Collagen cross-linking for resistant corneal ulcer
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ORIGINAL PAPER
Collagen cross-linking for resistant corneal ulcer Rana Sorkhabi • Mohamadreza Sedgipoor Ali Mahdavifard
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Received: 26 March 2012 / Accepted: 10 September 2012 / Published online: 27 September 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract Corneal ulcer is a devastating corneal disease which is potentially sight-threatening and conventionally is treated by topical antibiotics and in some cases with more invasive procedures such as keratoplasty. The aim of this study is to evaluate the efficacy of corneal collagen cross-linking in resistant corneal ulcers. Ten patients with resistant infectious corneal ulcers who had not responded properly to maximal treatment with topical and subconjunctival antibiotics were enrolled in the study and underwent classic corneal collagen cross-linking with riboflavin and UV-A under sterile conditions in the operating room and were followed up regularly. The result was healing and scar formation with improvement of vision in all patients except for two who underwent enucleation and tectonic penetrating keratoplasty. Corneal collagen cross-linking is a viable therapeutic option for treatment of corneal ulcers and can be used as an adjuvant for conventional treatment in resistant cases. Keywords Corneal ulcer Collagen cross-linking Resistant ulcer
R. Sorkhabi (&) M. Sedgipoor A. Mahdavifard Tabriz University of Medical Sciences, Tabriz, Iran e-mail: [email protected]
Introduction Corneal ulcers may have a devastating impact on ocular tissue and are potentially sight-threatening. Uncontrolled corneal sterile or infectious ulceration may lead to corneal perforation necessitating tectonic corneal transplantation. In these cases keratoplasty is a well-established technique; however, long-recognized complications give rise to serious concerns. Avoiding emergency keratoplasty therefore has several advantages [1, 2]. Corneal collagen cross-linking (CXL) was introduced for the first time by Seiler et al. in 1996. Wollensak et al. employed the procedure in the treatment of keratoconus. In this procedure, riboflavin as a photosensitizer is exposed to ultraviolet (UV)-A light (365–370 nm) which leads to the generation of oxygen free radicals and, following photochemical reactions, covalent bonds are formed in the corneal stroma. These bonds can increase collagen fiber resistance and stiffness, resulting in more corneal stability and prevention of progression of corneal ectasia [3–5]. Spoerl [6] have shown that CXL enhances corneal stromal resistance against enzymatic digestion by pepsin and collagenase. The first report of treatment of corneal ulcers by means of riboflavin–UV-A photosensitization was published in 2000 [7], and thereafter several observations have reported a response to CXL therapy in complicated infectious keratitis [8–12]. It is hypothesized that the combination of the anticollagenase effect of CXL and the antimicrobial effect
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of the UV light could act synergistically to protect corneas from
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