RESUMEN
PURPOSE: To present 7 cases of peripheral sterile corneal infiltrates that occurred after corneal cross-linking (CXL) for progressive keratectasia. METHODS: Seven patients who had their progressive keratoconus documented underwent corneal deepithelization and subsequently CXL, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to UVA light (370 nm, 2.9-3.1 mW/cm(2)) for 30 minutes. RESULTS: Nearly a week after the procedure, the patients presented with peripheral stromal infiltrates. The ring-like infiltrates were superficial and were present at the 9.0-mm zone. Sterile infiltration was diagnosed. Patients were treated with topical corticosteroids, and complete resolution was achieved after a few weeks of treatment. CONCLUSIONS: We hypothesize that the phototoxic effect on the corneal stroma may be the main mechanism that triggers these infiltrates. Alternatively, alterations in antigenicity that occur in native proteins after CXL could result in patients recognizing the proteins as nonself and mounting immune responses.
Asunto(s)
Colágeno/metabolismo , Enfermedades de la Córnea/inducido químicamente , Reactivos de Enlaces Cruzados/efectos adversos , Queratocono/tratamiento farmacológico , Fármacos Fotosensibilizantes/efectos adversos , Riboflavina/efectos adversos , Adolescente , Adulto , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/tratamiento farmacológico , Sustancia Propia/metabolismo , Sustancia Propia/patología , Progresión de la Enfermedad , Femenino , Glucocorticoides/uso terapéutico , Humanos , Queratocono/metabolismo , Masculino , Fármacos Fotosensibilizantes/uso terapéutico , Riboflavina/uso terapéutico , Rayos Ultravioleta , Adulto JovenRESUMEN
A 33-year-old woman with corneal ectasia after radial and astigmatic keratotomy had corneal collagen crosslinking with resultant gaping of the inferior incisions (2 radials and 1 transverse) that required suturing. At 6 months, the incisions healed leaving fibrotic scars. Visual acuity, refractions, corneal photographs, and topographic and corneal wavefront measurements are presented. At 2.5 years, the topographic inferior corneal irregularity continued to improve.
Asunto(s)
Reactivos de Enlaces Cruzados/efectos adversos , Hiperopía/cirugía , Queratotomía Radial , Dehiscencia de la Herida Operatoria/etiología , Adulto , Colágeno/metabolismo , Córnea/metabolismo , Córnea/patología , Córnea/cirugía , Topografía de la Córnea , Dilatación Patológica/cirugía , Femenino , Humanos , Hiperopía/etiología , Fármacos Fotosensibilizantes/efectos adversos , Riboflavina/efectos adversos , Dehiscencia de la Herida Operatoria/cirugía , Técnicas de Sutura , Rayos Ultravioleta , Agudeza Visual/fisiologíaRESUMEN
Calcification is one of the major causes of failure of heart valve bioprostheses (HVBs) derived from glutaraldehyde (GA)-processed bovine pericardium (BP) or porcine aortic valves. New crosslinking reagent procedures are still far from giving satisfactory results, and this is the main reason why GA is still the reagent of choice for the fixation of native tissue intended for HVB manufacture. Nevertheless, two new findings with respect to GA processing may significantly improve HVB performance postimplantation: the finding that increasing concentrations of GA result in a decrease in calcification; the blocking of free aldehyde usually by nucleophyles or the treatment of processed material at low pH. This work investigates the in vitro properties of BP fixed with GA followed by the treatment with glutamic acid under alkaline conditions in order to prepare BP materials with lower calcification potential postimplantation. In comparison to conventional processing, except for the tensile strength that was slightly lower, elongation and toughness were higher than the accepted values. No significant differences were observed in the performance indexes (mean pressure gradient, mean effective area, regurgitant fraction, performance and efficiency indexes) with wear resistance over 150 × 106 cycles. These results indicate that the processing of BP described in this work may be of potential use in the manufacture of HVBs.