Anti-inflammatory and dry eye benefits of accelerated epi-off corneal cross-linking in pediatric keratoconus with allergic ocular surface disease and elevated MMP-9.

IF 5.2 1区医学 Q1 OPHTHALMOLOGY

Eye and Vision Pub Date : 2026-01-02 DOI:10.1186/s40662-025-00469-7

Cosimo Mazzotta, Caterina Gagliano, Fabiana D'Esposito, Francesco Cappellani, Carlos Rocha De Lossada, Davide Borroni, Alessandro Meduri, Marco Ferrise

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Abstract

Purpose: To assess the functional and ocular surface anti-inflammatory outcomes of epithelium-off accelerated corneal cross-linking (ACXL) in adolescents with progressive keratoconus associated with allergic ocular surface disease and dry eye disease (DED) characterized by elevated tear matrix metalloproteinase-9 (MMP-9) concentrations.

Methods: Prospective interventional case series of 30 eyes from 15 patients (mean age 16.41 ± 2.36 years; Krumeich stage II) undergoing epi-off ACXL. Outcomes at baseline and 1, 3, 6, and 12 months included corrected distance visual acuity (CDVA), maximum keratometry (Kmax), minimum corneal thickness (MCT), computerized non-invasive tear break-up time (cBUT), Ocular Surface Disease Index (OSDI), and tear MMP-9 (point-of-care test). In vivo qualitative confocal microscopy (IVCM) investigation provided supportive imaging. Paired t-tests were used and results reported with 95% confidence intervals (CI).

Results: CDVA improved to 0.09 logMAR at 12 months (≈ 0.81 decimal; 95% CI: 0.10-0.08 logMAR; P < 0.001). Kmax decreased from 55.00 to 53.75 D (95% CI: 53.55-53.95 D; Δ = - 1.25 D; P < 0.001), indicating ectasia stabilization. cBUT increased from 10.11 to 14.41 s (95% CI: 14.11-14.71; P < 0.01). OSDI decreased to 12.15 (95% CI: 11.65-12.65). Tear MMP-9 levels diminished from 64.79 to 16.15 ng/mL (P < 0.0001) and the proportion < 38.6 ng/mL reached 86.7% of the study cohort at 12 months. IVCM documented disappearance of inflammatory infiltrates. No postoperative persistent adverse events occurred.

Conclusions: Epi-off ACXL stabilized ectasia, improving visual and ocular surface outcomes, markedly lowering tear MMP-9 levels. Although exploratory, these findings are consistent with a potential ocular surface anti-inflammatory and neuromodulatory role of ACXL, meriting validation in studies involving inflammatory DED beyond keratoconus.

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在伴有过敏性眼表疾病和MMP-9升高的儿童圆锥角膜患者中，加速角膜外显素脱落交联的抗炎和干眼症益处

目的：评估以泪液基质金属蛋白酶-9 （MMP-9）浓度升高为特征的变应性眼表疾病和干眼病（DED）相关的进行性角膜锥状病变青少年患者上皮脱落加速角膜交联（ACXL）的功能和眼表抗炎结果。方法：前瞻性介入病例系列，15例患者（平均年龄16.41±2.36岁，Krumeich II期）接受epi-off ACXL治疗，共30眼。基线和1、3、6和12个月的结果包括矫正距离视力（CDVA）、最大角膜密度（Kmax）、最小角膜厚度（MCT）、计算机化无创泪液破裂时间（cBUT）、眼表疾病指数（OSDI）和泪液MMP-9（护理点测试）。体内定性共聚焦显微镜（IVCM）研究提供了支持性成像。采用配对t检验，结果以95%置信区间（CI）报告。结果：12个月时CDVA改善至0.09 logMAR（≈0.81十进制；95% CI: 0.10-0.08 logMAR； P）结论：Epi-off ACXL稳定扩张，改善视力和眼表预后，显著降低泪液MMP-9水平。虽然是探索性的，但这些发现与ACXL潜在的眼表抗炎和神经调节作用是一致的，值得在涉及圆锥角膜以外的炎性DED的研究中得到验证。

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来源期刊

Eye and Vision OPHTHALMOLOGY-

CiteScore

8.60

自引率

2.40%

发文量

审稿时长

15 weeks

期刊介绍： Eye and Vision is an open access, peer-reviewed journal for ophthalmologists and visual science specialists. It welcomes research articles, reviews, methodologies, commentaries, case reports, perspectives and short reports encompassing all aspects of eye and vision. Topics of interest include but are not limited to: current developments of theoretical, experimental and clinical investigations in ophthalmology, optometry and vision science which focus on novel and high-impact findings on central issues pertaining to biology, pathophysiology and etiology of eye diseases as well as advances in diagnostic techniques, surgical treatment, instrument updates, the latest drug findings, results of clinical trials and research findings. It aims to provide ophthalmologists and visual science specialists with the latest developments in theoretical, experimental and clinical investigations in eye and vision.