 2013; 3 (1): 47. doi: 10.1186/1869-5760-3-47
20. Tal K., Gal-Or O., Pillar S., et al. Efficacy of primary collagen cross-linking with photoactivated chromophore (PACK-CXL) for the treatment of Staphylococcus aureus-induced corneal ulcers. Cornea. 2015; 34: 1281–6. doi: 10.1097/ICO.0000000000000550
21. Kozobolis V., Labiris G., Gkika M. UV-A collagen cross-linking treatment of bullous keratopathy combined with corneal ulcer. Cornea. 2010; 29 (2): 235–8. doi: 10.1097/ICO.0b013e3181a81802
22. Makdoumi K., Mortensen J., Sorkhabi O., et al. UVA-Riboflavin photochemical therapy of bacterial keratitis: a pilot study. Graefs Arch. Clin. Exp. Ophthalmol. 2012; 250: 95–102. doi: 10.1007/s00417-011-1754-1
23. Pot S.A, Gallh fer N.S, Matheis F.L., et al. Corneal collagen crosslinking as treatment for infectious and noninfectious corneal melting in cats and dogs: results of a prospective, nonrandomized, controlled trial. Vet. Ophthalmol. 2014; 17: 250–60. doi: 10.1111 / vop.12090
24. Cosar C.B., Kucuk M., Celik E., et al. Microbiologic, pharmacokinetic, and clinical effects of corneal collagen cross-linking on experimentally induced Pseudomonas keratitis in rabbits. Cornea. 2015 Oct; 34 (10): 1276–80. doi: 10.1097/ICO.0000000000000516
25. Neroev V.V., Yani E.V., Iomdina E.N., et al. Treatment of corneal ulcers using local ultraviolet crosslinking (experimental study). Russian ophthalmological journal. 2020; 13 (4): 48–57 (In Russian). https://doi.org/10.21516/2072-0076-2020-13-4-48-57
26. Iomdina E.N., Yani E.V., Khandzhian A.T., et al. Device for corneal crosslinking. Patent RU #199825, 22.09. 2020; bull. 27 (In Russian).
Review
For citations:
Yani E.V., Iomdina E.N., Pozdniakova V.V., Golikova V.A., Seliverstova K.E. Treating protracted corneal ulcers with UVA corneal collagen crosslinking: clinical cases. Russian Ophthalmological Journal. 2021;14(3):106-112. (In Russ.) https://doi.org/10.21516/2072-0076-2021-14-3-106-112
Views:
770
Email this article 