Corneal collagen cross-linking in mixed etiology keratitis treatment: a case of successful use

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Abstract

Acanthamoeba keratitis with bacterial, fungal superinfection or without it leads to development of an aggressive and long-standing corneal inflammation; up to now, the efficacy of its treatment stays doubtful and demands further investigation. For a long time, there were discussions on the possibility and expediency of corneal collagen cross-linking (PACK-CXL – photo activated chromophore for keratitis) in patients with bacterial, fungal and Acanthamoeba keratitis. This article presents a clinical case of effective treatment of mixed etiology keratitis by multiple high fluence accelerated PACK-CXL in a patient with severe local toxico-allergic reaction.

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About the authors

Kirill V. Khripun

City Multifield Hospital No. 2

Email: kirdoc@mail.ru

MD, Candidate of Medical Sciences, Ophthalmologist, Head of Microsurgery Department No. 3

Russian Federation, Saint Petersburg

Yulia V. Kobinets

Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: juliakobinets@ya.ru

Second Year Ophthalmology Resident, Department of Ophthalmology

Russian Federation, Saint Petersburg

Pavel A. Danilov

Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: pdanilov1989@gmail.com

Post-graduate Student of the Department of Ophthalmology with the clinic

Russian Federation, Saint Petersburg

Elizaveta S. Rozhdestvenskaya

City Multifield Hospital No. 2

Email: shorie48@gmail.com

MD, Ophthalmologist, Microsurgery Department No. 3

Russian Federation, Saint Petersburg

Yulduz Sh. Nizametdinova

City Multifield Hospital No. 2

Email: yulduzik55@gmail.com

MD, ophtalmologist. Microsurgery Department No. 3.

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Patient E, 31 y.o. The condition of the cornea upon admission

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3. Fig. 2. Anterior segment optical coherence tomography upon admission

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4. Fig. 3. HRT II Cornea Module. Arrows indicate the supposed Acanthamoeba cysts

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5. Fig. 4. Toxico-allergic reaction of the eyelids on the 7th day of treatment

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6. Fig. 5. CL-UVR Rapid device for corneal collagen cross-linking

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7. Fig. 6. Wessely immune ring formation, 3 weeks from the disease onset

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8. Fig. 7. Clearing of infiltrate´s central area. The Wessely ring is formed. 5th week from the disease onset

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9. Fig. 8. A few days before the third PACK-CXL session; а – in the optical zone, the ring-shaped infiltrate acquired more blurred contours; epithelium grows up from the periphery. The Wessely ring is slowly disappearing; b – hyperemia and edema of the eyelids decrease, no crusts and oozing

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10. Fig. 9. Decreased deepitelization zone. Ingrowth of superficial and deep stromal vessels into the cornea (4-7 o´clock)

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11. Fig. 10. Increased neovascularization

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12. Fig. 11. Epithelium edge swelling decreases, increase of transparency of the infiltration area

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13. Fig. 12. Complete deepitalization area closure, gradual depletion of vessels

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14. Fig. 13. Further depletion of vessels, cicatricial clouding formation

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15. Fig. 14. Outcome: nubecula cloudiness of the cornea with “ghost vessels”

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Copyright (c) 2021 Khripun K.V., Kobinets Y.V., Danilov P.A., Rozhdestvenskaya E.S., Nizametdinova Y.S.

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