First Experience of Combined Treatment of Corneal and Graft Ulcers in Preschool Children Using Local Ultraviolet Crosslinking (Clinical Cases)

Abstract

Purpose: to evaluate the results of a new combined method for the treatment of corneal and graft ulcers in preschool children, including local ultraviolet crosslinking (UVA CL) of corneal collagen and amniotic membrane transplantation (AMT).Methods. 1 patient 4 years old with a corneal ulcer and transplant disease after penetrating subtotal keratoplasty and 1 child 6 years old with a corneal ulcer of herpetic etiology was under observation for 1 year. The treatment included 3–5 consecutive procedures of local UVA CL of the cornea lasting 5 min. and amniotic membrane transplantation (AMT) after the first CL procedure. Biomicroscopy with fluorescein test and optical coherence tomography (OCT Spectralis, Heidelberg Engineering, Germany) were used to dynamically monitor the clinical course of corneal and graft ulcers. Local CL was performed using a new Keratolink device (OA Elatomsky Instrument Plant, Russia). Immediately after the 1st CL procedure, a TAM operation was performed under operating conditions under anesthesia, after which 2–4 more local CL procedures were performed sequentially every 3 days.Results. During treatment with each subsequent CL procedure, the clinical condition of the eyes improved: inflammation was relieved, photophobia, lacrimation, blepharospasm disappeared, a gradual increase in the epithelium from the periphery of the cornea with the formation of a gentle translucent opacification was noted, vascular activity decreased, and visual acuity significantly increased. After 2–10 months, in both cases there are no active complaints, the eyes are calm, infiltrates were not determined, in their place a gentle cloud-like translucent opacity formed, including in a child after keratoplasty. Vessels are empty.Conclusion. Combined treatment of corneal and graft ulcers in children (local UVA CL together with TAM) demonstrated high therapeutic efficacy, ensured stable corneal epithelialization in a short time and improved visual functions at the end of the inflammatory process. This method can significantly expand the possibilities of treating ulcerative lesions of the cornea and graft in preschool children.