Delayed-Onset Transient Light Sensitivity Syndrome after Corneal Collagen Cross-Linking: A Case Series
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 8 No. 3 (2019),
20 September 2019
,
Page 250-256
Abstract
In this case series, we report a potentially novel association of corneal collagen crosslinking (CCL) with the development of photophobia symptoms in a series of patients at a tertiary ophthalmology clinic and describe their clinical course. Photosensitivity is a rare and seemingly unpredictable complication of refractive surgery but can present as a disabling, bilateral ocular pain that requires immediate treatment. This complication, termed transient light-sensitivity syndrome (TLSS), can have a substantially delayed presentation after ocular procedures and is associated with inflammation of structures in the anterior chamber that can be imperceptible on slit-lamp examination. Traditionally, exposure to high-energy femtosecond lasers is hypothesized to create stromal gas bubbles powering postoperative inflammatory reactions. TLSS-like symptoms after CCL may be due to a secondary inflammatory response involving activated keratocytes and cytokine release. However, free radical damage from the interaction of riboflavin and ultraviolet in CCL may also drive this inflammatory process.![](https://mehdijournal.com/public/journals/1/cover_article_752_en_US.jpg)
References
Farjo AA, Sugar A, Schallhorn SC, Majmudar PA, Tanzer DJ, Trattler WB, et al. Femtosecond lasers for LASIK flap creation: a report by the American Academy of Ophthalmology. Ophthalmology. 2013;120(3):e5-e20. doi: 10.1016/j.ophtha. 2012.08.013 pmid: 23174396
Desautels JD, Moshirfar M, Quist TS, Skanchy DF, Hoopes PC. Case of Presumed Transient Light-Sensitivity Syndrome After Small-Incision Lenticule Extraction. Cornea. 2017;36(9):1139-40. doi: 10.1097/ICO.0000000000001240 pmid: 28644232
Munoz G, Albarran-Diego C, Sakla HF, Javaloy J, Alio JL. Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser Incidence and prevention. J Cataract Refract Surg. 2006;32(12):2075-9. doi: 10.1016/j.jcrs.2006.07.024 pmid: 17137986
Raiskup F, Spoerl E. Corneal crosslinking with riboflavin and ultraviolet A. I. Principles. Ocul Surf. 2013;11(2):65-74. doi: 10.1016/j.jtos.2013.01.002 pmid: 23583042
Vinciguerra P, Albe E, Trazza S, Rosetta P, Vinciguerra R, Seiler T, et al. Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology. 2009;116(3):369-78. doi: 10. 1016/j.ophtha.2008.09.048 pmid: 19167087
Jankov Ii MR, Jovanovic V, Nikolic L, Lake JC, Kymionis G, Coskunseven E. Corneal collagen cross-linking. Middle East Afr J Ophthalmol. 2010;17(1):21-7. doi: 10.4103/0974-9233. 61213 pmid: 20543933
Mohammadpour M, Masoumi A, Mirghorbani M, Shahraki K, Hashemi H. Updates on corneal collagen cross-linking: Indications, techniques and clinical outcomes. J Curr Ophthalmol. 2017;29(4):235-47. doi: 10.1016/j.joco.2017. 07.003 pmid: 29270469
Cifariello F, Minicucci M, Di Renzo F, Di Taranto D, Coclite G, Zaccaria S, et al. Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up. J Ophthalmol. 2018; 2018:4947983. doi: 10.1155/2018/4947983 pmid: 30151277
Stonecipher KG, Dishler JG, Ignacio TS, Binder PS. Transient light sensitivity after femtosecond laser flap creation: clinical findings and management. J Cataract Refract Surg. 2006; 32(1):91-4. doi: 10.1016/j.jcrs.2005.11.015 pmid: 16516785
Kamiya K, Ishii R, Shimizu K, Igarashi A. Evaluation of corneal elevation, pachymetry and keratometry in keratoconic eyes with respect to the stage of Amsler-Krumeich classification. Br J Ophthalmol. 2014;98(4):459-63. doi: 10. 1136/bjophthalmol-2013-304132 pmid: 24457362
Moshirfar M, Gardiner JP, Schliesser JA, Espandar L, Feiz V, Mifflin MD, et al. Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison. J Cataract Refract Surg. 2010;36(11):1925-33. doi: 10.1016/j.jcrs.2010. 05.027 pmid: 21029902
McCulley JP, Petroll WM. Quantitative assessment of corneal wound healing following IntraLASIK using in vivo confocal microscopy. Trans Am Ophthalmol Soc. 2008;106:84-90; discussion -2. pmid: 19277224
Mencucci R, Marini M, Paladini I, Sarchielli E, Sgambati E, Menchini U, et al. Effects of riboflavin/UVA corneal cross-linking on keratocytes and collagen fibres in human cornea. Clin Exp Ophthalmol. 2010;38(1):49-56. doi: 10.1111/ j.1442-9071.2010.02207.x pmid: 20447101
Wollensak G, Spoerl E, Wilsch M, Seiler T. Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/ UVA treatment. Cornea. 2004;23(1):43-9. pmid: 14701957
Hovakimyan M, Stachs O, Celine O, Guthoff RF. Matrix-Based Regenerating Agent for Corneal Wound Healing After Collagen Cross-Linking. Cornea. 2016;35(12):1638-43. doi: 10.1097/ICO.0000000000001047 pmid: 27755188
Croxatto JO, Tytiun AE, Argento CJ. Sequential in vivo confocal microscopy study of corneal wound healing after cross-linking in patients with keratoconus. J Refract Surg. 2010;26(9):638-45. doi: 10.3928/1081597X-20091111-01 pmid: 19928694
Dhawan S, Rao K, Natrajan S. Complications of corneal collagen cross-linking. J Ophthalmol. 2011; 2011:869015. doi: 10.1155/2011/869015 pmid: 22254130
Mazzotta C, Traversi C, Baiocchi S, Caporossi O, Bovone C, Sparano MC, et al. Corneal healing after riboflavin ultraviolet-A collagen cross-linking determined by confocal laser scanning microscopy in vivo: early and late modifications. Am J Ophthalmol. 2008;146(4):527-33. doi: 10.1016/j.ajo.2008.05. 042 pmid: 18672225
Salomao MQ, Chaurasia SS, Sinha-Roy A, Ambrosio R, Jr., Esposito A, Sepulveda R, et al. Corneal wound healing after ultraviolet-A/riboflavin collagen cross-linking: a rabbit study. J Refract Surg. 2011;27(6):401-7. doi: 10.3928/1081597X-20101201-02 pmid: 21162471
Wollensak G, Spoerl E, Wilsch M, Seiler T. Endothelial cell damage after riboflavin-ultraviolet-A treatment in the rabbit. J Cataract Refract Surg. 2003;29(9):1786-90. doi: 10.1016/s0886-3350(03)00343-2 pmid: 14522302
Wollensak G, Sporl E, Reber F, Pillunat L, Funk R. Corneal endothelial cytotoxicity of riboflavin/UVA treatment in vitro. Ophthalmic Res. 2003;35(6):324-8. doi: 10.1159/ 000074071 pmid: 14688422
Lee HK, Ryu JS, Jeong HJ, Kim MK, Oh JY. Protection of Corneal Limbus from Riboflavin Prevents Epithelial Stem Cell Loss after Collagen Cross-Linking. J Ophthalmol. 2018; 2018:6854298. doi: 10.1155/2018/6854298 pmid: 29967694
Moshirfar M, Murri MS, Shah TJ, Skanchy DF, Tuckfield JQ, Ronquillo YC, et al. A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment. Ophthalmol Ther. 2019;8(2):195-213. doi: 10.1007/s40123-019-0169-7 pmid: 30859513
Gumus K. Acute Idiopathic Endotheliitis Early After Corneal Cross-linking With Riboflavin and Ultraviolet-A. Cornea. 2014;33(6):630-3. doi: 10.1097/ICO.0000000000000110 pmid: 24699560
Seiler TG, Batista A, Frueh BE, Koenig K. Riboflavin Concentrations at the Endothelium During Corneal Cross-Linking in Humans. Invest Ophthalmol Vis Sci. 2019;60(6):2140-5. doi: 10.1167/iovs.19-26686 pmid: 31099830
Barbisan PRT, Viturino MGM, Souto FMS, Tian B, Pacheco Pinto RD, Quagliato LB, et al. Macular phototoxicity after corneal cross-linking. Clin Ophthalmol. 2018;12:1801-7. doi: 10.2147/OPTH.S176025 pmid: 30271113
Glickman RD. Ultraviolet phototoxicity to the retina. Eye Contact Lens. 2011;37(4):196-205. doi: 10.1097/ICL. 0b013e31821e45a9 pmid: 21646980
Webb JN, Langille E, Hafezi F, Randleman JB, Scarcelli G. Biomechanical Impact of Localized Corneal Cross-linking Beyond the Irradiated Treatment Area. J Refract Surg. 2019;35(4):253-60. doi: 10.3928/1081597X-20190304-01 pmid: 30984983
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