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      A Retrospective Study of Herpetic Keratitis in Patients with Keratoconus after Crosslinking Surgery

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          Abstract

          Background: The aim of this study was to perform a retrospective analysis of patients who underwent cross-linking for keratoconus, in the Department of Ophthalmology of the Medical University of Silesia in Katowice, between 2011 and 2020, regarding the occurrence of herpetic keratitis after the procedure. Methods: We analyzed the medical history of 543 patients who underwent cross-linking surgery. Results: In the analyzed group, there were nine cases of herpetic keratitis (six men and three women), aged from 16 to 40 years (mean 26.2 years). The mean follow-up period was 49.3 months (16–82 months). The average time from surgery to the manifestation of the first symptoms of keratitis was 4.3 days (2–6 days). In two cases, iritis was observed, and in one of them, iritis was the first symptom. After systemic and topical administration of acyclovir, ulceration healed in all patients. Corneal healing time ranged from 10 days to 3 weeks (average 13.7 days). In one patient, a recurrence of the inflammation was observed after 8 months. Conclusion: Patients should be carefully observed in the early post-CXL period. Herpetic keratitis could be induced by CXL even in patients with no history of herpetic disease.

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          Complications of Corneal Collagen Cross-Linking

          Cross-linking of corneal collagen (CXL) is a promising approach for the treatment of keratoconus and secondary ectasia. Several long-term and short-term complications of CXL have been studied and documented. The possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. Formation of temporary corneal haze, permanent scars, endothelial damage, treatment failure, sterile infiltrates, and herpes reactivation are the other reported complications of this procedure. Cross-linking is a low-invasive procedure with low complication and failure rate but it may have direct or primary complications due to incorrect technique application or incorrect patient's inclusion and indirect or secondary complications related to therapeutic soft contact lens, patient's poor hygiene, and undiagnosed concomitant ocular surface diseases.
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            Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus.

            A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.
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              Photoactivated chromophore for infectious keratitis – Corneal cross-linking (PACK-CXL): A systematic review and meta-analysis

              To examine the efficacy of adjuvant photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) for the treatment of infectious keratitis (IK).
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                18 June 2021
                June 2021
                : 10
                : 12
                : 2684
                Affiliations
                [1 ]Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland; atrum2@ 123456gmail.com (A.N.); dominikacholewa1@ 123456gmail.com (D.S.); wylegala@ 123456gmail.com (E.W.)
                [2 ]Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland; dardobmd@ 123456wp.pl
                Author notes
                [* ]Correspondence: ewaw8@ 123456wp.pl
                [†]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-8418-3486
                Article
                jcm-10-02684
                10.3390/jcm10122684
                8234465
                dbbb3445-08e2-45a9-a34c-10408bf1ce6a
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 22 May 2021
                : 14 June 2021
                Categories
                Article

                herpetic keratitis,cross-linking,keratoconus
                herpetic keratitis, cross-linking, keratoconus

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