Microbial Keratitis After Accelerated Corneal Collagen Cross-Linking in Keratoconus

ABSTRACT Purpose of review To summarize the current understanding of effects of cross-linking (CXL) in infective keratitis based on available evidence. Method of literature search A PubMed search was conducted with combinations not limited to the following search terms: corneal collagen CXL, riboflavin, ultraviolet A, keratoconus, microbial keratitis, fungal keratitis, bacterial keratitis, Acantha-moeba keratitis. A review of the search results was performed and relevant articles to the topic were included. Summary Most of the published literature showed promising results in treatment of infectious keratitis by corneal collagen CXL using photoactivated riboflavin as an adjuvant therapy but with questionable efficacy in deep keratitis due to slow-growing organisms. How to cite this article Ummar S, Farrag AN. Corneal Collagen Cross-linking in Infective Keratitis. Int J Kerat Ect Cor Dis 2016;5(1):13-16.

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Profile of Microbial Keratitis after Corneal Collagen Cross-Linking

BioMed Research International ◽

10.1155/2014/340509 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Rohit Shetty ◽

Luci Kaweri ◽

Rudy M. M. A. Nuijts ◽

Harsha Nagaraja ◽

Vishal Arora ◽

...

Keyword(s):

Rare Complication ◽

Vernal Keratoconjunctivitis ◽

Cross Linking ◽

Topical Steroids ◽

Eye Drops ◽

Infectious Keratitis ◽

Microbial Keratitis ◽

Corneal Infiltrates ◽

Collagen Cross Linking ◽

Corneal Collagen

Purpose. To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients.Methods. A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistantStaphylococcus aureus(MXRSA) infectious keratitis are highlighted.Results. Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram’s stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema).Conclusion. The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics.

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