Clinical Study Of Corneal Collagen Crosslinking In The Treatment Of Infectious Corneal Diseases

Objective: To evaluate the clinical efficacy of corneal collagen cross-linking in the treatment of infectious corneal diseases.Methods: This study was approved by the ethics committee of the hospital.The clinical efficacy of CXL in 65 eyes diagnosed with infectious keratitis in our hospital from December2016 to June 2018 was retrospectively analyzed.After 6 months follow-up,the visual acuity,slit lamp microscopy,confocal microscopy,anterior segment OCT and corneal biomechanical parameters were recorded in detail.Corneal biomechanics was measured in 21 eyes(21 eyes)before and after the healing of corneal ulcer(3m after surgery)and without lesion in the central corneal area(5 mm).The biomechanical parameters of the healthy eye were also measured and compared with those of the healthy eye(control group).The clinical efficacy of CXL treatment was evaluated.Results: 1.The total healing rate was 93.85%,including 94.12% fungal keratitis and91.67% bacterial keratitis.There was no statistical difference between the two groups(P>0.05).According to the size of ulcer,the ulcer was divided into two groups: no more than 4mm×4mm,4mm×4mm-7mm×7mm.The healing rate of each group was 95.23% and91.67%.There was no statistical difference between the two groups(P>0.05).The lesion depth less than 1/3 the cure rate was 96.29%.1/3< lesion depth <2/3 cure rate was 92.10%.The cure rate showed no significant difference(P>0.05).1 eye of acanthamoeba keratitis was cured.2eye of exposure keratitis were cured.Among the 4 eye who failed the surgery,1 eye with bacterial keratitis and 1 eye with fungal keratitis finally underwent penetrating keratoplasty.And 2 eye with fungal keratitis were finally cured by 2% silver nitrate cauterization.No corneal endothelial dysfunction was observed in all patients.2.Visual acuity:For the two groups of patients whose lesions were located in the periphery and involved the pupil area,CXL cured patients were significantly improved 6m after operation.During thefollow-up period,the visual acuity of 2 eyes with corneal transplantation was 0.05,HM,respectively.The visual acuity of 2% silver nitrate cauterization in the other two eyes was 0.6and 0.8,respectively.3.Corneal healing: 61 eyes cured by CXL had partial corneal epithelial defect 1 week after operation,punctate corneal epithelial defect 2 weeks after operation,rough corneal ulcer 1m after operation in 59 eyes and complete healing of ulcer 3 m after operation in 2 eyes,eventually forming different degrees of corneal scar.After 2% silver nitrate cauterization,in the corneal lesion area,long-term brown matter deposition,6 months after cauterization,there are still some brown matter deposition on the corneal surface,or form serious corneal scar.4.Anterior segment OCT: The thickness of the cornea gradually thins within 3 months after surgery,with statistically significant difference(P<0.05).These became stable between 3 months and 6 months after surgery.5.Confocal microscopy: 48 eyes of fungal keratitis cured by CXL had less mycelium growth at 1 week after operation than before,42 eyes had no mycelium growth at 2 weeks after operation,and 48 eyes had no mycelium growth at 1m after operation.Confocal microscopy showed the disappearance of amoebic capsules in 1 eye with acanthamoebic keratitis at 1m after operation.6.Corneal biomechanical parameters: Preoperative DA,CCT and normal cornea group has statistical difference(P<0.05).CXL group corneal ulcer healing after DA preoperative group and normal cornea were smaller,with statistical difference(P<0.05),postoperative CCT CXL a preoperative has significant statistical difference(P<0.05),no statistical differences in the normal cornea group(P>0.05);Preoperative correlation between IOPnct and CCT(P<0.05).Preoperative IOPnct was higher than preoperative IOPpachy with statistical difference(P<0.05).Postoperative IOPpachy was higher than preoperative IOPpachy with statistical difference(P<0.05).Conclusion: 1.CXL is an effective and safe treatment for infectious corneal diseases.For patients with infectious corneal diseases whose lesions are located around the cornea,CXL is the first choice.Corneal scar has little effect on visual acuity.For patients with infectious corneal diseases whose lesions involve the pupil area,visual acuity can still be significantly improved after CXL.2.It is speculated that CXL is an effective treatment for acanthamoeba keratitis.3.CXL can change the characteristics of corneal biomechanics,increase the hardness of the cornea,and reduce the perforation rate,providing a safety guarantee forclinicians in the process of incision.4.In infectious corneal diseases,IOPnct is higher than real intraocular pressure in corneal edema.IOPnct can reflect real intraocular pressure after corneal healing after CXL.