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1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.

Peripheral Sterile Corneal Ring Infiltrate after Riboflavin-UVA Collagen Crosslinking in Keratoconus. Ramon C. Ghanem, M.D. 1, 2 ; Vinícius C. Ghanem, M.D. 1, 2 ; Marcony Santhiago , M.D. 2,3 ; Marcelo V. Netto , M.D. 2,3 ; Steven E. Wilson, M.D. 3.

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1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.

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  1. Peripheral Sterile Corneal Ring Infiltrate after Riboflavin-UVA Collagen Crosslinking in Keratoconus Ramon C. Ghanem, M.D.1, 2; Vinícius C. Ghanem, M.D.1, 2; MarconySanthiago, M.D. 2,3; Marcelo V. Netto, M.D. 2,3; Steven E. Wilson, M.D.3 1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. 2. Universityof São Paulo (USP), São Paulo, Brazil. 3. Cleveland Clinic, Cole Eye Institute, Ohio, USA

  2. Financial Disclosures The authors do not have a commercial or proprietary interest in this work. Purpose • To report a case series of peripheral ring-shaped corneal infiltrates that occurred a few days after crosslinking (CXL) for progressive keratectasia secondary to keratoconus. RC. Ghanem, Poster WCC 2010

  3. Methods • A prospective study including 362 eyes with progressive keratoconus was carried out. • After a 9.0 mm epithelial removal, 0.1% riboflavin with 20% dextran was applied for 30 minutes followed by ultraviolet-A (UVA) irradiation (370 nm, 3 mW/cm2)1. • Therapeutic contact lenses were placed for one week. 1. Wollensak G, et al. AJO. 2003 RC. Ghanem, Poster WCC 2010

  4. Results • Three eyes (0.8%) developed an unusual type of peripheral infiltrate. • These had a ring-shape and affected the anterior stroma in the transition between the treated and untreated peripheral cornea a few days after treatment. RC. Ghanem, Poster WCC 2010

  5. Case 1 • 25-year-old male • After 12 days of CXL

  6. Case 1 epithelial ulceration 360 degrees peripheral ring-like infiltrate at the 9.0-mm zone

  7. Case 1 • After 3 months

  8. Case 2 • 21-year-old male • A week after CXL

  9. Case 3 • 24-year-old male • A week after CXL

  10. Cases Sumary RC. Ghanem, Poster WCC 2010

  11. Results • All cases had rapid improvement with steroidal therapy. • Due to its shape and location, occurring in the 9.0 mm edge of the irradiation zone with a limbal clear area, immune reaction seems to be the main explanation. • We hypothesize that the cytotoxic effects of UVA irradiation during CXL may alter the antigenic sites on native proteins in the corneal stroma resulting in a localized autoimmune reaction. RC. Ghanem, Poster WCC 2010

  12. Conclusion • Peripheral sterile corneal infiltrates are not a rare complication after CXL. • Although the exact mechanism is unclear, identification of this entity and its differentiation from infectious keratitis is essential. • The inflammatory response of the UVA light irradiation during CXL and its role on the immune mechanisms of the cornea demand further investigation. Thank you RC. Ghanem, Poster WCC 2010

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