Case Reports

When corneal cross-linking goes bad

Case Report Details

First Author: R.Abdi MOROCCO

Co Author(s):    C. Siham   M. Asmae   S. Rachid              

Abstract Details

Purpose:

To describe trough case of severe corneal abcess after a standard cxl procedure

Setting:

University Hospital Center Mohammed VI Oujda

Report of Case:

A 21-year-old man with keratoconus presented to our department complaining of progressive visual impairment in his right eye. Progression of keratoconus was documented in his right eye by serial corneal topography over a period of 18 months. the patient was diagnosed with progressive keratoconus and scheduled for CXL. After informed consent, he underwent right standard CXL treatment in attempt to stop the progression. A standard Dresden protocol was performed for CXL under topical anesthesia: after mechanical debridement of corneal epithelium over the central 9–10mm, 0,1% riboflavin in 20% dextran solution was instilled topically every 5 minutes for 30minutes. At the end of the procedure, antibiotic and corticosteroid drops were administered and a therapeutic soft contact lens was placed on the cornea. On the first postoperative day, ophthalmic examination was unremarkable except for mild corneal edema and central epithelial defect of 6mm. On day5, the patient presented with pain, redness and vision loss in his right eye. Examination of the right eye revealed severe conjunctival hyperemia, and corneal abcess. corneal scraping was performed for microbiologic examination. The bandage contact lens was removed and dexamethasone and diclofenac were stopped. Cultures were negative for all microorganisms. antibiotic and anti-inflammatory therapy was started with good evolution

Conclusion/Take Home Message:

Although CXL has been described as a safe procedure, the devastating complication observed in our case illustrates the need for a close follow-up of patients until corneal epithelial healing is complete.

Financial Disclosure:

None