Infectious crystalline keratopathy caused by two different organisms after corneal cross-linking

Elsevier

Available online 29 July 2022

Journal Français d'OphtalmologieIntroduction

Infectious crystalline keratopathy (ICK) is a rare, indolent infection that was first described in 1983 by Gorovoy et al. in a patient with corneal graft [1]. This condition is characterized by white branching crystalline opacities located deep in the corneal stroma without significant associated inflammation. The microorganisms isolated in ICK cases generally exhibit low virulence, and their growth is potentiated by local immunosuppression, including steroid eye drops, and immunocompromised ocular surfaces [2]. Other risk factors include a history of keratoplasty and incisional corneal surgery. Corneal cross-linking (CXL) treatment, which was described by Wollensak et al. in 2003 [3], has now been used for many years to halt the progression of keratoconus (KCN) by increasing corneal strength. “Epi-off” protocol using a photosensitizer (riboflavin) and UVA light results in an increased biomechanical stability of the cornea. Severe complications like infectious keratitis are rare [4].

We report a case of ICK post-CXL treatment in a patient with bilateral progressive KCN.

Section snippetsCase Description

A 16-year-old male underwent CXL in our department for progressive KCN in both eyes. The patient had no medical history except for eye rubbing. The right eye (RE) had undergone uneventful CXL four months before the same procedure was performed on his left eye (LE). The treatment was conducted in the operating theater under general anesthesia. A sponge and scarifier were employed to remove the central 8.0 mm corneal epithelium. A hypotonic ophthalmic solution containing riboflavin 0.1% (Horus

Discussion

CXL is known to be an effective and safe procedure, which is indicated for early stabilization of KCN and better progress in terms of BCVA and keratometry parameters. Infectious complications occur in 0.0017% of cases, and they may be severe [5]. The “epi-off” protocol enables better penetration of riboflavin into the corneal stroma, but it likely induces neurotrophic keratopathy and exposes the patient to a higher risk of microbial infection. In addition, the bandage contact lens used

Disclosure of interest

The authors declare that they have no competing interest.

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